{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:56:52Z","timestamp":1786121812962,"version":"build-2736575974"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurourology and Urodynamics"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Timing of clean intermittent catheterization (CIC) in infants with neurogenic lower urinary tract dysfunction (NLUTD) remains uncertain. We compared 12\u2010month infectious and renal\u2013bladder ultrasound (RBUS) outcomes in infants started on CIC within 30\u2009days of life versus those managed without neonatal CIC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Single\u2010center ambispective cohort of 221 infants with NLUTD (June 2017 to January 2025). Primary analysis compared immediate CIC (\u2264\u200930\u2009days;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200953) versus non\u2010immediate management (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009168). Secondary descriptive analyses stratified non\u2010immediate management into never CIC (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009116) and delayed CIC initiation (&gt;\u200930\u2009days;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200952). Outcomes through 12\u2009months included bacteriuria, symptomatic UTI, febrile UTI counts, baseline and follow\u2010up RBUS findings, Kaplan\u2013Meier time to first symptomatic UTI, and an exploratory multivariable Cox model (interpreted as associative given confounding by indication and time\u2010varying escalation).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Immediate CIC infants had higher neurologic risk (upper motor neuron phenotype 79% vs 33%) and more antibiotic prophylaxis exposure (57% vs 32%). Bacteriuria was higher with immediate CIC (43% vs 24%; RR 1.78, 95% CI 1.18\u20132.67), consistent with catheter\u2010associated colonization and increased detection. Symptomatic UTI incidence was similar in the primary comparison (47% vs 38%; RR 1.24, 95% CI 0.88\u20131.75). In secondary three\u2010group analyses, delayed CIC had the highest symptomatic UTI rate (73% delayed vs 47% immediate vs 22% never) and higher febrile UTI counts, with shorter time to first symptomatic UTI on Kaplan\u2013Meier analysis. Follow\u2010up RBUS abnormalities (bladder wall thickening\/irregularity, ureteral dilatation, and reported renal scarring) were most frequent in delayed CIC infants; however, these findings are limited by longer imaging follow\u2010up and likely confounded by indication. Circumcision status among males did not differ by CIC timing in either the primary or three\u2010group comparisons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this institutional cohort, immediate CIC was associated with increased bacteriuria consistent with colonization without higher symptomatic UTI rates in the primary comparison. Associations between delayed CIC initiation and worse infectious and imaging outcomes likely reflect reactive escalation (time\u2010varying exposure) and baseline non\u2010exchangeability rather than a causal effect of \u201cdelay.\u201d Findings support risk\u2010adapted CIC initiation and symptom\u2010based UTI diagnosis to promote antimicrobial stewardship.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/nau.70375","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T07:34:30Z","timestamp":1786088070000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Institutional Outcomes of Immediate vs Delayed or No Clean Intermittent Catheterization in Infant Neurogenic Bladder"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4388-4067","authenticated-orcid":false,"given":"Michael E.","family":"Chua","sequence":"first","affiliation":[{"name":"Division of Urology The Hospital for Sick Children Toronto Ontario Canada"},{"name":"Institute of Urology St. Luke's Medical Center Quezon NCR Philippines"},{"name":"Section of Global Surgery, Depart ment of Surgery University of Toronto Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Iwano","sequence":"additional","affiliation":[{"name":"Division of Urology The Hospital for Sick Children Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4359-0444","authenticated-orcid":false,"given":"Joana","family":"Dos Santos","sequence":"additional","affiliation":[{"name":"Division of Urology The Hospital for Sick Children Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0598-1824","authenticated-orcid":false,"given":"Mandy","family":"Rickard","sequence":"additional","affiliation":[{"name":"Division of Urology The Hospital for Sick Children Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5786-1002","authenticated-orcid":false,"given":"Rodrigo L. P.","family":"Romao","sequence":"additional","affiliation":[{"name":"Division of Urology The Hospital for Sick Children Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7735-0994","authenticated-orcid":false,"given":"Usman","family":"Kahloon","sequence":"additional","affiliation":[{"name":"Division of Urology The Hospital for Sick Children Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6735-9462","authenticated-orcid":false,"given":"Armando J.","family":"Lorenzo","sequence":"additional","affiliation":[{"name":"Division of Urology The Hospital for Sick Children Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9232-5581","authenticated-orcid":false,"given":"Abby","family":"Varghese","sequence":"additional","affiliation":[{"name":"Division of Urology The Hospital for Sick Children Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.5489\/cuaj.8390"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpurol.2021.12.002"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpurol.2021.04.019"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpurol.2021.01.037"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.3233\/PRM-200712"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpurol.2021.07.007"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12519-025-01007-0"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2018.10.096"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpurol.2022.10.016"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpurol.2023.08.033"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpurol.2016.02.010"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.25245"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2021-005934"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000001818"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000001690"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy1121"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-1330"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2024.114092"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpurol.2018.03.017"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41393-021-00679-5"}],"container-title":["Neurourology and Urodynamics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/nau.70375","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/nau.70375","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/nau.70375","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T07:34:31Z","timestamp":1786088071000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/nau.70375"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,7]]},"references-count":21,"alternative-id":["10.1002\/nau.70375"],"URL":"https:\/\/doi.org\/10.1002\/nau.70375","archive":["Portico"],"relation":{},"ISSN":["0733-2467","1520-6777"],"issn-type":[{"value":"0733-2467","type":"print"},{"value":"1520-6777","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,7]]},"assertion":[{"value":"2026-04-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"nau.70375"}}