A boy with spina bifida & neuropathic bladder managed with CIC and medicines

Master R.S., 8 years old boy, was a known case of Spina Bifida (lumbosacral meningomyelocele) and had undergone surgery for the same in infancy.

He was referred to us with a history of continuous urinary leakage in undergarments and was in diapers even at 8 years of age. He had issues with urine control right from neonatal age and lately was having frequent urinary infections. We suspected him to have neurogenic bladder (also called neuropathic bladder)

On clinical examination, his undergarments were wet and the bladder was full. There was a scar on the back due to meningomyelocele surgery. There was mild weakness of left lower limb at ankle.

Ultrasound showed bilateral hydronephrosis with distended thick walled bladder. His serum creatinine and kidney function tests were borderline high indicating some loss of kidney function. MCU test showed a picture suggestive of neuropathic bladder and non-relaxing external sphincter. This was further confirmed on pediatric Urodynamic studies which showed high pressures in bladder with high leak point pressure. We instituted full scale treatment for his neuropathic bladder by starting him on bladder relaxants, CIC- Clean intermittent catheterization and prophylactic antibiotics in a low dose.

At three months follow-up, R.S is dry (no diapers), free of urinary infections and very happy to go to school and play like a normal child. His serum creatinine and kidney function tests have also come back to normal. Children with Neurogenic bladder and urine incontinence can be managed very well with medical therapy by expert pediatric urologist doctors.

Child with scar of meningomyelocele surgery

MCU showing abnormal bladder & sphincter

Facts about CIC

• CIC- Clean intermittent catheterization – is a modality of treatment which involves regular bladder catheterization at home to avoid over distension of bladder, to lower bladder pressures and to prevent infections.
• It is the most simple and effective strategy for children with neuropathic bladder and various other ailments which lead to poor bladder emptying. Note it is not a sterile catheterization, it is clean catheterization done by parents/ or patients themselves once they are trained and in familiar circumstances at home or at work.
• CIC has changed the lives of millions of young kids and adults as they no longer need to wear diapers or urinary collecting bags. CIC permits them to live a free life and contribute more to the family and society.
• Initially parents and caregivers may find it difficult to adjust to CIC but once they realize that CIC can keep the child free of diapers and infections, they are very happy with it.
• CIC can also help in avoiding major reconstructive surgeries if chosen properly and given along with other medicines.
• In female children and also in boys with pain during catheterization an alternative route for passing a catheter to empty the bladder may be provided to help in CIC. Such a channel is created surgically by using appendix or a short segment of small intestine. This can be cosmetically hidden in the navel. This procedure is called Mitrofanoff principle.
• CIC is also required after all bladder augmentation surgeries.

Dr A.K.Singal is one of the best Pediatric Urologists in the India and practices in Navi Mumbai, Thane and Mumbai area. He runs a Neuropathic bladder clinic at MITR Hospital in Kharghar where he does regular urodynamic studies in children which are required for best treatment of incontinence and urinary control issues in children.

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