Intermittent Catheterization: The Devil Is in the Details

JOURNAL OF NEUROTRAUMA, 2018 · DOI: 10.1089/neu.2017.5413 · Published: April 1, 2018

Spinal Cord Injury Urology Research Methodology & Design

Simple Explanation

The international community has debated urinary tract infection (UTI) and re-use of catheters during the management of neurogenic lower urinary tract dysfunction (NLUTD) among individuals with spinal cord injury (SCI). The most frequent complication of intermittent catheterization is UTI. A 2014 Cochrane review influenced clinicians' opinions and recommendations on intermittent catheterization, concluding that there was no convincing evidence that the incidence of UTI is affected by various catheterization techniques. This paper presents an independent appraisal of the 2014 Cochrane review, identifying crucial discrepancies in data extraction and analyses, and suggesting a trend to favor single over multiple use of catheters.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Independent appraisal of Cochrane review

Key Findings

1
The authors identified concerns with the Cochrane review related to data selection, extraction, symptomatic UTI definition, and data analysis.
2
Re-evaluation of trials, with corrections, found that hydrophilic catheters significantly favored a lower incidence of UTI.
3
Applying an up-to-date definition of symptomatic UTI revealed a trend favoring single versus multiple use of catheters.

Research Summary

The paper critically appraises a 2014 Cochrane review on intermittent catheterization, which concluded that there was no convincing evidence that UTI incidence is affected by catheterization techniques. The appraisal identified discrepancies in data selection, extraction, UTI definition, and data analysis within the Cochrane review. The authors' analysis suggests a trend favoring single-use catheters and highlights the benefits of hydrophilic catheters in reducing UTI incidence.

Practical Implications

Clinical Practice

Healthcare providers should advocate single-use catheters for individuals with SCI until evidence demonstrates that multiple use is equally safe.

Future Research

A more homogeneous systematic review is necessary to identify evidence accumulated since 2014, and high-quality RCTs are needed if analyses remain inconclusive.

Catheter Cleaning

Standardized and universally accepted cleaning methods are needed as a prerequisite for multiple use of catheters.

Study Limitations

1
The small number of participants in some of the re-analyzed trials.
2
The short duration of investigation in some trials.
3
Reliance on corrected data from previously published trials, which may contain inherent biases.

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