Development of a bladder management protocol as part of a comprehensive care program for spina bifida in Kenya.

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.