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Value of sufficient clean intermittent catheterization in urinary tract infection and upper urinary tract protection in children with neurogenic bladder

  • Author Footnotes
    1 These authors contribute equally to this work.
    Jialin Liu
    Footnotes
    1 These authors contribute equally to this work.
    Affiliations
    Department of Urology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
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  • Author Footnotes
    1 These authors contribute equally to this work.
    Yunli Bi
    Footnotes
    1 These authors contribute equally to this work.
    Affiliations
    Department of Urology, Children's Hospital of Soochow University, 92# Zhongnan Street, SIP, Suzhou, 215025, China
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  • Ying Liu
    Correspondence
    Correspondence to: Ying Liu, Department of Urology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China, Tel.: +8613386138383
    Affiliations
    Department of Urology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
    Search for articles by this author
  • Liangfeng Tang
    Affiliations
    Department of Urology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
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  • Anle Wang
    Affiliations
    Department of Urology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contribute equally to this work.

      Summary

      Introduction

      Clean intermittent catheterization (CIC) is a mainstay in the management of neurogenic bladder.

      Objective

      To assess the effect of CIC on urinary tract infection and upper renal tract function in pediatric patients with neurogenic bladder, and the influence of duration of CIC on these variables.

      Study design

      A retrospective study was performed in 67 pediatric patients with neurogenic bladder who started CIC between 2014 and 2019 at our institution. The febrile urinary tract infection (fUTI) rate, renal pelvis diameter (measured by antero-posterior renal pelvis diameter, APPD), bladder wall thickness (BWT) on ultrasound, and creatinine level at 6 months and 12 months of CIC were compared with baseline in all patients. The grade of vesicoureteral reflux (VUR) at 12 months of CIC were also compared with baseline.

      Results

      There were no significant differences compared with baseline after 6 months of CIC in the rate of fUTI, APPD, and BWT (p > 0.05); however, all of these parameters significantly improved after 12 months of CIC (p < 0.05). The VUR grade was significantly reduced after 12 months of CIC(p = 0.03). There was no significant change in serum creatinine level with any duration of CIC (both p > 0.05).

      Discussion

      Continuing CIC for more than 6 months had a beneficial influence on protecting the upper urinary tract. Complications of CIC, such as recurrent fUTI and lower urinary tract trauma, are more likely to occur in the early stage of CIC due to poor technique by the caregivers and poor patient compliance underscoring the importance of caregiver education. Study limitations include the retrospective nature and small sample size.

      Conclusion

      CIC for less than 6 months may have limited influence on renal protection; however, a longer duration of CIC (12 months) resulted in significant improvement in outcomes. This study demonstrates the importance of proper caregiver education to establish standardized CIC techniques and to improve CIC quality.

      Keywords

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