Efficacy of Clean Intermittent Catheterization for Urinary Incontinence in Children with Neurogenic Bladder Dysfunction Secondary to Myelodysplasia.

Objectives: 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).

Conclusion: 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.