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Evidence summaries

Urinary Catheter Policies for Short-Term Bladder Drainage in Adults

Suprapubic catheters appear to be advantageous over indwelling urethral catheterisation in respect of bacteriuria, recatheterisation and discomfort in adults for short-term bladder drainage. Intermittent catheterisation appears to be associated with a lower risk of bacteriuria than indwelling one, but might be more costly. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 42 studies.

Twenty five trials compared indwelling urethral catheterisation with suprapubic catheterisation. Participants with indwelling catheters had more cases of asymptomatic bacteriuria (RR 2.25, 95% CI 1.63 to 3.10; 19 trials, 1894 participants; very low quality evidence) and more participants reported pain (RR 5.62, 95% CI 3.31 to 9.55; 4 trials, 535 participants; low-quality evidence). Duration of catheterisation was shorter in the indwelling urethral catheter group (MD -1.73, 95% CI -2.42 to -1.05; 2 trials, 274 participants).

Fourteen compared indwelling urethral catheterisation with intermittent catheterisation. Two trials had data for symptomatic UTI which were suitable for meta-analysis. Due to evidence of significant clinical and statistical heterogeneity, the results weren't pooled, which were inconclusive and the quality of evidence was very low. The evidence was also inconclusive for asymptomatic bacteriuria (RR 1.04; 95% CI 0.85 to 1.28; 13 trials, 1333 participants; very low quality evidence). Almost three times as many people developed acute urinary retention with the intermittent catheter (16% with urethral versus 45% with intermittent); RR 0.45, 95% CI 0.22 to 0.91; 4 trials, 384 participants.

    References

    • Kidd EA, Stewart F, Kassis NC et al. Urethral (indwelling or intermittent) or suprapubic routes for short-term catheterisation in hospitalised adults. Cochrane Database Syst Rev 2015;(12):CD004203. [PubMed]

Primary/Secondary Keywords