Introduction: While children with spina bifida (SB) start self-catheterizing at around 9 years old (yo), little is known about why some do not perform it. We sought to describe how self-catheterization changes with age and reasons why patients do not self-catheterize. Methods: Patients (3-20yo) and their parents who catheterize their bladders were surveyed in the SB clinic at our institution (2017-2022). We asked if the patient self-catheterized (yes/no) and if they did not: “Why don’t you do the catheterizations by yourself?” Analysis was performed across patient encounters, to retain data points across patients’ lives. Non-parametric statistics were used. Results: Median age of 240 participants attending 483 visits was 11.5 years (52% male, 36% wheelchair users, 73% shunted). Self-catheterization increased with age: 63% at 9-11yo, increasing to 80-93% by age 12-20yo (p < 0.001) (Figure 1). After 9yo, 36% of self-catheterizations were performed per urethra and 64% per channel. Among those self-catheterizing, females and males had similar probabilities of using a channel (67% vs. 56%, p=0.08). Self-reported reasons for not self-catheterizing differed with age. Being “too young” was the predominant reason in younger patients (91% in 3-5yo, 59% in the 6-8yo). Older patients cited physical limitations, including “difficulty moving hands” and “core stability,” as predominant reasons for not self-catheterizing (21-33% after age 9). Lack of interest was rarely reported (4%). After excluding being “too young” as a reason, other reasons for not self-catheterizing were similar between age groups (p=0.20) but differed between patients with and without channels (p < 0.001). Physical limitations were more common among those self-catheterizing per urethra. Conclusions: Rates of self-catheterization increased with age. According to parents of patients 9 years or older with SB, not self-catheterizing is rarely due to disinterest. Patients with physical limitations may be more likely to self-catheterize through a channel. SOURCE OF Funding: None
