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

Elzeneini, Wael M.; Waly, Ramy; Marshall, David; Bailie, Alan

doi:10.1016/j.jpedsurg.2018.10.096

Cited by 22 publications

(18 citation statements)

References 24 publications

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“…We argue, that for children with closed SD the screening method VOP gives valuable information to sort out children needing CIC and/or invasive UDS, and for the decision to perform neurosurgery or not. A reasonable rationale is to start CIC in all newborns with open SD [9,18] with VOP as a good method to confirm the need of CIC. In a newborn where CIC has been introduced from birth, we perform VOP within 2 weeks of age.…”

Section: Discussionmentioning

confidence: 99%

Four-hour voiding observation with provocation test reveals significant abnormalities of bladder function in newborns with spinal dysraphism

Wide

Duchén

Mattsson

et al. 2020

Journal of Pediatric Urology

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Conclusion Newborns with spinal dysraphism differ from healthy newborns in many aspects of bladder function. Bladder function varies between newborns with closed and open spinal dysraphism. Many newborns with spinal dysraphism leak at bladder provocation and void without a stream but healthy newborns do not. Early determination of post-void residuals is mandatory in children with spinal dysraphism and non-invasive VOP gives this information in a standardized way, also adding information on frequency, voiding with a stream and leakage at provocation.

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Section: Discussionmentioning

confidence: 99%

Four-hour voiding observation with provocation test reveals significant abnormalities of bladder function in newborns with spinal dysraphism

Wide

Duchén

Mattsson

et al. 2020

Journal of Pediatric Urology

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“…The effect of bladder management methods on the preservation of UUT has been investigated in many studies, especially after the introduction of CIC as an alternative to indwelling catheters, abdominal straining, and/or the Credè maneuver. 9,19,20 In recent years, early management with a combination of CIC plus antimuscarinic drugs was favored and established as first-line treatment for the management of a neuropathic bladder secondary to spina bifida. 2 In adult series, oral anticholinergic treatment and intermittent catheterization were also regarded as first-line treatments for bladder management in patients with SCI.…”

Section: Discussionmentioning

confidence: 99%

Risk factors predicting upper urinary tract deterioration in children with spinal cord injury

Önal

Kırlı

Selçuk

et al. 2020

Neurourology and Urodynamics

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The aim of this study is to determine the risk factors predicting upper urinary tract (UUT) deterioration in children with spinal cord injury (SCI). Methods: The medical records of 108 children with SCI who were referred to our unit between 1996 and 2018 were retrospectively reviewed. The data included general patient demographics, SCI characteristics, bladder management methods, presence of urinary tract infection, radiological evaluation of the UUT and lower urinary tract (LUT), and videourodynamic findings. The receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff values of the maximum detrusor pressure during filling and the bladder volume ratio (BVR) for predicting UUT deterioration. Multivariate analyses were used to determine the risk factors predicting UUT deterioration. Results: Complete data were available for 76 children. The median patient age was 15 years (2-17). The leading causes of SCI were motor vehicle accidents (44%) and fall (33%). UUT deterioration was identified in 33 patients (43%). Iatrogenic SCI etiology, abnormal radiological LUT findings, and detrusor pressures greater than 70 cmH 2 O were found to be independent risk factors for UUT deterioration using regression analysis. In addition, ROC analysis revealed that a BVR less than 0.7 was the cutoff value for UUT deterioration in children with SCI. Conclusion: Abnormal radiological LUT findings, iatrogenic SCI etiology, detrusor pressure greater than 70 cmH 2 O, and a BVR less than 0.7 were independent risk factors for UUT deterioration in children with SCI.

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“… 18 Typically, intervention is warranted for detrusor leak-point pressures of ≥40 cmH2O, consistent with the UMPIRE risk stratification guideline, or findings of NDO and detrusor sphincter dyssynergia (DSD). 6 , 34 …”

Section: Diagnosticsmentioning

confidence: 99%

“… 16 Similarly, Elzeneini et al suggest annual UDS in early childhood, especially if prior studies demonstrated “unsafe” bladder parameters and non-surgical therapies were started or altered. 34 Given the valuable information regarding bladder parameters provided by UDS, it could be argued that it is important to establish baseline function with UDS early in childhood, ideally shortly after birth, to inform a patient’s care trajectory in the short-term. UDS should then be sequentially repeated as the child grows to ensure that no detrimental (but clinically silent) changes are occurring.…”

Section: Diagnosticsmentioning

confidence: 99%

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The Importance of Early Diagnosis and Management of Pediatric Neurogenic Bladder Dysfunction

Hobbs

Krischak

Tejwani

et al. 2021

RRU

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Neurogenic bladder dysfunction is a major source of urologic morbidity in children, especially in those with spina bifida (SB). Complications from progression of bladder dysfunction can include urinary tract infections (UTIs), urinary incontinence, upper tract deterioration, and renal dysfunction or failure. In these children, there has been a recent trend toward proactive rather than expectant management of neurogenic bladder. However, there is a lack of consensus on how to best achieve the three main goals of neurogenic bladder management: 1) preserving kidney function, 2) achieving continence (if desired by the family/individual), and 3) achieving social and functional urologic independence (if appropriate). Hence, our objective was to perform a narrative literature review to evaluate the approaches to diagnosis and management of pediatric neurogenic bladder dysfunction, with special focus on children with SB. The approach strategies vary across a spectrum, with a proactive strategy on one end of the spectrum and an expectant strategy at the other end. The proactive management strategy is characterized by early and frequent labs, imaging, and urodynamic (UDS) evaluation, with early initiation of clean intermittent catheterization (CIC) and proceeding with pharmacotherapy, or surgery if indicated. The expectant management strategy prioritizes surveillance labs and imaging prior to proceeding with invasive assessments and interventions such as UDS or pharmacotherapy. Both treatment strategies are currently utilized and data have historically been inconclusive in demonstrating efficacy of one regimen over the other. We performed a narrative literature evaluating proactive and expectant treatment strategies as they relate to diagnostics and management of Spina Bifida. From the available literature and our practice, a proactive strategy favors greater benefit in preventative management and may decrease risk of renal dysfunction compared with expectant management.

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

Cited by 22 publications

References 24 publications

Four-hour voiding observation with provocation test reveals significant abnormalities of bladder function in newborns with spinal dysraphism

Four-hour voiding observation with provocation test reveals significant abnormalities of bladder function in newborns with spinal dysraphism

Risk factors predicting upper urinary tract deterioration in children with spinal cord injury

The Importance of Early Diagnosis and Management of Pediatric Neurogenic Bladder Dysfunction

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