Management of neuropathic urinary incontinence in children by intermittent catheterisation.

Abstract

genital spinal anomalies.8-'4 The purpose of this paper is to report on a consecutive series of 49 children treated by IC since the policy was introduced with reference to the measurement of intravesical pressure/volume relationships and urethral closing pressures, the effect of pharmacological agents on the neuropathic bladder, urographic changes after 12 months' treatment, the management of bacteriuria, and the control of incontinence. PatientsThe spinal cord lesions which caused the incontinence were congenital (spina bifida) in 48 and traumatic in one.Age and sex. There were 22 boys and 27 girls. The majority were aged between 5 and 16 years when treatment with IC was started. Some would undoubtedly have started treatment earlier had the method been available. Perhaps the best time to start treatment is just before the child starts school, although much depends on the willingness of the child and his parents to accept the method, and on the state of the child's upper urinary tract. The latter factor led to the decision to start treatment in one infant who had urinary retention, infection, upper urinary tract dilatation, and renal failure.Paralysis. Twenty-seven children, of whom 15 were boys, had complete bilateral lower limb paralysis and had been confined to wheelchairs for most of their lives. These boys had hitherto used penile urinals but as they became older their obesity and spinal deformities increased to the point when their urinals were ineffective. Paralysis in the remaining children was less extensive so that they were able to walk, although most of them had orthopaedic appliances.Radiology and renal function. Intravenous urography and cystography were performed in all children before starting IC. The upper urinary tracts were 253 on 9 May 2018 by guest. Protected by copyright.

Fortnightly Review: Intermittent catheterisation: simple, safe, and effective but underused

“…Patients are sometimes denied a trial of intermittent catheterisation purely because of an adverse urodynamic study. For example, a hyperactive detrusor shown by such a study may become normal if the bladder is emptied effectively30 or if anticholinergic drugs are used 6 11 22…”

“…Patients should normally catheterise at least four times a day6 10 12 13 15 21—more frequently in children and patients with a high fluid intake or small capacity bladder. The volume obtained on catheterisation gives an estimate of bladder capacity and suggests how much can be drunk between catheterisations if the patient is to remain dry.…”

“…This technique has transformed the lives of people rendered housebound by bladder problems and has preserved the kidneys of children with spina bifida3 4 5 6 7 8 9 10 and of adults with spinal cord injury 11 12 13 14 15. Intermittent catheterisation is a clean but not sterile technique.…”

“…A combination of a contracting urethral sphincter with hyperreflexic bladder contractions (detrusor-sphincter dyssynergia) accelerates the damage. If the obstruction of the bladder outlet is overcome by intermittent catheterisation then dilatation of the upper urinary tracts is reduced and renal function improved 6 22…”

Instability in the augmented bladder

“…In early studies, intravesical pressure changes were recorded with fluid-filled catheters and strain gauges [9], but since 1985 such recordings have been made using Gaeltec minitransducer-tipped catheters and an Ormed isolated preamplifier. The children were screened radiographically during the examination.…”