Urinary catheter policies for long-term bladder drainage

Niël-Weise BS, van den Broek PJ

Published Online:

October 7, 2009

Some people use catheters to help them manage their bladder problems (such as leaking urine or not being able to pass urine). Catheters may be permanent urethral catheters (in the tube draining the bladder), suprapubic catheters (via the abdomen) or intermittent catheters (when a catheter is inserted via the urethra several times a day). No trials were found comparing these different methods with each other. Sometimes people using the catheters develop urinary tract infections. There was some weak evidence that using antibiotics all the time reduced the chance of having a urinary tract infection while using intermittent catheters, but there was not enough information about side effects.

Abstract (click to read)

Background:

People requiring long-term bladder draining commonly experience catheter-associated urinary tract infection and other problems.

Objectives:

To determine if certain catheter policies are better than others in terms of effectiveness, complications, quality of life and cost-effectiveness in long-term catheterised adults and children.

Search strategy:

We searched the Cochrane Incontinence Group Specialised Trials Register (searched 15 January 2009). Additionally, we examined all reference lists of identified trials.

Selection criteria:

All randomised and quasi-randomised trials comparing catheter policies (route of insertion and use of antibiotics) for long-term (more than 14 days) catheterisation in adults and children.

Data collection and analysis:

Data were extracted by both reviewers independently and compared. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. If the data in trials have not been fully reported, clarification were sought from the authors. When necessary, the incidence-density rates (IDR) and/or the incidence-density differences (IDD) within a certain time period were calculated.

Main results:

Seven trials met the inclusion criteria involving 328 patients in four crossover and three parallel-group randomised controlled trials. Only two of the pre-stated six comparisons were addressed in these trials.

Three trials compared antibiotic prophylaxis with antibiotics when clinically indicated. For patients using intermittent catheterisation, there were inconsistent findings about the effect of antibiotic prophylaxis on symptomatic urinary tract infection. For patients using indwelling urethral catheterisation, one small trial reported fewer episodes of symptomatic UTI in the prophylaxis group.

Four trials compared antibiotic prophylaxis with giving antibiotics when microbiologically indicated. For patients using intermittent catheterisation, there was limited evidence that receiving antibiotics reduced the rate of bacteriuria (asymptomatic and symptomatic). There was weak evidence that prophylactic antibiotics were better in terms of fewer symptomatic bacteriuria.

Authors' conclusions:

No eligible trials were identified that compared alternative routes of catheter insertion. The data from seven trials comparing differing antibiotic policies were sparse, particularly when intermittent catheterisation was considered separately from in-dwelling catheterisation. Possible benefits of antibiotic prophylaxis must be balanced against possible adverse effects, such as development of antibiotic resistant bacteria; these cannot be reliably estimated from currently available trials.

This record should be cited as:

Niël-Weise BS, van den Broek PJ. Urinary catheter policies for long-term bladder drainage. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD004201. DOI: 10.1002/14651858.CD004201.pub2

Assessed as up to date:

August 5, 2008

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Primary Review Group:

Incontinence Group

Health topics:

Gynaecology > Urinary incontinence > Mechanical treatment

Urology > Incontinence > Mechanical treatment

Urology > Urological procedures

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Urinary catheter policies for long-term bladder drainage

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