Long Term Catheter Usage

One of the questions that was posed to us is, um, you know, in low-income countries, can you manage a child with valves with just leaving a catheter in their bladder? Um, the answer is no, and the reason why it's no is that living with a catheter for a long extended period of time does two things. One is it deffunctionalizes the bladder. So the bladder won't be healthy. So we're adding new injury upon existing injury from the valves by leaving a catheter in. In order for bladders to stay healthy, the bladder has to cycle, and what I mean by that is the bladder has to fill and empty, fill and empty. By doing this constant filling and emptying, we're keeping the bladder muscle nice and healthy. It also keeps the blood flow to the bladder going well, and the the lining of the bladder secretes a very special layer of protein that prevents bacteria from sticking to our bladder and causing infections. When you leave a bladder at rest with a catheter and it's always in this collapse state, it doesn't grow, so the bladder will be always much smaller than it should be. You don't get that proper protein layer inside the bladder to protect against infection, so children who are left with a chronic indwelling catheter are at a very high risk of getting urinary tract infections, and those infections are a second injury to the kidney. So for those reasons, I would say that leaving a child with an indwelling catheter. Regardless of where that child is in the world is not a good option for taking care of them with valves. As a temporizing measure, absolutely, do that for a short period of time until you can do the more appropriate therapy. Absolutely. While we did talk about the use of catheterization to help empty the bladder, uh, it is important to remember that this is a spectrum, and we're gonna have children on the favorable end of the spectrum where they're not gonna need any active bladder management. Their bladders are gonna be OK, to the other end of the spectrum where the children will need a catheter to empty their bladder, and that might be a lifelong commitment that they have to make to emptying their bladder. So, um, not every single child born with a diagnosis of postrethral valves is going to need active bladder management. Uh, sometimes that bladder management just might mean that we make sure the child goes to the bathroom on a very regular schedule. Uh, when the bladders get really big and over distended, a child won't be able to register that sensation of bladder fullness properly, so we teach them to go to the bathroom on a regular schedule by time, and that keeps their bladder emptying and filling appropriately, uh, and prevents that over distention that can cause damage to the bladder muscle. When we do use catheters, um, the only time we leave a catheter in dwelling, so left in place for any extended period of time is overnight. So, in the children who make a very large quantity of urine, uh, a couple of liters of urine overnight, that's very dangerous to the bladder. Because, uh, you know, a child's sleeping, they're not going to wake up, so the bladder is just gonna fill and then get to a point where it's just going to be constantly overflowing, and that's overstretching the bladder muscle and causing scarring developing. So, in some instances, in some children, we will just teach the parents to put a catheter in just overnight and let the bladder drain all night long, so that the pressure in that bladder is zero for that 8 to 10 hours that the child's sleeping. And then there are some children where we'll teach them to use a catheter during the daytime every 3 hours instead of urinating. Through their urethra like normal, they would have to use a catheter to drain the bladder, and the reason we do this is in instances where either their bladder's not emptying to completion or they're having such high voiding pressures that that pressure is going to damage the kidneys.