Association between age of starting clean intermittent catheterization and current urinary continence in individuals with myelomeningocele

Details

• Alternative Title:
  J Pediatr Urol
• Personal Author:
  Freeman, Kurt A. ; Liu, Tiebin ; Smith, Kathryn ; Castillo, Heidi ; Castillo, Jonathan ; Joseph, David ; Wang, Yinding ; Tanaka, Stacy
• Description:
  Introduction
  
  Patients with myelomeningocele often use clean intermittent catheterization (CIC) for renal preservation and to promote urinary continence. While starting CIC at an early age is associated with better renal outcomes, the impact of age of CIC initiation on continence outcomes has not been examined.
  
  Objective
  
  To examine whether earlier CIC initiation is associated with higher likelihood of current urinary continence for patients with myelomeningocele.
  
  Study design
  
  Data of patients aged ≥5 years at last visit were obtained from 35 spina bifida clinics participating in the National Spina Bifida Patient Registry from 2013 to 2018. Sociodemographic characteristics, disease characteristics, and current bladder management strategies were collected. Via univariate and multiple logistic regression models, the latter conducted controlling for all variables associated with current continent status, associations between continence and sociodemographic factors, condition characteristics, and age CIC began (<3 years of age, 3–5 years, 6–11 years, ≥12 years) were analyzed.
  
  Results
  
  Data from 3510 individuals were included (mean age at last visit = 17.0 years, range 5.0–88.7). The sample was evenly distributed by sex (52% female); most individuals were non-Hispanic White (62.6%). The majority of patients (55.2%) started CIC before age 3 years. Continence varied markedly across those who never started CIC (0.6% of patients were continent) and those who started at any age (range 35.3–38.5%). Among those who started CIC, the magnitude of the association was not proportional to age CIC was started. Compared with those who started CIC at age 12 or older, estimated adjusted odds ratio of being continent ranged from 1.04 (6–11 years, 95% CI, 0.72–1.52) to 1.25 (<3 years, 95% CI, 0.89–1.76).
  
  Discussion
  
  Although CIC may be positively associated with achieving urinary continence in individuals with myelomeningocele, we could not demonstrate that younger age at CIC initiation increased the likelihood of achieving this goal. Limitations include lack of data on reason for starting CIC, urodynamic data, and the observational nature of data collection.
  
  Conclusions
  
  Further study is needed addressing limitations of the current investigation to determine if urinary continence outcomes are influenced by the age of starting CIC among patients with myelomeningocele.
  
  
• Keywords:
  Adolescent Adult Aged Aged, 80 And Over Child Child, Preschool Clean Intermittent Catheterization Female Humans Infant Intermittent Urethral Catheterization Male Meningomyelocele Middle Aged Myelomeningocele Spinal Dysraphism Urinary Bladder Urinary Bladder, Neurogenic Urinary Catheterization Urinary Continence Young Adult

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• Source:
  J Pediatr Urol. 18(5):614.e1-614.e10
• Pubmed ID:
  36163222
• Pubmed Central ID:
  PMC10426730
• Document Type:
  Journal Article
• Funding:
  U01DD001080/ACL/ACL HHSUnited States/ ; U01DD001072/ACL/ACL HHSUnited States/ ; U01 DD000742/DD/NCBDD CDC HHSUnited States/ ; U01 DD000383/DD/NCBDD CDC HHSUnited States/ ; U01 DD001078/DD/NCBDD CDC HHSUnited States/ ; U01 DD000773/DD/NCBDD CDC HHSUnited States/ ; U01 DD000769/DD/NCBDD CDC HHSUnited States/ ; U01 DD001080/DD/NCBDD CDC HHSUnited States/ ; U01DD001063/ACL/ACL HHSUnited States/ ; U01 DD000388/DD/NCBDD CDC HHSUnited States/ ; U01 DD000381/DD/NCBDD CDC HHSUnited States/ ; U01DD001057/ACL/ACL HHSUnited States/ ; U01 DD000738/DD/NCBDD CDC HHSUnited States/ ; U01DD001065/ACL/ACL HHSUnited States/ ; U01 DD000771/DD/NCBDD CDC HHSUnited States/ ; U01 DD001069/DD/NCBDD CDC HHSUnited States/ ; U01 DD001074/DD/NCBDD CDC HHSUnited States/ ; U01 DD001082/DD/NCBDD CDC HHSUnited States/ ; U01 DD001093/DD/NCBDD CDC HHSUnited States/ ; U01 DD000382/DD/NCBDD CDC HHSUnited States/ ; U01 DD000768/DD/NCBDD CDC HHSUnited States/ ; U01 DD000745/DD/NCBDD CDC HHSUnited States/ ; U01DD001093/ACL/ACL HHSUnited States/ ; U01 DD001071/DD/NCBDD CDC HHSUnited States/ ; U01 DD001063/DD/NCBDD CDC HHSUnited States/ ; U01 DD000767/DD/NCBDD CDC HHSUnited States/ ; U01 DD000740/DD/NCBDD CDC HHSUnited States/ ; U01 DD000385/DD/NCBDD CDC HHSUnited States/ ; U01 DD001073/DD/NCBDD CDC HHSUnited States/ ; U01 DD000387/DD/NCBDD CDC HHSUnited States/ ; U01DD001071/ACL/ACL HHSUnited States/ ; U01DD001062/ACL/ACL HHSUnited States/ ; U01DD001082/ACL/ACL HHSUnited States/ ; U01 DD000737/DD/NCBDD CDC HHSUnited States/ ; U01 DD001057/DD/NCBDD CDC HHSUnited States/ ; U01 DD000772/DD/NCBDD CDC HHSUnited States/ ; U01 DD000774/DD/NCBDD CDC HHSUnited States/ ; U01 DD001265/DD/NCBDD CDC HHSUnited States/ ; U01 DD001072/DD/NCBDD CDC HHSUnited States/ ; U01 DD000744/DD/NCBDD CDC HHSUnited States/ ; U01 DD000386/DD/NCBDD CDC HHSUnited States/ ; U01 DD001062/DD/NCBDD CDC HHSUnited States/ ; U01DD001078/ACL/ACL HHSUnited States/ ; U01 DD000389/DD/NCBDD CDC HHSUnited States/ ; U01 DD000736/DD/NCBDD CDC HHSUnited States/ ; U01DD001069/ACL/ACL HHSUnited States/ ; U01 DD000766/DD/NCBDD CDC HHSUnited States/ ; U01 DD001065/DD/NCBDD CDC HHSUnited States/ ; U01 DD001091/DD/NCBDD CDC HHSUnited States/ ; U01DD001091/ACL/ACL HHSUnited States/ ; U01 DD000743/DD/NCBDD CDC HHSUnited States/ ; U01DD001073/ACL/ACL HHSUnited States/ ; U01 DD001275/DD/NCBDD CDC HHSUnited States/ ; U01DD001074/ACL/ACL HHSUnited States/ ; U01 DD000770/DD/NCBDD CDC HHSUnited States/
• Volume:
  18
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:d6ced4f6ed9be4c3dded97480ca3b84952e73bfff6a66ab12a933301094e02d4
• Download URL:
  https://stacks.cdc.gov/view/cdc/132041/cdc_132041_DS1.pdf
• File Type:
  [PDF - 155.55 KB ]