Risk factors for bladder spasm in children with indwelling catheters

Risk factors for bladder spasm in children with indwelling catheters | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Risk factors for bladder spasm in children with indwelling catheters Chunjing Li, Shilin Zhang, Fengshen Ling, Huiling Wei, Jianfeng Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5997884/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version 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. Risk factors bladder spasm children with indwelling catheters Introduction Bladder spasm is an external manifestation of detrusor muscle instability, and its clinical symptoms include spasmodic pain of bladder or urethra, strong urination, urgent urinary incontinence of urethra, etc, which may be accompanied by urine overflowing from the urethral opening along the pericatheteral space [1] . There are many speculations about the causes of bladder spasms, but the denervation hypersensitivity theory is currently accepted by many people [2] . Various physical and chemical stimuli in the bladder, such as infection, may eventually stimulate the M-cholinocepter in the bladder, resulting in paroxysmal spasm of the detrusor muscle [3] . Bladder spasm is usually seen in elderly patients after electroprostatectomy due to lower urinary tract obstruction caused by long-term prostatic hyperplasia leading to detrusor instability [4] . Bladder spasms also frequently occur in pediatric populations, particularly in catheterized cohorts. These episodes manifest as acute suprapubic discomfort that significantly impairs quality of life. Common complications include periurethral leakage, hemorrhagic cystitis, and inadvertent catheter dislodgement, all the above complications could cause serious clinical consequences and poor prognosis [5] . Bladder spasms secondary to prolonged catheterization constitute a subtype of catheter-associated bladder dysfunction (CRBD), demonstrating significant clinical overlap with overactive bladder (OAB) symptomatology including urinary urgency and detrusor hyperreflexia. The duration of the spasm varies from a few minutes to a few hours [6] . At present, the incidence study and treatment of bladder spasm are mostly focused on adult patients [7] , However, within pediatric urology, catheter-associated detrusor hyperactivity represents a prevalent clinical challenge. However, pediatric catheterization does not universally induce bladder spasm, as current evidence cannot fully elucidate its multifactorial etiopathogenesis [8] . The few studies on bladder spasm in children mainly focus on treatment, there are currently no reports on the epidemiology or large-scale clinical studies of bladder spasms in children, and there are few studies on the risk factors that cause bladder spasm [9] . In view of the fact that children indwelling catheters are a large special group, it is of positive significance to explore the risk factors of bladder spasm in this group. Due to the fact that bladder spasms may be influenced by multiple factors, this study will collect clinical data from patients and establish a logistics regression model to explore the risk factors for bladder spasms. The conclusion of this study may be beneficial for healthcare professionals to increase their understanding of bladder spasms and minimize the occurrence of this complication. Patients and methods Participants and clinical features We retrospectively analyzed the clinical data of 203 children hospitalized in Foshan Maternal and Child Health Hospital from January 2014 to December 2023. The patients included 184 males and 19 females. The mean age of all patients was 6.12 ±2.76 y (range from 3 to 13y) and the mean weight was 22.38 ± 9.35Kg (range from 11 to 60Kg). The study protocol was approved by the hospital's Ethics Committee (No. FFY-MEC-2022-116). The parents or guardians of all the children in this study were informed of the diagnosis and treatment process at admission, and the parents or guardians all signed informed consent forms which were recorded and kept in our hospital. The diseases types of 203 children included hypospadias, urethral masses, pyeloureteral junction obstruction, concealed penis, repeated renal and ureters, and vesicoureteral reflux. All the children received surgical treatment during hospitalization, and urine analysis were conducted before surgery. If the WBC of urine analysis was positive ([WBC] >10/μL), antibiotics were given to patients first, and the operation could not be performed until the WBC of urine analysis turned negative([WBC] <10/μL). None of the patients had indwelled catheters within 1 month before this admission, and all Foley catheters were indwelled during the surgery. A sterile operating environment avoids potential infections. The materials of the catheter included silicone and latex. Urine analysis was performed at least once every two days after surgery. Important clinical data were recorded and traceable, such as postoperative pain (whether pain medication was still needed 24 hours after surgery); whether the catheter was blocked; whether there was appearance of gross hematuria (red urine with red blood cells are positive), and whether patients have daily defecation. Symptoms of bladder spasm for all children were also well documented. The diagnosis of bladder spasm is that the child has paroxysmal pain in the pubic area and urine spills around the catheter simultaneously. Children were divided into positive group (group A) and negative group (group B) according to whether they were diagnosed bladder spasm. After data analysis, there were no statistically significant differences in age, weight and hospital stay between the two groups (Table 1). We also collected clinical characteristics that may be associated with bladder spasm, including postoperative pain (pain medication is still required 24 hours after surgery), catheter retention time, positive WBC in urine, catheter obstruction (urine in the bladder cannot be effectively drained), gross hematuria, frequency of defecation, catheter material (silicone or latex). The clinical features of the two groups of children are recorded as follows (Table 2). Statistical analysis Statistical analysis of such data were analyzed by IBM SPSSS Statistics, version23.0 (IBMCorp. Armonk, NY, USA) software. The measurement data were expressed as mean±standard deviation, and the difference in ratio or percentage was compared by Chi-square test. A binary logistic regression model was established between positive bladder spasm and specific clinical features to explore the risk factors for its occurrence. Risk factors were represented by odds ratio (OR) and 95% confidence interval (CI), and P < 0.05 was considered statistically significant. Results All 203 children (184 males and 19 females) had the catheter removed on schedule, and no accidental catheter shedding occurred. 