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Comparison of Quality of Life and Bladder Symptoms in Adolescents and Young Adults with Spina Bifida who Catheterize via Urethra Versus Continent Catheterizable Channel
Josephine Hirsch, BA1, Rachel Berkowitz, MPH1, Theresa Meyer, RN, MS, CPN1, James Rague, MD1, Soojin Kim, MD2, Ilina Rosoklija, MPH1, Stephanie Kielb, MD3, Jill Larson, MD1, Vineeta Swaroop, MD1, Robin Bowman, MD1, Earl Cheng, MD1, Diana Bowen, MD1, Elizabeth Yerkes, MD1, David Chu, MD, MSCE1.
1Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA, 2BC Children's Hospital, Vancouver, BC, Canada, 3Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Background Clean intermittent catheterization (CIC) is a common bladder management method for adolescents and young adults (AYA) with spina bifida (SB). A continent catheterizable channel is often created to promote continence and independence, compared to CIC via urethra. A channel presumably also improves quality of life (QOL), but previous studies provide conflicting evidence. We sought to assess the association between QOL and CIC route among AYA with SB, hypothesizing that those who catheterize via channel would have a better QOL than those who catheterize via urethra. Methods We performed a retrospective cross-sectional analysis of clinical questionnaires administered to patients ≥12-years-old between June 2019 and March 2020 in a multi-disciplinary SB clinic. Questionnaires were available in English and Spanish and completed independently by the patient or with caregiver assistance. Medical records were reviewed for demographic and clinical characteristics, including bladder management and urinary incontinence. Patients who emptied their bladder via CIC were included in the study. The primary exposure was CIC route (urethra or channel). The primary outcome was general QOL, measured by the Patient Reported Outcome Measure Information System Pediatric Global Health 7 (PGH-7). Secondary outcomes were bladder-specific QOL and bladder symptoms, both measured by the Neurogenic Bladder Symptom Score (NBSS) with lower symptom score signifying fewer bladder symptoms. Multivariable linear regression models were parsimoniously fit to assess the associations between CIC route and questionnaire scores. Results 232 of 241 patients who were approached returned questionnaires during the study period. 162/232 managed their bladder via CIC. 146/162 patients completed both the PGH-7 and NBSS and were included in the analysis. 106/146 (73%) patients catheterized via urethra; 40/146 (37%) patients catheterized via channel. Median age was 17.5 years, 58% of patients were female, and 80% had myelomeningocele. Having any urinary incontinence was more frequent in patients who catheterized via urethra (60%) compared to channel (33%). For the primary outcome, CIC route was not significantly associated with PGH-7 scores in both bivariable and multivariable analysis after adjusting for covariates (Table 1). However, CIC via channel was significantly associated with higher bladder-specific QOL than CIC via urethra (Table 2) even after adjusting for urinary incontinence, past bladder neck/augmentation procedures, education level, ethnicity, health literacy, caregiver assistance with questionnaire, age, and
sex. CIC via channel was also significantly associated with lower bladder symptom scores on adjusted analyses (Table 3), compared to CIC via urethra. Conclusions AYA with SB who catheterized via channel had better bladder-specific QOL and less bladder symptoms than those who catheterized via urethra. There was no association between CIC route and general QOL.




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