84 EARLY START OF CLEAN INTERMITTENT CATHETERISATION HELPS PREVENT RENAL SCARS IN PATIENTS WITH SPINAL DYSRAPHISM
Wael Elzeneini, Ramy Waly, David Marshall, Alan Bailie
Royal Belfast Hospital for Sick Children, Belfast, United Kingdom

Abstract

Aim of the Study:

In 1997, we instituted early clean intermittent catheterisation (CIC) in all newborn babies with spina dysraphism (SD). We compared this group to a similar historical group managed expectantly, to see if early catheterisation was associated with a reduction in scar rate as determined by DMSA scanning.

Methods:

The data were retrospectively studied on all newborns with SD over a 13-year period from 1997-2010 who were treated in a regional paediatric urology department.  These were compared to our previously published outcomes in a historical group that was managed expectantly.

Main Results:

In this time-period, 114 babies with SD were born. Thirteen patients were excluded: eleven who had had no DMSA scan as deemed very low risk, and two who died immediately after birth.  The remaining 101 patients (57.4 % males) had the following pathologies: spina bifida aperta with or without hydrocephalus (95), lipomyelomeningocoele (5) and spina bifida occulta with intra-dural lipoma (1).

With a mean follow-up of 11.4 years, DMSA scan revealed renal scarring in 19 of the 101 patients (18.8 %). Renal scarring was first detected at 0.5-15 years of age, with a mean of 4.5 years.  In 9 of these (47 %), scarring appeared before the age of 4 years.

These data were compared to our historical cohort of 100 patients (55 % males) representing all SD patients born between 1985-1994 when early universal CIC was not our standard practice. Follow-up was 4-13 years. The rate of renal scarring then was 39 out of the 100 patients (39 %), appearing before four years of age in 28 patients (72 %). In comparison, early CIC was associated with a highly statistically significant reduction in scar-formation (p-value = 0.002).

Conclusion:

Based on these renal protective data, we recommend indwelling and then intermittent catheterisation from birth in all patients with SD.


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