49 children experienced unbearable postoperative pain, which was relieved by ibuprofen for pain relief. 50 patients were found WBC in their postoperative urine test and were treated with antibiotics. When 52 patients had urinary catheter obstruction, the catheter was squeezed or rinsed with physiological saline to ensure smooth drainage, and no patients had to replace the catheter. 44 patients defecate less than or equal to once every two days, among which 4 patients were used laxatives for defecation. 121 patients were placed with silicone catheters, while 82 children were placed with latex catheters. Indwelling durations stratified as short-term (≤3 days, n=27, 13.3%), intermediate (4~7 days, n=81, 39.9%), and prolonged (≥7 days, n=95, 46.8%). A total of 45 children experienced gross hematuria, but no special treatment was given but increasing the fluid intake, and the gross hematuria disappeared on its own. The symptoms of 49 patients (43 boys and 6 girls) with bladder spasm were relieved by tolterodine, an M receptor antagonist (medication based on body surface area). Binary logistics regression analysis showed that positive WBC in urine, catheter obstruction and decreased frequency of defecation were closely related to the occurrence of bladder spasm (P 0.05). According to the statistical results, positive urine WBC (OR: 3.115, 95%CI: 1.357~7.152, P=0.007), urinary catheter obstruction (OR: 3.950, 95%CI: 1.856~8.407, P=0.000) and decreased frequency of defecation (OR: 2.601, 95%CI: 1.177~5.747, P=0.018) were risk factors for bladder spasm(Table 3). Discussion Standardized diagnostic criteria for catheter-associated bladder spasms remain undefined. Prior studies have defined this condition variably, with some protocols requiring suprapubic pain alone [ 4 ] , while others mandate concomitant urinary leakage [ 10 ] . Our investigation employed both the two criterion. To ensure reliable symptom reporting, we implemented a strict eligibility criterion restricting enrollment to children ≥ 3 years old capable of verbalizing suprapubic discomfort through validated pain assessment. This study observed prolonged hospitalization durations in some special cases, potentially reflecting China's flexible postoperative admission protocols and subsidized healthcare expenditures [ 11 ] . While all participants required transurethral catheterization, extended dwell times were documented in a small portion of cases, particularly among concealed penis patients. These extensions primarily stemmed from parental requests motivated by concerns over voiding-induced wound contamination, as parents frequently perceived spontaneous micturition as risking surgical site infection. Extended indwelling urinary catheterization is a recognized risk factor for catheter-associated urinary tract infections(CAUTI) [ 12 ] . In this study of 203 pediatric patients, pyuria ([WBC] > 10/µL))was detected in 50 cases (24.6%). Paradoxically, among the 35 concealed penis cases demonstrating the biggest proportion of extended catheterization, only 4 patients (11.4%) exhibited urinary leukocytosis. This paradoxical finding indicates a lower CAUTI incidence rate in concealed penis patients compared to the overall cases. A possible explanation is that: ①No concealed penis patients were detected with pyuria before surgery; ②Considering such patients require a longer indwelling catheter after surgery, antibiotics are used preventively in these patients after surgery. Admittedly we should clearly recognize that extended catheter indwelling is not recommended. The relationship between clinical features and bladder spasms deserves further exploration. Due to the patients who had catheterization for a long time in the study so that we were able to retrospectively analyze the relationship between catheter retention time and bladder spasm. Previous research has shown that catheter is a foreign body in the bladder that may trigger bladder contraction [ 13 ] , but our findings showed that there was no significant relationship between catheter retention time and bladder spasm. The reason may be related to the body's gradual adaptation to foreign objects. This analysis demonstrated no statistically significant association between postoperative pain and bladder spasm incidence, contrasting with that children undergoing open intravesical reimplantation had a high incidence of bladder spasms [ 14 ] . We speculate that the reason was that only a very small number of patients (9 cases with vesicoureteral reflux) have undergone bladder surgery in our study, and the surgical method has chosen the less traumatic Lich-Gregoir surgery, most of other children were operated on non-bladder sites and had no bladder-originated pain. Another possible explanation for this difference is that we applied painkillers to children with postoperative pain. Catheter materials predominantly comprise silicone and latex variants, with latex demonstrating higher propensity to induce urethral inflammation, yet remaining prevalent due to cost-effectiveness [ 15 ] . Despite differential material formation of catheter, multivariate analysis revealed no significant association between material composition and spasmogenesis. A possible explanation for this result is that the material of the catheter is not significantly correlated with the occurrence of CAUTI [ 16 ] , which is considered as a risk factor for bladder spasms. While balloon inflation near the bladder neck may theoretically trigger detrusor hyperreflexia, however, in this study, all patients were placed with balloon catheters, thus eliminating this difference. Gross hematuria signifies active urinary tract hemorrhage, though blood components lack direct detrusor activation capacity. In patients