Cochrane Corner

An update of the 2007 Cochrane Review on intermittent catheter techniques, strategies, and designs for managing long-term bladder conditions was published in October 2021. Intermittent catheterization is associated with frequent complications: urinary tract infection, urethral trauma, and discomfort during catheter use. The objective of the review was to assess the clinical effectiveness and cost‐effectiveness of different catheterization techniques, strategies and catheter designs, and their impact, on UTI and other complications, and measures of satisfaction/quality of life among adults and children whose long‐term bladder condition is managed by intermittent catheterization.

The review culled data from 233 trials (1339 participants), including 12 RCTs and eleven cross-over trials. However, most had a small sample size (fewer than 60 participants completed) with a variable follow-up period (range: 1 – 12 months) and there was considerable variation in the definition of UTI. Also, most of the data from the cross-over trials were not presented in a useable form for the review. There was significant bias due to insufficient information, lack of blinding, and a high risk of attrition.

The evidence they gathered is as follows:

1. Aseptic versus clean technique: The authors were uncertain if there is any difference between aseptic and clean techniques in the risk of symptomatic UTI (one study, 36 participants), adverse events (no studies) or participant satisfaction or preference (no studies).
2. Single use (sterile) catheter versus multiple use (clean): The authors were uncertain if there is any difference between the two methods in terms of risk of symptomatic UTI (two studies, 97 participants). One study reported zero adverse events in either group while no data has been reported in any study on participant satisfaction or preference.
3. Hyrdophilic-coated catheters versus uncoated catheters: While there is some evidence that uncoated catheters slightly reduce the risk of urethral trauma and bleeding (RR 1.37, 95% CI 1.01 – 1.87, moderate-certainty evidence), there is equivocal evidence with respect to number of people with symptomatic UTI, participant satisfaction and preference.

Conclusions:

Given the paucity of usable data, uncertainty of evidence, and significant design and reporting issues, more well-designed trials are needed in addition to analysis of cost-effectiveness.