Affiliations: Munson Medical Center, Traverse City, MI, USA | Department of Physical Medicine and Rehabilitation,
University of Michigan Health Systems, Ann Arbor, MI, USA | AIC CURE Children's Hospital of Kenya/Bethany Kids at
Kijabe Hospital, Kijabe, Kenya
Note: [] Address for correspondence: Kimberly Augenstein, Munson Medical
Center, 3988 W. Royal Drive, Traverse City, MI 49684, USA. Tel.: +1 231 935
0860; E-mail: kaugenstein@tc-rehab.com
Abstract: Most children with spina bifida have neurogenic bladders. Prior to
the use of clean intermittent catheterization (CIC) in 1972, approximately
30% of children with spina bifida died of renal failure. In developing
countries where CIC is not done, even more children with spina bifida continue
to die from renal failure. This article presents data from Kenya collected from
a nurse run comprehensive spina bifida program which evaluates bladder function
with leak point pressure (LPP) and begins CIC in those children with LPP
>30 cm water. 371 children were seen for surgical closure.
Urodynamic studies were done in 249 and of these 167 were started on CIC
because of high LPP or need for social continence. 99/371 were lost to
follow-up. 72 have died. To date, only 3 deaths were from renal complications.
Of 59 children age 5 or older, 45 have achieved social continence. We conclude
that a nurse run bladder management program including CIC for children with
spina bifida can be done in a developing country with good results on renal
function and continence.