exhibiting concurrent hematuria and bladder spasms, detrusor hypercontractility may be mediated through prostaglandin-driven inflammatory pathways [ 17 ] . The results of this study also suggest that gross hematuria is not a risk factor for bladder spasm. Pyuria serves as a diagnostic marker for urinary tract infections, with lower urinary tract involvement characteristically manifesting detrusor overactivity. Bladder inflammation induces detrusor muscle hyperreactivity through neurogenic pathway activation [ 9 ] , which synergistically with urinary catheter-induced mechanical irritation of the mucosa potentiates involuntary detrusor activity, clinically manifesting as bladder spasms [ 18 ] . In pediatric populations requiring indwelling catheters, clinicians should implement enhanced urinalysis surveillance coupled with prophylactic antimicrobial therapy to mitigate infection-associated bladder spasm risk. Catheter obstruction triggers passive detrusor distension through bladder overfilling, inducing hypercontractility via ischemic mechanotransduction pathways, clinically manifesting as bladder spasms [ 19 ] . While urinary catheter obstruction remains relatively uncommon in adults, our findings demonstrate a clinically significant incidence in pediatric populations, likely attributable to the narrower lumen of pediatric urinary drainage devices. To mitigate spasm risk secondary to obstruction, clinicians should implement continuous catheter patency monitoring protocols and ensure adequate hydration to optimize urine dilution, thereby reducing crystalline sediment accumulation. Pediatric constipation, characterized by increased fecal consistency and prolonged defecation intervals, may provoke detrusor overactivity through elevated intra-abdominal pressure during straining. This viscero-visceral reflex mechanism can clinically manifest as bladder spasms secondary to bowel dysfunction. Previous studies also support our findings [ 20 ] . For children with constipation or reduced frequency of defecation, we suggest that medical staff provide necessary auxiliary defecation to reduce the occurrence of bladder spasms. Limitation There are also limitations in this study. For example, ①the sample size of this study was still not large enough, a larger sample size can lead to more reliable conclusions, such as whether gender is a risk factor for bladder spasms; ②In retrospective studies, the clinical characteristics of patients that can be collected are limited. We look forward to conducting a prospective study in the future to gather more clinical information; ③There are few types of diseases, and the number of cases for each disease is uneven, which may lead to biased results. Declarations Clinical trial number: Not applicable(This is a retrospective case analysis study, with all patients who have already been discharged. The study did not take any intervention measures in the patient's diagnosis and treatment process). Data availability statement The original data presented in the study are included in the article and supplementary material, further inquiries can be directed to the corresponding author. This study was registered already in Medical Research Registration and Filing System (https://www.medicalresearch.org.cn). (No. MR-44-24-032896). Ethics statement The studies involving humans were approved by the Foshan Maternal and Child Health Hospital ethics committee (ID: FSFY-MEC-2022-116). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article. Author contributions CL: Writing–Original Draft, SZ: Review and Editing, FL and HW: Sample Collecting, JW: Formal Analysis. Funding The study was fund by Guangdong Medical Science and Technology Research Fund Project (No.B2022012). Acknowledgments We sincerely extend our appreciation to the children and their families who participated in this study. Conflict of interest The authors declare that there are no conflict of interest in the study. Approval of the research protocol by an Institutional Reviewer Board The protocal was approved by Foshan Maternal and Child Health Hospital(No. 2024026) Informed Consent All patients' family members have signed informed consent forms which could obtain from the fist authors. References Yates V, Tanner J, Crossley A. Bladder spasm following transurethral surgery. Br J Perioper Nurs. 2004 Jun;14(6):259-60, 262-4 Brading AF, Turner WH. The unstable bladder: towards a common mechanism. Br J Urol. 1994 Jan;73(1):3-8 Gillies D, Lane L, Murrell D, Cohen R. Bladder spasm in children after surgery for ureteric reimplantation. Pediatr Surg Int. 2003 Dec;19(11):733-6 Peng XF, Lv XG, Xie H, Sa YL, Xu YM, Feng C, Zhang XR. Effectiveness of Solifenacin for Managing of Bladder Spasms in Patients With Urethroplasty. Am J Mens Health. 2017 Sep;11(5):1580-1587 Merkel SI, Danaher JA, Williams J. Pain Management in the Post-Operative Pediatric Urologic Patient. Urol Nurs. 2015 Mar-Apr;35(2):75-81. Shepherd AJ, Mackay WG, Hagen S. Washout policies in long-term indwelling urinary catheterisation in adults. Cochrane Database Syst Rev. 2017 Mar 6;3(3):CD004012 Ma ZZ, Yang DD, Niu ME, Lu XM, Du YT, Chin P, Ding YH, Qian CY. Construction of early warning classification of risk in bladder spasm and its intervention plans guided by the rate adjustment card of continuous bladder irrigation after transurethral resection of the prostate (TURP): development and usability study. Transl Androl Urol. 2024 May 31;13(5):802-811.. Al-Shammari A, Bhatti A, Kupchak J, Mix LW, Decter A, Leonard MP. Ureteroneocystostomy with and without the use of an intravesical catheter. Can J Urol. 1999 Aug;6(4):844-849. Park JM, Houck CS, Sethna NF, Sullivan LJ, Atala A, Borer JG, Cilento BG, Diamond DA, Peters CA, Retik AB, Bauer SB. Ketorolac suppresses postoperative bladder spasms after pediatric ureteral reimplantation. Anesth Analg. 2000 Jul;91(1):11-5. Sirls E, Peters KM, Sirls LT. Intradetrusor OnabotuliniumtoxinA injection for refractory bladder spasms before vesicovaginal fistula repair. Urol Case Rep. 2022 Dec 25;46:102307. Ruan C, Shi S, Shen Z, Guo L, Gong L. Effect of precision management scheme based on the best evidence summary on reducing catheter-associated urinary tract infection. