1495 A PROSPECTIVE COMPARISON OF URINARY TRACT INFECTIONS (UTI) IN PATIENTS TREATED WITH EITHER CLEAN INTERMITTENT CATHETER IZATI ON OR URINARY DIVERSION

Abstract

Clean intermittent catheterization (CIC) has become the treatment of choice for patients with a neurogenic bladder replacing urinary diversion. However, no well controlled studies are available assessing the efficacy of CIC over ileal loop diversion (ILD) in altering short term morbidity and frequency of UTI's. Consequently, a one year prospective study was carried out comparing patient morbidity, infection rates, and bacterial organisms in 33 children with meningomyelocele. Twenty four of the children, aged 3-12 years, performed CIC while 9 of the children, aged 10-18, had ILD. A minimum of 4 cultures per year were obtained on each patient. All ILD and 21/24 CIC patients were maintained on urinary tract antiseptics. One patient on CIC sustained a transient doubling of serum creatinine with progressive hydronephrosis requiring diversion. However, no patient in either group demonstrated a permanent decrease in renal function. Only 5 of 90 (5.6%) positive cultures from patients with CIC and 1/36 (2.8%) positive cultures from patients with ILD were associated with signs or symptoms. This difference was not statistically significant. Over the study period, 3/24 (13%) children treated by CIC had sterile urine cultures while none of the IID patients were free from bacteriuria. Otherwise, the frequency of bacteriuria was similar in both groups. The most common cause of bacteriuria was E. coli accounting for approximately 1/3 of infections in both groups. These data suggest that patients treated with CIC are not significantly different from those with ILD with respect to UTI morbidity, frequency, or bacterial organisms. CIC may then be preferable to ILD as surgical morbidity can be avoided.

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