Association between Age of Starting Clean Intermittent Catheterization and Current Urinary Continence in Individuals with Myelomeningocele
Kurt A. Freeman, PhD1, Tiebin Liu, MSPH2, Kathryn A. Smith, RN, MN, DrPH3, Heidi Castillo, MD4, Jonathan Castillo, MD, MPH4, David B. Joseph, MD5, Yinding Wang, PhD6, Stacy T. Tanaka, MD, MS7.
1Oregon Health & Science University, Portland, OR, USA, 2Centers for Disease Control and Prevention, Atlanta, GA, USA, 3Children's Hospital of Los Angeles, Los Angeles, CA, USA, 4Texas Children's Hospital, Houston, TX, USA, 5University of Alabama at Birmingham, Birmingham, AL, USA, 6McKing Consulting Corporation, Consultant to Centers for Disease Control and Prevention, Atlanta, GA, USA, 7Vanderbilt University Medical Center, NASHVILLE, TN, USA.
BACKGROUND: The benefits of clean intermittent catheterization (CIC) on renal preservation in individuals with myelomenigocele are well established. CIC may also aid in achieving urinary continence. There is low level evidence that suggests starting CIC earlier in childhood improves continence outcomes. We hypothesize earlier initiation of CIC is associated with higher likelihood of current urinary continence.
METHODS: Data on individuals with myelomeningocele who were 5 years or older at the time of their last visit were obtained from the National Spina Bifida Patient Registry. Variables related to sociodemographic characteristics, disease characteristics and current bladder management strategies collected between 2013 and 2018 were analyzed. Patients/guardians indicated the age at which CIC was started: never, younger than 3 years of age, 3 to 5 years, 6 to 11 years, and 12 years or older. Patients were classified as continent if they answered “never” or “less than once a month” to the question: “Quantify frequency of urinary incontinence during the day over the last month (when not having a urinary tract infection)”. Univariate and multivariable logistic regression models were utilized to analyze the associations between continence and sociodemographic factors, age CIC began and disease characteristics.
RESULTS: 3510 individuals with myelomeningocele aged 5 years and older were identified in the study sample. The mean age was 17.0 years with a range of 5.0 - 88.7 years. The sample was evenly distributed by sex (52% female) and the majority of individuals were non-Hispanic White (62.6%). The majority of patients (55.1%) started CIC when they were younger than 3 years of age. Current bladder continence was significantly associated with having started CIC; however, the magnitude of the association was not proportional to the age CIC was initiated. Compared with those who never started CIC, the estimated adjusted odds ratio of being continent ranged from 1.95 (3 to 5 years, 95% CI, 1.11 - 3.41 ) to 2.26 (younger than 3 years, 95% CI, 1.31 - 3.89).
CONCLUSIONS: Although CIC may help some individuals with myelomeningocele achieve urinary continence, our study did not demonstrate that initiating CIC at a younger age helps achieve this goal.
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