Early start of clean intermittent catheterization versus expectant management in children with spina bifida

Purpose

We instituted early clean intermittent catheterization (CIC) in 1997 for all newborn infants with spina bifida (SB). We compared this group to a historical group managed expectantly to see if early catheterization was associated with a reduction in renal scar rate as determined by DMSA scanning.

Methods

Data were studied retrospectively on all infants with SB over a recent 13-year period who were treated with early universal CIC in a regional pediatric urology department. These were compared to our previously published outcomes in a historical group (1985–1994) that was managed expectantly [Brown et al. Chronic pyelonephritis in association with neuropathic bladder. Eur J Pediatr Surg 1999;9 Suppl 1:29–30.]

Results

114 infants were born with SB from 1997 to 2010, of which 13 were excluded from this analysis. Mean follow-up was 11.4?years. In the historical cohort there were 126 infants born from 1985 to 1994, with 26 exclusions; follow-up then ranged from 4 to 13?years. DMSA scan showed renal scarring in 19/101 (18.8%) of the recent cohort versus 39/100 (39%) of the previous group (P?=?0.002). Renal scarring at a later age also appeared to be a feature of the recent group, with first detection occuring by 4?years in only 9/19 (47%) in the latest cohort compared to 28/39 (72%) in the historical cohort.

Conclusion

Based on these renal protective data, we recommend indwelling and then intermittent catheterization from birth in all patients with SB.

Level of evidence

Level III.

Type of study

Retrospective, cohort comparison study.