Skip to main content

Advertisement

SpringerLink
Log in

Hydrophilic versus non-hydrophilic catheters for clean intermittent catheterization: a meta-analysis to determine their capacity in reducing urinary tract infections

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Introduction

Clean intermittent catheterization (CIC) is associated with an increased risk of urinary tract infections (UTI), urethral trauma, urethral stenosis, hematuria, and pain. The first catheters were developed of polyvinyl carbon (PVC). Several types of catheters have been developed to reduce these complications, such as those with hydrophilic coating.

Objective

To conduct a systematic review and meta-analysis to evaluate the effectiveness of hydrophilic coated catheters compared to uncoated catheters on the rate of UTI in patients using CIC.

Methodology

A systematic literature search was performed in OVID, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases. Randomized controlled trials (RCTs) or randomized crossover trials comparing UTI and hematuria rates in patients using hydrophilic vs. non-hydrophilic catheters for CIC were identified. The selected trials were evaluated for risk of bias using the “Revised Cochrane risk-of-bias tool for randomized trials (RoB 2).” The results were expressed as a risk ratio (RR) with a 95% confidence interval (CI), under a random-effects model. Data were analyzed using Review Manager 5.4 software.

Results

Nine studies with a total of 525 patients in CIC were analyzed. Overall, the use of hydrophilic catheters had a lower risk of UTIs compared to uncoated catheters (RR = 0.78; 95% CI 0.62–0.97; I2 = 37%). Five of the studies include patients > 18 years, showing a reduction of UTIs with the use of hydrophilic catheters (RR = 0.83; 95% CI 0.74–0.93; I2 = 0%). There was no difference in UTI development when comparing single-use uncoated vs hydrophilic catheters. However, heterogeneity was high (RR = 0.77; 95% CI 0.59–1.00; I2 = 57%). Regarding hematuria risk reduction, we were unable to identify differences between the use of hydrophilic catheters compared to uncoated catheters (RR = 1.02; 95% CI 0.66–1.60).

Conclusion

We found a risk reduction of UTIs associated with using hydrophilic catheters in adults, with low heterogeneity. Regarding hematuria, significant differences were not proved. We do not find a significant difference in UTI risk reduction in the pediatric population. Urethral trauma presence could not be meta‐analyzed due to a lack of information reported.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Abrams P, Andersson KE, Apostolidis A, et al (2018) 6th International Consultation on Incontinence. Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence. Neurourol Urodyn 37(7):2271–2272. https://doi.org/10.1002/nau.23551

  2. Chaikin DC, Blaivas JG (2001) Voiding dysfunction: definitions. Curr Opin Urol 11(4):395–398. https://doi.org/10.1097/00042307-200107000-00010

    Article  CAS  PubMed  Google Scholar 

  3. Lamin E, Newman DK (2016) Clean intermittent catheterization revisited. Int Urol Nephrol 48(6):931–939. https://doi.org/10.1007/s11255-016-1236-9

    Article  PubMed  Google Scholar 

  4. Panicker JN, Fowler CJ, Kessler TM (2015) Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol 14(7):720–732. https://doi.org/10.1016/S1474-4422(15)00070-8

    Article  PubMed  Google Scholar 

  5. Engberg S, Clapper J, McNichol L, Thompson D, Welch VW, Gray M (2020) Current evidence related to intermittent catheterization. J Wound Ostomy Continence Nurs 47(2):140–165. https://doi.org/10.1097/WON.0000000000000625

    Article  PubMed  Google Scholar 

  6. Lauridsen S, Cobussen-Boekhorst H, Eikenboom J, et al (2013) European Association of Urology Nurses Evidence-Based Guidelines for Best Practice in Urological Health Care Catheterisation Urethral Intermittent in Adults Dilatation, Urethral Intermittent in Adults Evidence-Based Guidelines for Best Practice in Urological Health Care Catheterisation Urethral Intermittent in Adults Dilatation, Urethral Intermittent in Adults

  7. Wyndaele JJ, Brauner A, Geerlings SE, Bela K, Peter T, Bjerklund-Johanson TE (2012) Clean intermittent catheterization and urinary tract infection: review and guide for future research. BJU Int 110(11c):E910–E917. https://doi.org/10.1111/j.1464-410X.2012.11549.x

