Little to choose between catheter types for intermittent self-catheterization

By Caroline Price, Senior medwireNews Reporter

Patients undertaking intermittent self catheterization for urinary retention should be offered the choice of clean noncoated, hydrophilic, or gel reservoir catheters, say researchers who found none offers a strong advantage in avoiding urinary tract infection (UTI).

Their systematic review and meta-analysis of the evidence to date found little difference in terms of risk for symptomatic UTI with various noncoated and coated types.

And, while clean noncoated catheterization was the most cost-effective method, the authors concede that this may not be a viable option; after this, gel reservoir catheters may be slightly more cost-effective than hydrophilic ones.

However, the team stresses that the evidence base is limited, and that individual patients may find one type of catheter more comfortable or easier to use than another - benefits that they were not able to capture in their study.

Sarah Bermingham (Royal College of Physicians, London, UK) and team identified eight eligible studies, most of patients with spinal cord injuries, for inclusion in their analysis.

Five compared hydrophilic with noncoated catheters, one compared gel reservoir with noncoated catheters, and two compared clean noncoated with sterile noncoated catheters.

As reported in the BMJ, they found no difference in the mean number of monthly UTIs at 1 year, or total antibiotic treatment episodes at 1 year, between patients using hydrophilic catheters and those using noncoated ones.

Individuals using gel reservoir or hydrophilic catheters were less likely to report one or more UTIs than those using sterile noncoated catheters, but confidence intervals were wide and overlapping, note Bermingham et al.

And there was no difference in the incidence of symptomatic UTI for people using clean versus sterile noncoated catheters, they report.

Taking the uncertainties over significance of the clinical effectiveness findings into account, the researchers calculated that clean noncoated catheterization was the most cost-effective method under currently applied thresholds in the UK National Health Service (£ 20,000-30,000 [US$ 36,266-48,399; € 24,174-36,261] per quality adjusted life year [QALY] gained).

Where these are not an option, they note that gel reservoir catheters may be more cost-effective than hydrophilic; gel reservoir were slightly more effective than hydrophilic catheters, with a small additional cost and incremental cost effectiveness ratio of around £ 3000 (US $ 4840; € 3626) per QALY gained.

However, the authors conclude: "Additional data about the incidence of infection, urethral complications, patient compliance, methods of cleaning catheters, and quality of life are needed before such a change in practice is implemented."

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