Comparative Study of Intermittent Catheters and Occurrence of Urinary Tract Infections

Introduction:

Spinal cord injured (SCI) constitutes a large group of patients suffering from neurogenic
bladder dysfunction, which is often managed by intermittent catheterization (IC).
Intermittent catheterization is accepted as a safe and effective method for maintaining
bladder and renal health in individuals with neurogenic bladder dysfunction. However, IC
several times a day places an individual at risk for urethral trauma, hematuria, and
particularly symptomatic urinary tract infections (UTI).

Attempts to control UTI with prophylactic antibiotics or sterile technique have not been
overly successful but more recent advances in catheter technology, such as the
hydrophilic-coated catheter, offer potential benefit. The hydrophilic-coated catheter has a
slippery, pre-lubricated surface (along the entire length of the catheter) when soaked in
water, allowing smooth insertion without the need for additional water soluble lubricant.
Two proposed advantages over uncoated catheters are 1) reduced incidence of symptomatic UTI,
and 2) reduction of urethral irritation or urethral trauma, and lowered risk of urethral
strictures. Currently, while there are trends in favour of hydrophilic-coated catheters with
respect to UTI overall evidence remains inadequate for clinical decision-making for choice
of catheter type. Randomised trials to date have been limited by short follow up,
heterogeneity, attrition, imprecise outcome measures, and varying definitions of UTI5.
Conclusions of the Cochrane group in 20076 were echoed in a recent comprehensive re-view of
all studies on hydrophilic-coated catheters - there is modest evidence favouring
hydrophilic-coated catheter in reduction of UTI, but further robust research is required.

Inclusion Criteria:

- Traumatic spinal cord injury within 3 months prior to inclusion

- Neurogenic bladder dysfunction requiring intermittent catheterization at least 3
times daily

Exclusion Criteria:

- Has symptoms of UTI at inclusion

- Treated with prophylactic antibiotics to prevent UTIs

- Has a history of unresolved bladder-ureteral reflux and/or stones in the urinary
tract

- Has used intermittent catheterization for more than 10 days prior to inclusion