Feasibility and outcome of clean intermittent catheterization for children with sensate urethra
DOI:
https://doi.org/10.5489/cuaj.955Abstract
Objective: Clean intermittent catheterization (CIC) is an important
asset in managing children with noncompliant bladders. We review
the feasibility and late outcomes of patients with normal urethral
sensation who began CIC.
Materials and methods: We reviewed all patients with posterior
urethral valve (PUV) or non-neuropathic bladder sphincter dysfunction
(NNBSD) who began on CIC, and had at least 2 years of
follow-up. We considered their age, indication, acceptance and
compliance with CIC. Additionally, we examined the late outcome
of bladder function and the need for any surgical intervention at
follow-up.
Results: Between 1999 and 2006, 52 patients with PUV (38
patients) or NNBSD (14 patients) were started on CIC. Of these 52
patients, 48% were under the age of 4. A total of 44 patients (85%)
accepted the recommendation for CIC, and 34 patients (65%) were
compliant with the protocol after at least 2 years of follow-up. The
age of the patients was the only significant factor related to the
success of the protocol (4 years old or younger, p = 0.03). After
at least 2 years of follow-up, 28 patients (54%) remained on CIC
and have not required urinary diversion or bladder reconstruction.
Conclusion: The current study showed that CIC is a feasible option
for patients with sensate urethra, which necessitates the introduction
of treatment as early as possible. Further, those patients who
are compliant with the CIC demonstrated a better chance of avoiding
subsequent surgical intervention for the management of a noncompliant
bladder.
Objectif : Le cathétérisme intermittent propre (CIP) est un élément
important de la prise en charge de l’insuffisance vésicale chez les
enfants. Nous passons ici en revue la faisabilité et les résultats tardifs
chez des patients affichant des sensations urétrales normales
qui ont entrepris un traitement par CIP.
Matériel et méthodologie : Nous avons examiné tous les patients
atteints d’une dysfonction de la valve urétrale postérieure (DVUP)
ou d’une dysfonction non névrotique du sphincter vésical (DNNSV)
ayant entrepris un traitement par CIP, et suivis pendant au moins
2 ans. Nous avons tenu compte de leur âge, de l’indication du
traitement, de leur acceptation et leur observance du traitement
par CIP. En outre, nous avons examiné les résultats tardifs de la
fonction vésicale et le besoin de recourir à tout type d’intervention
chirurgicale lors du suivi.
Résultats : Entre 1999 et 2006, 52 patients atteints de DVUP
(38 patients) ou de DNNSV (14 patients) ont entrepris un traitement
par CIP. De ce nombre, 48 % avaient moins de 4 ans. Au total,
44 patients (85 %) ont accepté la recommandation de procéder
au CIP, et 34 patients (65 %) observaient toujours le traitement
après au moins 2 ans de suivi. L’âge des patients représentait
le seul facteur significatif lié à la réussite du traitement (4 ans
ou moins, p = 0,03). Après au moins 2 ans de suivi, 28 patients
(54 %) poursuivaient leur traitement par CIP et n’avaient pas besoin
d’un détournement urinaire ou d’une reconstruction de la vessie.
Conclusion : Notre étude a montré que le CIP est une option
raisonnable pour les patients avec urètre sensible, qui nécessite
l’instauration d’un traitement le plus rapidement possible. Par ailleurs,
les patients qui observent bien le traitement par CIP présentaient
de meilleures chances d’éviter une intervention chirurgicale
subséquente pour le traitement d’une insuffisance vésicale.
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