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2023 Sept 28;48(9):1333-1342. Shuman EK, Chenoweth CE. Urinary Catheter-Associated Infections. Infect Dis Clin North Am. 2018 Dec;32(4):885-897. Nazarko L. Bladder pain from indwelling urinary catheterization: case study. Br J Nurs. 2007 May 10-23;16(9):511-2, 514. Bayne AP, Herbst KW, Corbett ST, Nelson ED. Parental perception of bladder spasms and hematuria after surgery for vesicoureteral reflux: A prospective multicenter study. J Pediatr Urol. 2020 Aug;16(4):449-455 Woodward S. Complications of allergies to latex urinary catheters. Br J Nurs. 1997 Jul 24-Aug 13;6(14):786-8, 790, 792-3 Gambrill B, Pertusati F, Hughes SF, Shergill I, Prokopovich P. Materials-based incidence of urinary catheter associated urinary tract infections and the causative micro-organisms: systematic review and meta-analysis. BMC Urol. 2024 Aug 30;24(1):186. Bai X, Cheng J, Zhao L, Cheng M. Gefitinib-induced hemorrhagic cystitis and inflammatory contracted bladder in a patient with advanced lung adenocarcinoma harboring compound epidermal growth factor receptor G719S and S768I missense mutations: a case report. Ann Transl Med. 2022 Jul;10(14):809. Griffiths D. Neural control of micturition in humans: a working model. Nat Rev Urol. 2015 Dec;12(12):695-705. Vereecken RL, Proesmans W. Urethral instability as an important element of dysfunctional voiding. J Urol. 2000 Feb;163(2):585-8.. Iguchi N, Carrasco A Jr, Xie AX, Pineda RH, Malykhina AP, Wilcox DT. Functional constipation induces bladder overactivity associated with upregulations of Htr2 and Trpv2 pathways. Sci Rep. 2021 Jan 13;11(1):1149. Tables Table 1 Clinical characteristics of patients in two groups Group Gender(case) Age (year) Weight (Kg) Hospital stay (day) Diagnosis(case) M F HP UM UPJO CP DKU VUR A (n=49) 43 6 6.55±3.14 ▼ 22.87±11.11 █ 9.16±2.63 ▲ 27 5 5 10 2 0 B (n=154) 141 13 5.99±2.63 ▼ ▼ 22.23±9.45 █ 8.64±3.04 ▲ 103 0 10 25 7 9 ▼, █, ▲, P＞ 0.05. M:male. F:female. HP:hypospadias. UM:urethral mass. UPJO:ureteropelvic junction obstruction. CP:concealed penis. DKU:duplex kidney and ureter. VUR:vesicoureteral reflux. Table 2 Clinical characteristics for logistics analysis Clinical characteristics Group A (case) Group B (case) Pain after surgery Yes 15 34 No 34 120 Catheter indwelling ≤ 3 days 3 24 ＜ 3 ≤ 7 days 27 54 ＞ 7 days 19 76 WBC in urine Positive 19 31 Negative 30 123 Catheter obstruction Yes 22 30 No 27 124 Hematuria Yes 10 35 No 39 119 Reduced frequency of defecation Yes 17 27 No 32 127 Material of catheter Silica gel 28 93 Latex 21 61 Table 3. Risk factors for Bladder spasms in children with Catheter indwelling Risk fators OR 95%CI P WBC in urine Positive versus Negative 3.115 1.357～7.152 0.007 Catheter obstruction Yes versus No 3.950 1.856～8.407 0.000 D efecation frequency Reduced versus Normal 2.601 1.177～5.747 0.018 gross hematuria Yes versus No 0.428 0.152～1.202 0.107 Pain after surgery Yes versus No 1.239 0.560～2.743 0.597 Catheter indwelling ≤3d versus 3～7d versus ＞ 7 d 1.071 0.865～1.327 0.527 Material of catheter Silica gel versus Latex 0.468 0.169～1.297 0.144 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5997884","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":448859145,"identity":"cf4d8145-f1b2-45c9-88e0-422f4b8c378c","order_by":0,"name":"Chunjing Li","email":"","orcid":"","institution":"Foshan Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chunjing","middleName":"","lastName":"Li","suffix":""},{"id":448859146,"identity":"578f9606-b665-4950-8682-b65d6ad36fe2","order_by":1,"name":"Shilin Zhang","email":"","orcid":"","institution":"Foshan Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shilin","middleName":"","lastName":"Zhang","suffix":""},{"id":448859147,"identity":"299d5749-6337-466b-a30b-2876cb9d98d9","order_by":2,"name":"Fengshen Ling","email":"","orcid":"","institution":"Foshan Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Fengshen","middleName":"","lastName":"Ling","suffix":""},{"id":448859148,"identity":"d2c52820-760b-4299-91b8-f2065d538204","order_by":3,"name":"Huiling Wei","email":"","orcid":"","institution":"Foshan Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Huiling","middleName":"","lastName":"Wei","suffix":""},{"id":448859149,"identity":"01dc17a6-50fe-4015-938d-0ebc22e6c90e","order_by":4,"name":"Jianfeng Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIie3RsQqCUBTG8SOBNtxqPRHoEwQ3hMilXuVI0NjS4lRKoUuP4FsE0nhDsOW6u7o0uTTX0FqTty3o/vcfnI8DoNP9YKaVXB/PAHcDyIUa6TNJyOSMhlFBasRG4tg7BMRzyRUPQyI+DHENhbxXDcztcdhGWC1ocsaNcSxPXgpLdyraiEUkfInGHstsxED4WSsBmoSXGI3YaW6KpEuuEcXoH0GaioTJVQckugiF66VcYYuTJEUHgq29EHldNcHcbiUfIVN8zTv5Vuh0Ot1f9AI/R0N2fwwVBQAAAABJRU5ErkJggg==","orcid":"","institution":"Foshan Maternal and Child Health Hospital","correspondingAuthor":true,"prefix":"","firstName":"Jianfeng","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-02-10 09:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5997884/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5997884/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81843073,"identity":"b96bded2-ef36-4b97-8b4b-912bcf531e34","added_by":"auto","created_at":"2025-05-02 16:46:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":577773,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5997884/v1/46479051-fdae-46ad-8e7a-c3df371d6aeb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Risk factors for bladder spasm in children with indwelling catheters","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBladder spasm is an external manifestation of detrusor muscle instability, and its clinical symptoms include spasmodic pain of bladder or urethra, strong urination, urgent urinary incontinence of urethra, etc, which may be accompanied by urine overflowing from the urethral opening along the pericatheteral space\u003csup\u003e\u0026nbsp;[1]\u003c/sup\u003e. There are many speculations about the causes of bladder spasms, but the denervation hypersensitivity theory is currently accepted by many people\u003csup\u003e[2]\u003c/sup\u003e. Various physical and chemical stimuli in the bladder, such as infection, may eventually stimulate the M-cholinocepter in the bladder, resulting in paroxysmal spasm of the detrusor muscle\u003csup\u003e[3]\u003c/sup\u003e. Bladder spasm is usually seen in elderly patients after electroprostatectomy due to lower urinary tract obstruction caused by long-term prostatic hyperplasia leading to detrusor