Management of neuropathic urinary incontinence in children by intermittent catheterisation.

Forty-nine children with urinary incontinence owing to neuropathic bladder were treated by intermittent catheterisation. Manometric studies to determine urethral closing pressures and intravesical pressure/volume relationships were performed before or during treatment in all children. Cystography and intravenous urography were carried out at the beginning of treatment and intravenous urography was repeated after treatment for at least 12 months. Routine long-term antibacterial therapy was not used. With a 3-hourly catheterisation regimen a total of 46 (93%) children achieved day-time control but 27 (55%) did so only with the help of propantheline or imipramine or both of these. Night-time control was also substantially improved in 43 (87%) children. The manometric studies enabled a reliable prediction to be made on whether drugs would be required to achieve success. One child with an undilated urinary tract before treatment developed unilateral dilatation owing to mechanical problems during treatment. Upper urinary tract dilatation which was present before treatment in 20 children (33 kidneys) disappeared or improved in all. Early renal failure in 2 children also responded favourably. The technique had to be abandoned in 2 children.