Follow-up of long-term treatment with clean intermittent catheterization for neurogenic bladder in children.
OBJECTIVE
To assess the results of long-term clean intermittent catheterization (CIC) treatment for neurogenic bladder in children born with myelomeningocele, and to compare the long-term results between the early treatment group (< 1 year old) and late treatment group (> 3 years old).


METHODS
Thirty-six paediatric patients with myelomeningocele who were treated in the first year of life (Group 1) and 31 cases who were treated after the age of 3 years (Group 2) were followed regularly for at least 11 years. All medical records were reviewed and long-term results of treatment, including increases in blood urea nitrogen (BUN) and serum creatinine, development of hydronephrosis, recurrent upper urinary tract infection, and the number of augmentation cystoplasties needed, were noted. Kaplan-Meier methods were used to analyse time-to-event data.


RESULTS
Mean age at start of treatment was 6.88 months (range, 3-1 months) in Group 1 and 44.97 months (range, 37-60 months) in Group 2. Increases in BUN and serum creatinine were found in 12 cases (33.3%) in Group 1 and 19 cases (61.3%) in Group 2. Patients in Group 2 showed earlier renal deterioration and worse renal function at the last follow-up. Hydronephrosis was found in 10 cases (27.8%) in Group 1 and 18 cases (58.1%) in Group 2. Patients in Group 2 also had earlier and more severe hydronephrosis. Augmentation cystoplasty was needed in five cases (13.9%) in Group 1 and 10 cases (32.3%) in Group 2. The results of surgery were better in Group 1 than in Group 2, and surgery was needed earlier in Group 2 compared with Group 1. There was no significant difference regarding upper urinary tract infection between the two groups.


CONCLUSIONS
For most patients and with close long-term follow-up, early treatment of neurogenic bladder using CIC in children born with myelomeningocele yields better results than late treatment. In our experience, treatment is recommended as soon as possible, especially during the first year of life.
Kochakarn
Wachira
W
Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital and Medical School, Mahidol University, Bangkok 10400, Thailand. ravkc@mahidol.ac.th
Ratana-Olarn
Krisada
K
Lertsithichai
Panuwat
P
Roongreungsilp
Ubolrat
U
D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008591:Meningomyelocele / Q000150:complications*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000628:therapy*; D014546:Urinary Catheterization / Q000379:methods*