Barriers to successful CIC implementation in pediatric spina bifida: A retrospective observational study of gender and family dynamics

Purpose: This study aimed to identify clinical and psychosocial factors associated with caregiver and patient acceptance of clean intermittent catheterization (CIC) in pediatric patients with spina bifida, with a specific focus on gender-related disparities in an Asian population. Materials and methods: We conducted a retrospective review of 72 pediatric patients (35 boys and 37 girls) with spina bifida evaluated for CIC initiation at a single Japanese center between 2011 and 2024. Data on caregiver consent and transition to self-catheterization were collected. Multivariate logistic regression was used to assess the impact of demographic and clinical variables on CIC acceptance. Results: Caregiver consent for CIC was obtained in 73.6% of cases. Girls were significantly more likely to receive caregiver consent (89.1%) than boys (57.1%, P = 0.0038), and more likely to achieve self-catheterization (83.8% vs. 42.8%, P < 0.001). Female sex independently predicted lower odds of both caregiver consent (odds ratio = 5.14, P = 0.0205) and patient self-consent (odds ratio = 5.58, P = 0.0101). A history of follow-up interruption was also a strong negative predictor. Other factors, such as wheelchair use, cognitive disability, and residential location, were not significantly associated. Conclusion: This study is the first to quantitatively demonstrate gender-based disparities in CIC acceptance among Asian pediatric patients with spina bifida. Our findings suggest that boys encounter greater psychosocial barriers to CIC, likely influenced by family dynamics and cultural norms. Targeted, gender-sensitive education and continuous caregiver support are essential for improving CIC uptake and adherence in this population.