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Association between age of starting clean intermittent catheterization and current urinary continence in individuals with myelomeningocele

  • Kurt A. Freeman
    Correspondence
    Correspondence to: Kurt A. Freeman, Oregon Health & Science University 707 SW Gaines Portland, OR 97239, USA, Fax: +503 494 6868
    Affiliations
    Institute on Development and Disability, Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines, Portland, OR 97239, USA
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  • Tiebin Liu
    Affiliations
    Rare Disorders and Health Outcomes Team, Birth Defects Monitoring and Research Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention 4770 Buford Hwy, Mail StopS106-3, Chamblee, GA 30341-3717, USA
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  • Kathryn Smith
    Affiliations
    Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Blvd., Mailstop 53, Los Angeles, CA 90027, USA
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  • Heidi Castillo
    Affiliations
    Developmental Pediatrics, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, 8080 North Stadium Drive, Suite 150, Houston, TX 77054, USA
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  • Jonathan Castillo
    Affiliations
    Developmental Pediatrics, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, 8080 North Stadium Drive, Suite 150, Houston, TX 77054, USA
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  • David Joseph
    Affiliations
    Department of Urology, School of Medicine, University of Alabama at Birmingham 1600 7th Avenue, South, ACC 318, Birmingham, AL 35233-1711, USA
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  • Yinding Wang
    Affiliations
    Rare Disorders and Health Outcomes Team, Birth Defects Monitoring and Research Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention 4770 Buford Hwy, Mail StopS106-3, Chamblee, GA 30341-3717, USA

    McKing Consulting Corporation, Atlanta, GA 2900 Chamblee Tucker Rd #10, Chamblee, GA 30341, USA
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  • Author Footnotes
    1 Present Address: Children’s Hospital of Alabama, 1600 7th Avenue, South, ACC 318, Birmingham, AL 35233-1711, USA.
    Stacy Tanaka
    Footnotes
    1 Present Address: Children’s Hospital of Alabama, 1600 7th Avenue, South, ACC 318, Birmingham, AL 35233-1711, USA.
    Affiliations
    Departments of Urology and Pediatrics, Vanderbilt University Medical Center, 2200 Children’s Way, 4102 DOT, Nashville, TN 37232, USA
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  • Author Footnotes
    1 Present Address: Children’s Hospital of Alabama, 1600 7th Avenue, South, ACC 318, Birmingham, AL 35233-1711, USA.
Published:September 02, 2022DOI:https://doi.org/10.1016/j.jpurol.2022.08.022

      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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