Indications for and outcomes of clean intermittent catheterization in children with normal genital sensation.

PURPOSE: Clean intermittent catheterization is generally accepted by parents and children with neurogenic bladder. We analyzed the indications for and feasibility of clean intermittent catheterization in children with normal genital sensation. MATERIALS AND METHODS: We reviewed the records of 2 girls and 15 boys 15 months to 15 years old (mean age 8 years) on clean intermittent catheterization with normal genital sensation. Indications for clean intermittent catheterization were urinary retention and poor urodynamic compliance with or without hydronephrosis. Parents evaluated the protocol via a questionnaire and the children were studied with age appropriate standard instruments to assess the consequences of clean intermittent catheterization on psychological development. RESULTS: There were no medical complications related to clean intermittent catheterization. Four of the 7 children with urinary retention and 7 of the 10 with poor bladder compliance continued the protocol. There was no difference in the results of psychological testing for patients who had success or failure (mean followup 5 years). Parent and patient comfort levels were most important for the success of clean intermittent catheterization. CONCLUSIONS: Our results show that clean intermittent catheterization is feasible in children with normal genital sensation but successful in only two-thirds.

Cloacal and urogenital abnormalities induced by etretinate in mice.

Etretinate, a synthetic retinoid, is a potent teratogen. It has previously been shown that acute exposure of gestational day 8 (equivalent to human week 4 post-fertilization) C57BL/6J mouse embryos to this retinoid results in a spectrum of abnormalities that are recognized as constituting caudal regression (dysgenesis). These defects, which include spina bifida, imperforate anus, genitourinary anomalies, omphalocele and limb anomalies, result from a major insult to the primitive streak, that is the gastrulation process. Developmental stages present early on gestational day 9 in mice represent the final stages during which the primitive streak contributes to the trunk of the embryo and, therefore, the last opportunity for abnormalities within the realm of caudal regression to be induced. In fact, acute etretinate exposure on gestational day 9 resulted in anal and urethral atresia, bladder and ureteral dilatation, and tail deficiencies as observed in 251 near-term fetuses in this study. To examine in further detail the gestational day 9 etretinate induced urogenital and anal abnormalities and their pathogenetic basis, analyses were conducted using scanning electron microscopy, light microscopy, antegrade cystourethrograms and a vital staining technique as early as 6 hours following maternal drug administration. It appears that diminution of the caudal cell populations, including those of and those surrounding the cloaca, at this critical stage of embryogenesis accounts for the observed phenotype. We propose that anal and urethral atresia temporally represents the end of the caudal regression (dysgenesis) syndrome.