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Comparison of Intermittent Catheterization Catheter Types

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Table: Comparison of Intermittent Catheterization Catheter Types

Discussion

The traditional catheter used for IC has long been the poly vinyl catheter (PVC) in varying lengths and gauges individualized for each patient. However, recent advances in catheter material, lubricant, and length have led to the development of several new catheter types. Hydrophilic catheters are made of a water-adherent polymer that, when lubricated with water, creates an extremely slippery surface effective for smooth insertion. Frictionless insertion reduces incidence of UTIs, bleeding, and other urinary complications. Other methods to reduce friction include gel-lubricated or pre-coated non-hydrophilic catheters. In total, there have been ten RCTs, and several small non-RCTs, investigating varying types and properties of catheters used for IC.

Several studies and one systematic review (Bermingham et al. 2013) have aimed to determine whether there is a superior catheter type for IC. In a small RCT, Sarica et al. (2010) found that gel-lubricated non-hydrophilic catheters were superior to hydrophilic and PVC catheters in terms of reduced urethral microtrauma and pyuria, and increased patient satisfaction, despite higher cost. However, there was no significant difference rate of UTIs between groups. Giannantoni et al. (2001) also examined pre-lubricated non-hydrophilic catheters versus conventional PVC catheters and demonstrated a reduction in the incidence of UTIs and the presence of asymptomatic bacteriuria. Of note, there were three subjects initially requiring assistance with a conventional catheter transitioning to independence with a pre-lubricated catheter. However, the order of catheter use by type was not reported. In terms of general satisfaction, subjects rated the pre-lubricated catheter significantly higher than the conventional catheter with respect to comfort, ease of insertion, extraction, and handling. De Ridder et al. (2005) compared hydrophilic catheters to non-coated PVC catheters and found reduced incidence of UTIs in favour of the hydrophilic catheter. Although this multi-centre investigation employed a RCT design (N=123) results should be cautiously interpreted given a 54% drop-out rate.

An additional investigation examined the effect of osmolality on two different hydrophilic catheters. Waller et al. (1997) demonstrated reduced friction with the high-osmality catheter versus the other, a finding corroborated by nursing reports of fewer catheter “stickings”. These differences did not translate into clinically significant results for differences in the incidence of UTIs with either hydrophilic catheter type.

To reduce risk of infection, a new “no touch” ValPro® catheter has been developed and being trialled for use. Denys et al. (2012) performed a crossover RCT whereby patients trialled the ValPro® catheter and a standard catheter. The authors reported that the majority of patients were confident and secure with catheter (>75%) and would recommend it (>50%). It is important to note that bacteremia analyses were not conducted.

To improve QoL and user satisfaction, discrete compact size catheters continue to be developed. Chartier-Kastler et al. (2011) examined the effectiveness of compact catheters compared to standard catheters in a small crossover RCT. The authors reported that patients were more satisfied with the compact versus standard catheters as the former were more discrete when carrying and disposing; further, the standard catheter had greater resistance on insertion. The findings were echoed in a recent, large crossover RCT by Chartier-Kasler et al. (2013) and a small crossover RCT by Biering-Sorensen et al. (2007) where greater satisfaction was reported with use of the compact versus standard catheters.

While catheter length generally reflects the anatomy of the user, some compact catheters are shorter in length (30 cm) than standard catheters (40 cm). A comparison of the two catheters in terms of residual IC urine volume has demonstrated no significant difference in two crossover RCTs (Domurath et al. 2011; Biering-Sorensen et al. 2007). While a third crossover RCT by Costa et al. (2013) found that subjects reported greater satisfaction with standard catheters versus compact catheters for bladder emptying, only descriptive statistics were reported.

A study by Kovindha et al. (2004), provides data on reusable silicone catheters (average of 3 years of usage). The frequency of UTIs reported for the reusable catheter was comparable to that reported for standard disposable catheters (3-7 days of usage), but inferior to frequencies reported for pre-lubricated catheters. Kovindha et al. (2004) stated that the long-term silicone catheter is an economical option for those in developing countries. In developing countries, the high cost of the single use, pre-lubricated catheters is prohibitive outside of exceptional situations.

It should be noted that some assistive devices that may enhance compliance with intermittent catheterization for those with impaired hand function do exist, but are likely not in widespread use. For example, Adler and Kirshblum (2003) reported a series of 9 individuals with C5-C7 SCI, originally unable to perform intermittent catheterization, that were subsequently satisfied and successful with a device to help performance of intermittent catheterization.

Conclusion

There is level 1b evidence (from one RCT; Giannantoni et al. 2001) that, compared to conventional poly vinyl chloride catheters, pre-lubricated non-hydrophilic catheters are associated with fewer UTIs and reduced urethral bleeding.

There is level 2 evidence (from one RCT; De Ridder et al. 2005) that, compared to conventional poly vinyl catheters, hydrophilic catheters may be associated with fewer UTIs, but not necessarily urethral bleeding.

There is level 2 evidence (from one RCT; Sarica et al. 2010) that, compared to hydrophilic or conventional poly vinyl catheters, pre-lubricated non-hydrophilic catheters are associated with reduced pyuria and greater patient satisfaction.

There is level 1b evidence (from two RCTs; Giannantoni et al. 2001; Sarica et al. 2010) that, compared to hydrophilic or conventional poly vinyl catheters, pre-lubricated non-hydrophilic catheters are associated with reduced urethral microtrauma.

There is level 1b evidence (from one crossover RCT; Denys et al. 2012) that compared to standard catheters, no-touch catheters may promote greater confidence and security to individuals performing intermittent catheterization post SCI.

There is level 1a evidence (from three crossover RCTs; Chartier-Kastler et al. 2011, 2013; Biering-Sorensen et al. 2007) that, compared to standard catheters, compact catheters may be more discrete for carrying and disposing and therefore provide greater satisfaction to individuals performing intermittent catheterizations post SCI.

There is level 1b evidence (from two cross-over RCTs; Domurath et al. 2011; Biering-Sorecnsen et al. 2007) that compact catheters (30 cm) and standard catheters (40 cm) provide comparable bladder performance with equitable residual urine volume.

  • Although both pre-lubricated and hydrophilic catheters have been associated with reduced incidence of UTIs as compared to conventional PVC catheters, less urethral microtrauma with their use may only be seen with pre-lubricated catheters.

    Compact catheters are more discrete than standard catheters for carrying and disposal but offer comparable performance in bladder emptying and residual urine volumes.