instability\u003csup\u003e[4]\u003c/sup\u003e. Bladder spasms also frequently occur in pediatric populations, particularly in catheterized cohorts. These episodes manifest as acute suprapubic discomfort that significantly impairs quality of life. Common complications include periurethral leakage, hemorrhagic cystitis, and inadvertent catheter dislodgement, all the above complications could cause serious clinical consequences and poor prognosis\u003csup\u003e[5]\u003c/sup\u003e. Bladder spasms secondary to prolonged catheterization constitute a subtype of catheter-associated bladder dysfunction (CRBD), demonstrating significant clinical overlap with overactive bladder (OAB) symptomatology including urinary urgency and detrusor hyperreflexia. The duration of the spasm varies from a few minutes to a few hours\u003csup\u003e[6]\u003c/sup\u003e . At present, the incidence study and treatment of bladder spasm are mostly focused on adult patients\u003csup\u003e[7]\u003c/sup\u003e, However, within pediatric urology, catheter-associated detrusor hyperactivity represents a prevalent clinical challenge. However, pediatric catheterization does not universally induce bladder spasm, as current evidence cannot fully elucidate its multifactorial etiopathogenesis\u003csup\u003e[8]\u003c/sup\u003e. The few studies on bladder spasm in children mainly focus on treatment, there are currently no reports on the epidemiology or large-scale clinical studies of bladder spasms in children, and there are few studies on the risk factors that cause bladder spasm\u003csup\u003e[9]\u003c/sup\u003e. In view of the fact that children indwelling catheters are a large special group, it is of positive significance to explore the risk factors of bladder spasm in this group. Due to the fact that bladder spasms may be influenced by multiple factors, this study will collect clinical data from patients and establish a logistics regression model to explore the risk factors for bladder spasms. The conclusion of this study may be beneficial for healthcare professionals to increase their understanding of bladder spasms and minimize the occurrence of this complication.\u003c/p\u003e"},{"header":"Patients and methods ","content":"\u003cp\u003eParticipants and clinical features\u003c/p\u003e\n\u003cp\u003eWe retrospectively analyzed the clinical data of 203 children hospitalized in Foshan Maternal and Child Health Hospital from January 2014 to December 2023. The patients included 184 males and 19 females. The mean age of all patients was 6.12 \u0026plusmn;2.76 y (range from 3 to 13y) and the mean weight was 22.38 \u0026plusmn; 9.35Kg (range from 11 to 60Kg). The study protocol was approved by the hospital\u0026apos;s Ethics Committee (No. FFY-MEC-2022-116). The parents or guardians of all the children in this study were informed of the diagnosis and treatment process at admission, and the parents or guardians all signed informed consent forms which were recorded and kept in our hospital. The diseases types of 203 children included hypospadias, urethral masses, pyeloureteral junction obstruction, concealed penis, repeated renal and ureters, and vesicoureteral reflux. All the children received surgical treatment during hospitalization, and urine analysis were conducted before surgery. If the WBC of urine analysis was positive ([WBC] \u0026gt;10/\u0026mu;L), antibiotics were given to patients first, and the operation could not be performed until the WBC of urine analysis turned negative([WBC] \u0026lt;10/\u0026mu;L). None of the patients had indwelled catheters within 1 month before this admission, and all Foley catheters were indwelled during the surgery. A sterile operating environment avoids potential infections. The materials of the catheter included silicone and latex. Urine analysis was performed at least once every two days after surgery. Important clinical data were recorded and traceable, such as postoperative pain (whether pain medication was still needed 24 hours after surgery); whether the catheter was blocked; whether there was appearance of gross hematuria (red urine with red blood cells are positive), and whether patients have daily defecation. Symptoms of bladder spasm for all children were also well documented. The diagnosis of bladder spasm is that the child has paroxysmal pain in the pubic area and urine spills around the catheter simultaneously. Children were divided into positive group (group A) and negative group (group B) according to whether they were diagnosed bladder spasm. After data analysis, there were no statistically significant differences in age, weight and hospital stay between the two groups (Table 1). We also collected clinical characteristics that may be associated with bladder spasm, including postoperative pain (pain medication is still required 24 hours after surgery), catheter retention time, positive WBC in urine, catheter obstruction (urine in the bladder cannot be effectively drained), gross hematuria, frequency of defecation, catheter material (silicone or latex). The clinical features of the two groups of children are recorded as follows (Table 2). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStatistical analysis\u003c/p\u003e\n\u003cp\u003eStatistical analysis of such data were analyzed by IBM SPSSS Statistics, version23.0 (IBMCorp. Armonk, NY, USA) software. The measurement data were expressed as mean\u0026plusmn;standard deviation, and the difference in ratio or percentage was compared by Chi-square test. A binary logistic regression model was established between positive bladder spasm and specific clinical features to explore the risk factors for its occurrence. Risk factors were represented by odds ratio (OR) and 95% confidence interval (CI), and P \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAll 203 children (184 males and 19 females) had the catheter removed on schedule, and no accidental catheter shedding occurred. 49 children experienced unbearable postoperative pain, which was relieved by ibuprofen for pain relief. 50 patients were found WBC in their postoperative urine test and were treated with antibiotics. When 52 patients had urinary catheter obstruction, the catheter was squeezed or rinsed with physiological saline to ensure smooth drainage, and no patients had to replace the catheter. 