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      Risk factors associated with recurrent febrile urinary tract infection in children with neurogenic bladder who perform clean intermittent catheterization

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          Abstract

          Objective

          To identify the clinical and urodynamic risk factors associated with the development of recurrent febrile urinary tract infections (FUTIs) in children with neurogenic bladder (NB) who perform clean intermittent catheterization (CIC).

          Methods

          Children with NB receiving CIC were prospectively enrolled from January to December 2019 and followed up prospectively for 2 years. All data were compared between occasional (0–1 FUTI) and recurrent FUTIs (≥2 FUTI) groups. In addition, the risk factors for recurrent FUTIs in children were evaluated.

          Results

          Complete data from 321 children were analyzed. Occasional FUTIs occurred in 223 patients, and 98 patients experienced recurrent FUTIs. Univariate and multivariate analyses, showed late‐initiation and low‐frequency CIC, vesicoureteral reflux (VUR), small bladder capacity and low compliance, and detrusor overactivity were associated with an increased risk of recurrent FUTIs. Children with high‐grade VUR (grades IV‒V) had a higher risk of recurrent FUTIs than those with low‐grade VUR (grades I‒III) (odds ratio [OR]: 26.95 vs. OR: 4.78, p < 0.001).

          Conclusions

          Our study suggests that late‐initiation and low‐frequency CIC, VUR, small bladder capacity and low compliance, and detrusor overactivity were associated with recurrent FUTIs in patients with NB. In addition, high‐grade VUR is a crucial risk factor for recurrent FUTIs.

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          Most cited references20

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          The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction

          In the development of terminology of the lower urinary tract, due to its increasing complexity, the terminology for male lower urinary tract and pelvic floor symptoms and dysfunction needs to be updated using a male-specific approach and via a clinically-based consensus report.
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            Early start to therapy preserves kidney function in spina bifida patients.

            Renal scarring and renal failure remain life-threatening for children born with spinal dysraphism. We reviewed our data of spina bifida patients to evaluate whether optimal treatment of the neurogenic bladder from birth onwards can preserve kidney function. We reviewed data on all newborns with spinal dysraphism who were referred to our hospital between January 1988 and June 2001. We looked at their situations at referral and at follow-up: the type of treatment, antimuscarinic agents, clean intermittent catheterisation (CIC), antibiotic prophylaxis, and operations (sling procedures, bladder augmentations, antireflux procedures). Renal function (ultrasound, DMSA scan, serum creatinin, creatinin clearance) and bladder function (urodynamic studies) were evaluated over time. Data of 144 children of 176 could be evaluated by the end of the study: 5 patients had pre-existing renal abnormalities, 69 had an overactive sphincter, 27 had reflux, and six had renal scarring. None are currently developing end-stage renal disease. All patients with spina bifida aperta started CIC and antimuscarinic therapy shortly after birth. Five of the six patients with renal scarring were started on therapy with intermittent catheterisation and antimuscarinic therapy several months after birth. Sixty-three of 82 children with spina bifida were dry at school age (age six), although 37 of these had not had an operation. We show that an early start to therapy helps to safeguard renal function for children born with spina bifida. Our data support other recent reports that children born with spina bifida can probably use their own kidneys for a lifetime, if they are given adequate urological treatment. To protect the upper urinary tract, we need to ensure low intravesical pressure by starting children early on CIC (the preferred treatment); antimuscarinic agents to counteract detrusor instability are indispensable in most cases. Proactive treatment of risks for upper tract deterioration results in a negligible loss of renal function, even when early urinary continence is included in the treatment protocol.
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              Factors implicated in pathogenesis of urinary tract infections in neurogenic bladders: some revered, few forgotten, others ignored.

              To comprehensively review factors implicated in the pathogenesis of urinary tract infection in patients with neurogenic bladders, and to stimulate research, especially in the somewhat ignored and forgotten areas of this important clinical subject.
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                Author and article information

                Contributors
                Journal
                Neurourology and Urodynamics
                Neurourology and Urodynamics
                Wiley
                0733-2467
                1520-6777
                September 2023
                July 08 2023
                September 2023
                : 42
                : 7
                : 1485-1490
                Affiliations
                [1 ] Department of Urology and Laboratory of Pelvic Floor Muscle Function Shenzhen Children's Hospital Guangdong China
                [2 ] Department of Infectious Diseases Shenzhen Children's Hospital Shenzhen China
                [3 ] Department of Urology and Laboratory of Pelvic Floor Muscle Function Shenzhen Children's Hospital Shenzhen China
                [4 ] Department of Clinical Laboratory Shenzhen Children's Hospital Shenzhen China
                Article
                10.1002/nau.25245
                e6122f91-f712-45d2-a6c2-cea1812c2c90
                © 2023

                http://creativecommons.org/licenses/by-nc-nd/4.0/

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