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Evidence summaries

Intermittent Catheter Techniques, Strategies and Designs for Managing Longterm Bladder Conditions

There is insufficient evidence to state that incidence of urinary tract infection in persons using intermittent catheterisation is affected by use of sterile or clean technique, coated or uncoated catheters, single (sterile) or multiple use (clean) catheters, self-catheterisation or catheterisation by others, or by any other strategy. Level of evidence: "D"

A Cochrane review [Abstract] 1 included 23 trials (1339 randomised participants), including twelve RCTs and eleven cross-over trials. Length of follow-up ranged from one month to 12 months.

Aseptic versus clean technique.It is uncertain if there is any difference between aseptic and clean techniques in the risk of symptomatic UTI (RR 1.20 95% CI 0.54 to 2.66; one study; 36 participants).

Single-use (sterile) catheter versus multiple-use (clean).It is uncertain if there is any difference between single-use and multiple-use catheters in terms of the risk of symptomatic UTI (RR 0.98, 95% CI 0.55, 1.74; two studies; 97 participants).

Hydrophilic-coated catheters versus uncoated catheters.It is uncertain if there is any difference between hydrophilic and uncoated catheters in terms of the number of people with symptomatic UTI (RR 0.89, 95% CI 0.69 to 1.14; two studies; 98 participants). Uncoated catheters probably slightly reduce the risk of urethral trauma and bleeding compared to hydrophilic-coated catheters (RR 1.37, 95% CI 1.01 to 1.87).

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and more than 20% loss to follow up in several studies), by inconsistency (heterogeneity in outcomes; considerable variation in length of follow-up and definitions of UTI), by imprecise results (few patients and wide confidence intervals) and by indirectness (several studies were more than ten years old and outcome measures varied between studies; colonization without symptoms is not treated in intermittent catheterisation users nowadays).

    References

    • Prieto JA, Murphy CL, Stewart F et al. Intermittent catheter techniques, strategies and designs for managing long-term bladder conditions. Cochrane Database Syst Rev 2021;(10):CD006008. [PubMed]

Primary/Secondary Keywords