Response to the commentary 'Early clean intermittent catheterization may not prevent dimercaptosuccinic acid renal scan abnormalities in children with spinal dysraphism'.
We agree that the ideal study to address the value of early clean intermittent catheterization (CIC) would only be possible if myelodysplastic patients were followed prospectively with specific guidelines regarding imaging. As a result, we are advocating for dimercaptosuccinic acid (DMSA) scans as a baseline during the first year of life, at 5 years of age, and if there are clinical changes. Selection bias and the retrospective nature of this study are valid concerns that we realize prevent an absolute statement on when to initiate CIC. In fact, we were quite surprised to find a higher likelihood of renal scarring in patients who started early CIC versus CIC later in life since this was contrary to our initial hypothesis. Nevertheless, given the limitations, we can only propose that early CIC may not prevent renal scarring. There have been several studies looking at the early initiation of CIC or prophylactic CIC to prevent upper tract changes or prevent the need for further surgery. The 2006 study by Dik et al. addressed the value of early CIC as well. However, out of their population of 144 patients, only 10 DMSA scans were performed based on suspicion of ultrasound determined renal abnormalities. Of these, six scans