Objective
To characterize long-term outcomes for adults with cerebral palsy who have undergone
catheterizable channel creation without concurrent bladder augmentation.
Methods
Retrospective review was conducted of patients who underwent catheterizable channel
creation without augmentation by the senior author. Variables of interest included
development of de novo neurogenic detrusor overactivity, change in continence, escalation
in therapy, and upper tract changes. Descriptive statistics were conducted using t-tests
and chi-squared tests as appropriate.
Results
Nine patients were followed for an average of 70 months. Prior to surgery two patients
were on regular clean intermittent catheterization (CIC), six were not on CIC, and
one was on occasional CIC. Patients not on CIC preoperatively were more likely to
develop de novo neurogenic detrusor overactivity (83% vs 0%, P = .02), and have statistically significant decreases in average compliance (P = .04 vs P = .31). They were also more likely to require escalation in bladder therapy (83%
vs 50%) and have worsening of incontinence (67% vs 0%), though these did not reach
statistical significance (P = .34, 0.1). Five patients underwent repeat urodynamics an average of 46 months after
initial postoperative study because of persistent urgency - 4 of 5 had stable urodynamic
findings and one demonstrated >50% reduction in compliance and capacity.
Conclusion
Adults with cerebral palsy who are not on CIC prior to creation of a catheterizable
channel are at high risk for development of de novo neurogenic detrusor overactivity
and decrease in bladder compliance. Prophylactic augmentation should be considered
in this group.
Abbreviations:
AC (anticholinergics), BoNT (botulinum toxin), CC (catheterizable channel), CIC (clean intermittent catheterization), CP (cerebral palsy), DO (detrusor overactivity), DSD (detrusor sphincter dyssynergia), GMFCS (Gross Motor Function Classification System), NDO (neurogenicdetrusor overactivity), UDS (urodynamics), UUI (urge urinary incontinence)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 25, 2022
Accepted:
September 12,
2022
Received:
June 29,
2022
Footnotes
Conflict of interest: None.
Financial Disclosure: The authors declare that they have no relevant financial.
MDF: none.
RG: none.
SPE: consultant and speaker for Boston Scientific, PI of clinical trial and consultant for urotronic, investment interest for percuvision.
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© 2022 Elsevier Inc. All rights reserved.
