Risk factors for bladder spasm in children with indwelling catheters

Abstract Background: Bladder spasms represent a prevalent complication in pediatric populations with indwelling catheters, frequently manifesting as suprapubic discomfort that compromises quality of life, even causing patients to delay recovery. While anticholinergic therapy remains the therapeutic mainstay, evidence regarding predisposing factors remains scarce. This retrospective study aims to elucidate risk determinants for catheter-associated bladder spasms in children. Methods: We retrospectively analyzed 203 cases of children with indwelling catheters in Foshan Maternal and Child Health Hospital. All of these patients received surgical treatment and had indwelling catheters during the operation, and the catheter indwelling time were all more than 3 days. We recorded the occurrence of bladder spasm in detail, and we also collected some clinical characteristics that might be related to the occurrence of bladder spasm in patients including whether pain medication was still needed 24 hours after surgery; catheter retention time, positive white blood cells(WBC) in urine after surgery, catheter obstruction or not, gross hematuria or not, child defecation frequency, and catheter material. We established a binary logistics regression equation to investigate whether bladder spasm is associated with these clinical features and analyze the risk factors for bladder spasm in these patients. Results: Among 203 children with indwelling catheters, 49 patients experienced bladder spasm (24.1%), and the symptoms could be relieved after the application of M-cholinocepter blockers such as tolterodine. The binary logistics regression equation showed that the occurrence of bladder spasm was related to the following factors (P<0.05) : WBC in urine (positive versus negative) (OR: 3.115, 95%CI: 1.357~7.152, P=0.007), urinary catheter obstruction (yes versus not) (OR: 3.950, 95%CI: 1.856~8.407, P=0.000) and decreased defecation frequency (≤1 / 2 days versus ≥1 / day)(OR: 2.601, 95%CI: 1.177~5.747, P=0.018) . Conclusion: Pediatric patients undergoing indwelling urinary catheterization remain at risk for bladder spasms. Positve WBC in urine, catheter obstruction and reduced frequency of defecation are risk factors for occurrence of bladder spasm.