44 patients defecate less than or equal to once every two days, among which 4 patients were used laxatives for defecation. 121 patients were placed with silicone catheters, while 82 children were placed with latex catheters. Indwelling durations stratified as short-term (\u0026le;3 days, n=27, 13.3%), intermediate (4~7 days, n=81, 39.9%), and prolonged (\u0026ge;7 days, n=95, 46.8%). A total of 45 children experienced gross hematuria, but no special treatment was given but increasing the fluid intake, and the gross hematuria disappeared on its own. The symptoms of 49 patients (43 boys and 6 girls) with bladder spasm were relieved by tolterodine, an M receptor antagonist (medication based on body surface area). Binary logistics regression analysis showed that positive WBC in urine, catheter obstruction and decreased frequency of defecation were closely related to the occurrence of bladder spasm (P\u0026lt;0.05); while postoperative pain, catheter indwelling time, hematuria and catheter material were not significantly related to the occurrence of bladder spasm (P \u0026gt; 0.05). According to the statistical results, positive urine WBC (OR: 3.115, 95%CI: 1.357~7.152, P=0.007), urinary catheter obstruction (OR: 3.950, 95%CI: 1.856~8.407, P=0.000) and decreased frequency of defecation (OR: 2.601, 95%CI: 1.177~5.747, P=0.018) were risk factors for bladder spasm(Table 3).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eStandardized diagnostic criteria for catheter-associated bladder spasms remain undefined. Prior studies have defined this condition variably, with some protocols requiring suprapubic pain alone\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, while others mandate concomitant urinary leakage\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Our investigation employed both the two criterion. To ensure reliable symptom reporting, we implemented a strict eligibility criterion restricting enrollment to children\u0026thinsp;\u0026ge;\u0026thinsp;3 years old capable of verbalizing suprapubic discomfort through validated pain assessment. This study observed prolonged hospitalization durations in some special cases, potentially reflecting China's flexible postoperative admission protocols and subsidized healthcare expenditures\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. While all participants required transurethral catheterization, extended dwell times were documented in a small portion of cases, particularly among concealed penis patients. These extensions primarily stemmed from parental requests motivated by concerns over voiding-induced wound contamination, as parents frequently perceived spontaneous micturition as risking surgical site infection. Extended indwelling urinary catheterization is a recognized risk factor for catheter-associated urinary tract infections(CAUTI)\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. In this study of 203 pediatric patients, pyuria ([WBC]\u0026thinsp;\u0026gt;\u0026thinsp;10/\u0026micro;L))was detected in 50 cases (24.6%). Paradoxically, among the 35 concealed penis cases demonstrating the biggest proportion of extended catheterization, only 4 patients (11.4%) exhibited urinary leukocytosis. This paradoxical finding indicates a lower CAUTI incidence rate in concealed penis patients compared to the overall cases. A possible explanation is that: ①No concealed penis patients were detected with pyuria before surgery; ②Considering such patients require a longer indwelling catheter after surgery, antibiotics are used preventively in these patients after surgery. Admittedly we should clearly recognize that extended catheter indwelling is not recommended.\u003c/p\u003e \u003cp\u003eThe relationship between clinical features and bladder spasms deserves further exploration. Due to the patients who had catheterization for a long time in the study so that we were able to retrospectively analyze the relationship between catheter retention time and bladder spasm. Previous research has shown that catheter is a foreign body in the bladder that may trigger bladder contraction\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, but our findings showed that there was no significant relationship between catheter retention time and bladder spasm. The reason may be related to the body's gradual adaptation to foreign objects. This analysis demonstrated no statistically significant association between postoperative pain and bladder spasm incidence, contrasting with that children undergoing open intravesical reimplantation had a high incidence of bladder spasms\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. We speculate that the reason was that only a very small number of patients (9 cases with vesicoureteral reflux) have undergone bladder surgery in our study, and the surgical method has chosen the less traumatic Lich-Gregoir surgery, most of other children were operated on non-bladder sites and had no bladder-originated pain. Another possible explanation for this difference is that we applied painkillers to children with postoperative pain. Catheter materials predominantly comprise silicone and latex variants, with latex demonstrating higher propensity to induce urethral inflammation, yet remaining prevalent due to cost-effectiveness\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Despite differential material formation of catheter, multivariate analysis revealed no significant association between material composition and spasmogenesis. A possible explanation for this result is that the material of the catheter is not significantly correlated with the occurrence of CAUTI\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e, which is considered as a risk factor for bladder spasms. While balloon inflation near the bladder neck may theoretically trigger detrusor hyperreflexia, however, in this study, all patients were placed with balloon catheters, thus eliminating this difference. Gross hematuria signifies active urinary tract hemorrhage, though blood components lack direct detrusor activation capacity. In patients exhibiting concurrent hematuria and bladder spasms, detrusor hypercontractility may be mediated through prostaglandin-driven inflammatory pathways\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. The results of this study also suggest that gross hematuria is not a risk factor for bladder spasm. Pyuria serves as a diagnostic