EINFLUSS DES INTERMITTIERENDEN KATHETERISMUS AUF HARNWEGSINFEKTE UND INKONTINENZ BEI KINDERN MIT SPINA BIFIDA

Although the primary objective of clean intermittent (self) catherization (CIC) was to regain continence in (older) children with myelomeningocele (MMC), we used the method also in the very young with detrusor-sphincter dyssynergia, to prevent future damage from the combined effects of obstruction and urinary tract infection (UTI). The results, in terms of incidence of UTI and degree of incontinence before and during CIC, were assessed in 61 children with MMC who had started CIC between 1985 and 1988. Mean follow up was 45.3 ± 27.3 months, mean age at the start of CIC was 6.9 ± 4.6 years. The incidence of UTI during CIC proved significantly lower than before CIC (χ2 = 20.92, p < 0.001), and the improvement in incontinence was also statistically significant (χ2 = 45.16, p < 0.001). In children with MMC CIC seems ideally suited to prevent damage to the kidneys from the lifelong problem of recurrent UTI's. It will also help in preventing bladder wall fibrosis - an important cause of loss of detrusor compliance - secondary to repeated UTIs.