title: Efficacy of Clean Intermittent Catheterization for Urinary Incontinence in Children with Neurogenic Bladder Dysfunction Secondary to Myelodysplasia.
abstract: OBJECTIVE
  To evaluate the efficacy of clean intermittent catheterization for urinary incontinence in myelodysplastic children.
  
  
  METHODS
  The cohort comprised of 38 children (19 boys and 19 girls, aged between 10 months to 16 years) with neurogenic bladder secondary to myelodysplasia. Group A included 16 children who had dilated upper urinary tract or vesicoureteral reflux when clean intermittent catheterization was introduced. The remaining 22 children with normal upper urinary tract were enrolled to group B. In the present study, we defined socially acceptable continence as having completely dry or slight stress incontinence that patients can manage with several small pads.
  
  
  RESULTS
  Of the 16 group A patients, 9 obtained socially acceptable continence by conservative management. Of the 22 group B patients, 11 reported socially acceptable continence by conservative management. Vesical compliance was significantly higher in cases who reported socially acceptable continence than in those with incontinence persistent regarding all participants (10 ± 7.2 vs 6.8 ± 6.2 mL/cmH2 O, P = 0.0347) and group A (9.1 ± 6.7 vs 3.7 ± 1.4 mL/cmH2 O, P = 0.0350). Leak point pressure was significantly higher in patients who obtained socially acceptable continence than in those having persistent incontinence regarding all participants (50 ± 17.2 vs 25 ± 6.6 mL/cmH2 O, P = 0.0003), group A (51 ± 21.4 vs 26 ± 7.2 mL/cmH2 O, P = 0.0348) and also, group B (49 ± 12.8 vs 23.7 ± 6.3 mL/cmH2 O, P = 0.0043).
  
  
  CONCLUSIONS
  In our series, socially acceptable continence was obtained in only 20 patients (52%) by conservative management. The present study suggests that the limitation of conservative treatment seems to be apparent when they have urethral closure deficiency and/or intractable poor vesical compliance.
authors.affiliation: Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Obara
authors.affiliation: Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
authors.forename: Takaki
authors.initials: T
authors.lastname: Mizusawa
authors.affiliation: Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
authors.forename: Etsuko
authors.initials: E
authors.lastname: Isahaya
authors.affiliation: Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Hara
authors.affiliation: Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
authors.forename: Kota
authors.initials: K
authors.lastname: Takahashi
keywords: clean intermittent catheterization; myelodysplasia; urinary incontinence