Summary
Introduction
Patients with myelomeningocele often use clean intermittent catheterization (CIC)
for renal preservation and to promote urinary continence. While starting CIC at an
early age is associated with better renal outcomes, the impact of age of CIC initiation
on continence outcomes has not been examined.
Objective
To examine whether earlier CIC initiation is associated with higher likelihood of
current urinary continence for patients with myelomeningocele.
Study design
Data of patients aged ≥5 years at last visit were obtained from 35 spina bifida clinics
participating in the National Spina Bifida Patient Registry from 2013 to 2018. Sociodemographic
characteristics, disease characteristics, and current bladder management strategies
were collected. Via univariate and multiple logistic regression models, the latter
conducted controlling for all variables associated with current continent status,
associations between continence and sociodemographic factors, condition characteristics,
and age CIC began (<3 years of age, 3–5 years, 6–11 years, ≥12 years) were analyzed.
Results
Data from 3510 individuals were included (mean age at last visit = 17.0 years, range
5.0–88.7). The sample was evenly distributed by sex (52% female); most individuals
were non-Hispanic White (62.6%). The majority of patients (55.2%) started CIC before
age 3 years. Continence varied markedly across those who never started CIC (0.6% of
patients were continent) and those who started at any age (range 35.3–38.5%). Among
those who started CIC, the magnitude of the association was not proportional to age
CIC was started. Compared with those who started CIC at age 12 or older, estimated
adjusted odds ratio of being continent ranged from 1.04 (6–11 years, 95% CI, 0.72–1.52)
to 1.25 (<3 years, 95% CI, 0.89–1.76).
Discussion
Although CIC may be positively associated with achieving urinary continence in individuals
with myelomeningocele, we could not demonstrate that younger age at CIC initiation
increased the likelihood of achieving this goal. Limitations include lack of data
on reason for starting CIC, urodynamic data, and the observational nature of data
collection.
Conclusions
Further study is needed addressing limitations of the current investigation to determine
if urinary continence outcomes are influenced by the age of starting CIC among patients
with myelomeningocele.
Keywords
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Article info
Publication history
Published online: September 02, 2022
Accepted:
August 27,
2022
Received in revised form:
July 17,
2022
Received:
December 10,
2021
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