marker for urinary tract infections, with lower urinary tract involvement characteristically manifesting detrusor overactivity. Bladder inflammation induces detrusor muscle hyperreactivity through neurogenic pathway activation\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e, which synergistically with urinary catheter-induced mechanical irritation of the mucosa potentiates involuntary detrusor activity, clinically manifesting as bladder spasms\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. In pediatric populations requiring indwelling catheters, clinicians should implement enhanced urinalysis surveillance coupled with prophylactic antimicrobial therapy to mitigate infection-associated bladder spasm risk. Catheter obstruction triggers passive detrusor distension through bladder overfilling, inducing hypercontractility via ischemic mechanotransduction pathways, clinically manifesting as bladder spasms\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. While urinary catheter obstruction remains relatively uncommon in adults, our findings demonstrate a clinically significant incidence in pediatric populations, likely attributable to the narrower lumen of pediatric urinary drainage devices. To mitigate spasm risk secondary to obstruction, clinicians should implement continuous catheter patency monitoring protocols and ensure adequate hydration to optimize urine dilution, thereby reducing crystalline sediment accumulation. Pediatric constipation, characterized by increased fecal consistency and prolonged defecation intervals, may provoke detrusor overactivity through elevated intra-abdominal pressure during straining. This viscero-visceral reflex mechanism can clinically manifest as bladder spasms secondary to bowel dysfunction. Previous studies also support our findings\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. For children with constipation or reduced frequency of defecation, we suggest that medical staff provide necessary auxiliary defecation to reduce the occurrence of bladder spasms.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLimitation\u003c/strong\u003e \u003cp\u003eThere are also limitations in this study. For example, ①the sample size of this study was still not large enough, a larger sample size can lead to more reliable conclusions, such as whether gender is a risk factor for bladder spasms; ②In retrospective studies, the clinical characteristics of patients that can be collected are limited. We look forward to conducting a prospective study in the future to gather more clinical information; ③There are few types of diseases, and the number of cases for each disease is uneven, which may lead to biased results.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003eNot applicable(This is a retrospective case analysis study, with all patients who have already been discharged. The study did not take any intervention measures in the patient's diagnosis and treatment process).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original data presented in the study are included in the article and supplementary material, further inquiries can be directed to the corresponding author. This study was registered already in Medical Research Registration and Filing System (https://www.medicalresearch.org.cn). (No. MR-44-24-032896).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe studies involving humans were approved by the Foshan Maternal and Child Health Hospital ethics committee (ID: FSFY-MEC-2022-116). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCL: Writing–Original Draft, SZ: Review and Editing, FL and HW: Sample Collecting, JW: Formal Analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was fund by Guangdong Medical Science and Technology Research Fund Project (No.B2022012).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely extend our appreciation to the children and their families who participated in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflict of interest in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eApproval of the research protocol by an Institutional Reviewer Board\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe protocal was approved by Foshan Maternal and Child Health Hospital(No. 2024026)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients' family members have signed informed consent forms which could obtain from the fist authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eYates V, Tanner J, Crossley A. 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Complications of allergies to latex urinary catheters. Br J Nurs. 1997 Jul 24-Aug 13;6(14):786-8, 790, 792-3\u003c/li\u003e\n\u003cli\u003eGambrill B, Pertusati F, Hughes SF, Shergill I, Prokopovich P. Materials-based incidence of urinary catheter associated urinary tract infections and the causative micro-organisms: systematic review and meta-analysis. BMC Urol. 2024 Aug 30;24(1):186.\u003c/li\u003e\n\u003cli\u003eBai X, Cheng J, Zhao L, Cheng M. Gefitinib-induced hemorrhagic cystitis and inflammatory contracted bladder in a patient with advanced lung adenocarcinoma harboring compound epidermal growth factor receptor G719S and S768I missense mutations: a case report. Ann Transl Med. 2022 Jul;10(14):809.\u003c/li\u003e\n\u003cli\u003eGriffiths D. Neural control of micturition in humans: a working model. Nat Rev Urol. 2015 Dec;12(12):695-705.\u003c/li\u003e\n\u003cli\u003eVereecken RL, Proesmans W. Urethral instability as an important element of dysfunctional voiding. J Urol. 2000 Feb;163(2):585-8..\u003c/li\u003e\n\u003cli\u003eIguchi N, Carrasco A Jr, Xie AX, Pineda RH, Malykhina AP, Wilcox DT. Functional constipation induces bladder overactivity associated with upregulations of Htr2 and Trpv2 pathways. Sci Rep. 2021 Jan 13;11(1):1149. