Intermittent Catheterization using Specially Coated Catheters for Preventing UTI

Author Year
Country

Research Design
Score
Total Sample Size

Methods Outcome
Cardenas et al. 2011
USA
RCT
PEDro=5
N=224
Population: Treatment group: mean age: 37.2 yr; males=177, females=47, ASIA scale A=62%, B=18%, C=11%, D=11%; time post-injury=32 d.
Control: mean age: 35.1 yr; male=82%, female=18%; ASIA scale: A=68%, B=10% C=19%; D=3%; time post-injury=29 d.

Treatment: Intermittent catheterization with hydrophilic coated catheter.

Outcome Measures: Symptoms of urinary tract infection (UTI), treatment of antibiotics to prevent UTI, urolithiasis.

  1. The time of first symptomatic UTI is significantly delayed in the treatment group (p=0.038). The decrease in daily risk of developing first UTI in the treatment group is 33%.
  2. The incidence of UTI in treatment was reduced by 21% of treatment group. There is a significant difference presence of microhematuria (p<0.0001) between the two groups.
  3. Overall there is a significant higher satisfaction rate reported by caregivers and participants in the treatment group (p=0.007). However, nurses reported no significant differences in overall satisfaction of the 2 catheters group
Cardenas & Hoffman 2009
USA
RCT
PEDro=5
N=56
Population: Treatment Group: Mean age: 42.3 yr; Gender: males=17, females=5; Level of injury: Tetraplegia=5, Paraplegia=17; Severity of Injury: AIS C4-C8 A=2, C4-C8 B-D=3, T6-L5: grade A=13, T6-L5: grade B-D=4; Control Group: Mean age: 40.1 yr; Gender: males=12, females=11; Level of injury: Tetraplegia=12, Paraplegia=11; Severity of injury: AIS C4-C8: grade A=8, C4-C8: grade B-D=4, T6-L5: grade A=5, T6-L5: grade B-D=6.

Treatment: Individuals were randomly assigned to either the hydrophilic catheter or the noncoated catheter control group. Urine from these individuals was collected once a mo for first 3 mo and then at 6, 9 and 12 mo mark.

Outcome Measures: Urinary tract infection (UTI).

  1. At least 1 symptomatic UTI was seen over the course of 1 yr for 12 individuals in the hydrophilic catheter group and 14 of the control group.
  2. The hydrophilic catheter group had a mean of 1.18 UTIs, while the control group had 1.
  3. No significant difference was seen between the two groups in the number of symptomatic UTIs and type of symptoms.
  4. There was a significant number of symptomatic UTIs treated in the group using hydrophilic catheters (p=0.02).
  5. Females were more likely to develop UTIs regardless of catheter type.
De Ridder et al. 2005
Spain
RCT
PEDro=5
N=123
Population:SCI using hydrophilic versus polyvinyl chloride catheter (PVC): Mean age: 37.5 yr versus 36.7 yr; Severity of injury: AIS A-D.

Treatment: “SpeediCath®” hydrophilic catheters versus conventional uncoated PVC catheter for intermittent catheterization (IC).

Outcome Measures: Occurrence of symptomatic urinary tract infections (UTIs), hematuria, strictures, convenience of use, satisfaction with catheter, dropout rate. Data collected over a 12 mo period.

  1. Lower incidence of UTIs of those using SpeediCath hydrophilic versus PVC (p=0.02).
  2. No difference in number of bleeding episodes or occurrence of hematuria, leukocyturia and bacteriuria between 2 catheters.
  3. More individuals expressed greater satisfaction with various aspects of the hydrophilic catheter, although these differences were not significant.
  4. 54% dropout rate (slightly more so in hydrophilic group) partially due to the fact that many subjects no longer needed to catheterize when bladder function was retained within the 1 yr period.
Vapnek et al. 2003
USA
RCT
PEDro=6
Ninitial=62; Nfinal=49
Population: Complete Available Data: Male SCI patients: Hydrophilic Catheter Group: Mean age: 39.8 yr; Level of injury: paraplegia=25, tetraplegia=4; Polyvinyl chloride catheter (PVC) group: Mean age: 39.6 yr; Level of injury: paraplegia=26, tetraplegia=1.

Treatment: SCI individuals were randomly placed in either the hydrophilic coated plastic LoFric catheters or standard polyvinyl chloride catheter (PVC) group

Outcome Measures: Urinary tract infections (UTIs), degree of microscopic hematuria and pyuria, incidence of adverse events were all assessed at baseline and every 3 mo for 1 yr.

Urinary tract infections:

  1. Baseline: – mean incidence of monthly UTI’s was higher for the hydrophilic catheter (HC) group than for the PVC/control group (0.45±0.62 and 0.20±0.26 per patient respectively (p>0.3)).
  2. Study Conclusion: – still no significant difference between HC and PVC group for mean # of UTI’s/mo (0.13±0.18 and 0.14±0.21 per patient resp. (p>0.3)).
  3. ↓ in UTI rate per mo was significantly higher for HC group than for PVC group (0.44 to 0.14 or -0.3 versus 0.20 to 0.14 or -0.06 per patient), and was statistically significant in the HC group (p=0.012 versus 0.24)

Microscopic Hematuria:

  1. Baseline: – dipstick analysis showed some degree of hematuria in 8 of the 30 patients from the HC group and 11 of the 31 from the PVC group (no statistically significance difference).
  2. During study – HC group showed a significantly ↓ incidence of microhematuria (p=0.027) (mean code per urinalysis for HC versus PVC (0.31±0.46 and 0.65±0.69 respectively)

Microscopic Pyuria:

  1. Baseline: – number of patients were similar from both groups (HC – 19 of 30 versus PVC – 22 of 31 respectively.)
  2. Follow-up – no differences

Adverse Events:

  1. HC group – 1 gross hematuria, 1 epididymitis, 1 infected penile prosthesis requiring hospitalization and surgical removal (neurogenic bladder, unrelated to intermittent catheterization).
  2. PVC group – 1 gross hematuria, 1 epididymitis, 1 bladder stone surgically removed (neurogenic bladder, unrelated to intermittent catheterization).
Giannantoni et al. 2001 Italy
RCT
PEDro=9
N=18
Population: SCI: Mean age: 38.2 yr; Level of injury: C5-Cauda Equina; Severity of injury: AIS A-D; Time post-injury=18-60 d.

Treatment: Comparison of “Instacath®” pre-lubricated nonhydrophilic catheter versus conventional uncoated polyvinyl chloride (PVC) Nelaton catheter for intermittent catheterization (IC) (crossover design).

Outcome Measures: Symptomatic urinary tract infection (UTI) incidence of urethral complications (ultrasound, Cystourethrography(CUG)), urinalysis, visual analog scale of patient satisfaction. Collected at the start and end of 7 wk study period.

  1. Lower incidence of UTIs (p=0.03) and asymptomatic bacteriuria (p=0.0244) of those using pre-lubricated catheters versus PVC.
  2. More epithelial cells found on conventional versus pre-lubricated catheter (p=0.01) indicative of possible microtrauma.
  3. 2 people had urethral bleeding with conventional catheter, 0 with pre-lubricated.
  4. Pre-lubricated catheters had significantly higher satisfaction scores for 4 of 5 items on the scale.
  5. 3 subjects requiring assistance with the conventional catheter became independent with the pre-lubricated catheter (order effect unreported).
  6. No subject had impaired renal function of upper & lower tract abnormalities with either catheter.
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