Introduction: Standard urotherapy is part of the proactive approach to children with neurogenic bladder and bowel along with a clean intermittent catheterization (CIC) plan, which requires caregiver responsibilities leading toward self-CIC and independence. The objective of this study is to demonstrate the influence of integrated plans in the care of urinary and intestinal tract in spina bifida.Material and Methods: Retrospective cohort. Patients with spinal dysraphism were assessed by the multidisciplinary group between 2022 and 2024. Inclusion: neurogenic bladder in <18 years old with CIC. The exclusion criteria were children with LUTD without CIC. The integrated program included standard urotherapy, postural/pelvic kinesiology, training/retraining in CIC/autoCIC by nursing, voiding registry, Bristol scales and Rome IV criteria. Definition of constipation: Bristol 1-2 and <3 bowel movements/week from 4 years of age. Definition of fecal incontinence: >3 episodes/week from 6 years of age. Redcap was used to collect data. Descriptive statistics and Chi2 tests were used for categorical variables with stata18.Results: 189 cases were evaluated (myelomeningocele 84%). Postnatal defect closure: 98%. Female: 50%. Average age: 7.6 years. Ambulation with orthoses (62%). Regular school education with integration (42%). Constipation: 27%. CIC through urethra (95%) and stoma (5%). The most used catheter was the 8-10 Ch and 45% was reused. The majority performed 3-4 CIC/day (44%), including an indwelling nocturnal catheter in < 3 years (21%). 43% of children are dry for >3 hours and 83% use diapers, also due to fecal incontinence (50%). Upon admission, CIC training was distributed as follows: a) First time: 21%; b) retraining: 39% and autoCIC: 40%. The reasons for retraining were: 1) Failure to understand the technique: 62%; 2) Resistance to the procedure: 16%; 3) Time availability: 7% and 4) Lack of resources (physical space or supplies): 9.6%. After integrated program, the following was observed: an increase in CIC frequency (from 34 to 42%); decrease in constipation (22%), decrease in fecal incontinence (33%), no changes in the use of diaper and increase in autoCIC (45%). Besides, most frequent complications decreased: UTI (from 26 to 15%) and urethrorrhagia (from 5.4 to 4.7%). No urethral trauma or stuck catheter was observed (previously 1 of each). Although girls were associated with greater constipation (p=0.040), an association was found between them and drier periods among CIC (p=0.026). There was an association between >4 CIC per day and greater continence (p=0.05) and between all causes of retraining and <3 CIC per day (p=0.000). The use of lubricated catheters was associated with a higher degree of urinary continence (p=0.005).Conclusions: The implementation of the proactive and integrated program in the care of urinary and intestinal tract in children with spinal dysraphism increased the frequency of CIC, as well as autoCIC, decreased complications
due to CIC, improved intestinal status although no changes were observed in the use of diaper. This is a topic for future research.