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 Clinical characteristics of patients in two groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 52px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 68px;\"\u003e\n \u003cp\u003eGender(case)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 57px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003cp\u003e(year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003eWeight\u003c/p\u003e\n \u003cp\u003e(Kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital stay\u003c/p\u003e\n \u003cp\u003e(day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" style=\"width: 260px;\"\u003e\n \u003cp\u003eDiagnosis(case)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eHP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003eUM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eUPJO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003eCP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003eDKU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eVUR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003eA (n=49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e6.55\u0026plusmn;3.14\u003csup\u003e▼\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e22.87\u0026plusmn;11.11\u003csup\u003e█\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e9.16\u0026plusmn;2.63\u003csup\u003e▲\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003eB (n=154)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e5.99\u0026plusmn;2.63\u003csup\u003e▼\u003c/sup\u003e▼\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e22.23\u0026plusmn;9.45\u003csup\u003e█\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e8.64\u0026plusmn;3.04\u003csup\u003e▲\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e▼, █, ▲, P＞ 0.05. M:male. F:female. HP:hypospadias. UM:urethral mass. UPJO:ureteropelvic junction obstruction. CP:concealed penis. DKU:duplex kidney and ureter. VUR:vesicoureteral reflux.\u003c/p\u003e\n\u003cp\u003eTable 2 Clinical characteristics for logistics analysis\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003eClinical characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eGroup A (case)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eGroup B (case)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain after surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCatheter indwelling\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026le; 3 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp; ＜ 3 \u0026le; 7 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp; ＞ 7 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWBC in urine\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp; Positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp; Negative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e123\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCatheter obstruction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHematuria\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReduced frequency of defecation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaterial of catheter\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp; Silica gel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp; Latex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3. Risk factors for Bladder spasms in children with Catheter indwelling\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk fators\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWBC in urine\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u0026nbsp; Positive versus Negative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e3.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1.357～7.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCatheter obstruction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u0026nbsp; Yes versus No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e3.950\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1.856～8.407\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD\u003c/strong\u003e\u003cstrong\u003eefecation frequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u0026nbsp; Reduced versus Normal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e2.601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1.177～5.747\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003egross hematuria\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u0026nbsp; Yes versus No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e0.428\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.152～1.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain after surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eYes versus No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e1.239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.560～2.743\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.597\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCatheter indwelling\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026le;3d versus 3～7d versus ＞ 7 d\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e1.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.865～1.327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.527\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaterial of catheter\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u0026nbsp;Silica gel versus Latex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e0.468\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.169～1.297\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Risk factors, bladder spasm, children with indwelling catheters","lastPublishedDoi":"10.21203/rs.3.rs-5997884/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5997884/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Bladder spasms represent a prevalent complication in pediatric populations with \u0026nbsp;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.\u003c/p\u003e\n\u003cp\u003eMethods: 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAmong 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\u0026lt;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) .\u003c/p\u003e\n\u003cp\u003eConclusion: 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.\u003c/p\u003e","manuscriptTitle":"Risk factors for bladder spasm in children with indwelling catheters","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-30 07:36:03","doi":"10.21203/rs.3.rs-5997884/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5e5355d0-c132-42d3-a8b0-74c2bf8fe436","owner":[],"postedDate":"April 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-12T06:53:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-30 07:36:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5997884","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5997884","identity":"rs-5997884","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}