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