Clean Intermittent Catheterization in the Management of the Neurogenic Bladder in Children

Abstract

Clean intermittent catheterization was successful in the management of urinary incontinence and upper tract changes associated with a neurogenic bladder. The results of clean intermittent catheterization controlling urinary incontinence, ureteral reflux, upper tract dilatation and urinary infection in 84 children with a neurogenic bladder were evaluated for up to 3 yr of followup. Of the children 41 (49%) were totally incontinent and 14 (17%) were slightly damp. Preexisting ureteral reflux deteriorated in 25% of the patients, ceased in 35% and was unchanged in 40%, while preexisting upper tract dilatation improved in 12.5% and was unchanged in 87.5%. On clean intermittent catheterization and antibacterial medication 90% of the children had sterile urine and 7.5% had 105 or more colonies/ml. Complications occurred on 54 occasions but were minor in nature and were corrected easily. Half of the parents, schools and children found clean intermittent catheterization very acceptable or acceptable but a quarter of the parents and patients found it unacceptable or slightly unacceptable, or were undecided. Initial management of urinary complications associated with neurogenic bladder in children has changed to the clean intermittent catheterization program, with greatly improved results compared to Crede''s expression of the bladder, an indwelling urethral catheter or urinary diversion. The clean intermittent catheterization regimen was not effective completely, not without complications and not accepted completely by parents, schools and children.