    Article  PubMed  Google Scholar 

  8. Stensballe J, Looms D, Nielsen PN, Tvede M (2005) Hydrophilic-coated catheters for intermittent catheterisation reduce urethral micro trauma: a prospective, randomised, participant-blinded, crossover study of three different types of catheters. Eur Urol 48(6):978–983. https://doi.org/10.1016/j.eururo.2005.07.009

    Article  CAS  PubMed  Google Scholar 

  9. DeFoor W, Reddy P, Reed M et al (2017) Results of a prospective randomized control trial comparing hydrophilic to uncoated catheters in children with neurogenic bladder. J Pediatr Urol 13(4):373.e1-373.e5. https://doi.org/10.1016/j.jpurol.2017.06.003

    Article  PubMed  Google Scholar 

  10. Sutherland RS, Kogan BA, Baskin LS, Mevorach RA (1996) Clean intermittent catheterization in boys using the Lofric catheter. J urology 156(6):2041–2043. https://doi.org/10.1016/S0022-5347(01)65430-2

  11. Pachler J, Frimodt-Møller C (1999) A comparison of prelubricated hydrophilic and non-hydrophilic polyvinyl chloride catheters for urethral catheterization. BJU Int 83(7):767–769. https://doi.org/10.1046/j.1464-410x.1999.00013.x

  12. Cardenas DD, Moore KN, Dannels-McClure A et al (2011) Intermittent catheterization with a hydrophilic-coated catheter delays urinary tract infections in acute spinal cord injury: a prospective, randomized multicenter trial. PM&R 3(5):408–417. https://doi.org/10.1016/j.pmrj.2011.01.001

    Article  Google Scholar 

  13. Sarica S, Akkoc Y, Karapolat H, Aktug H (2010) Comparison of the use of conventional, hydrophilic and gel-lubricated catheters with regard to urethral micro trauma, urinary system infection, and patient satisfaction in patients with spinal cord injury: a randomized controlled study. Eur J Phys Rehabil Med 46(4):473–479

  14. de Ridder DJMK, Everaert K, Fernández LG et al (2005) Intermittent catheterisation with hydrophilic-coated catheters (SpeediCath) reduces the risk of clinical urinary tract infection in spinal cord injured patients: a prospective randomised parallel comparative trial. Eur Urol 48(6):991–995. https://doi.org/10.1016/j.eururo.2005.07.018

    Article  PubMed  Google Scholar 

  15. Cardenas DD, Hoffman JM (2009) Hydrophilic catheters versus noncoated catheters for reducing the incidence of urinary tract infections: a randomized controlled trial. Arch Phys Med Rehabil 90(10):1668–1671. https://doi.org/10.1016/j.apmr.2009.04.010

    Article  PubMed  Google Scholar 

  16. Massa LM, Hoffman JM, Cardenas DD (2009) Validity, accuracy, and predictive value of urinary tract infection signs and symptoms in individuals with spinal cord injury on intermittent catheterization. J Spinal Cord Med 32(5):568–573. https://doi.org/10.1080/10790268.2009.11754562

    Article  PubMed  PubMed Central  Google Scholar 

  17. Vapnek JM, Maynard FM, Kim J (2003) A prospective randomized trial of the lofric hydrophilic coated catheter versus conventional plastic catheter for clean intermittent catheterization. J Urol 169(3):994–998. https://doi.org/10.1097/01.ju.0000051160.72187.e9

    Article  PubMed  Google Scholar 

  18. Ginsberg DA, Boone TB, Cameron AP et al (2021) The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: treatment and follow-up. J Urol 206(5):1106–1113. https://doi.org/10.1097/JU.0000000000002239

    Article  PubMed  Google Scholar 

  19. Tornic J, Wöllner J, Leitner L, Mehnert U, Bachmann LM, Kessler TM (2020) The challenge of asymptomatic bacteriuria and symptomatic urinary tract infections in patients with neurogenic lower urinary tract dysfunction. J Urol 203(3):579–584. https://doi.org/10.1097/JU.0000000000000555

    Article  PubMed  Google Scholar 

  20. Hooton TM, Bradley SF, Cardenas DD et al (2010) Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 50(5):625–663. https://doi.org/10.1086/650482

    Article  PubMed  Google Scholar 

  21. Moore KN, Fader M, Getliffe K (2007) Long-term bladder management by intermittent catheterisation in adults and children. In: Moore KN (ed) Cochrane database of systematic reviews. Wiley. https://doi.org/10.1002/14651858.CD006008.pub2

    Chapter  Google Scholar 

  22. Bermingham SL, Hodgkinson S, Wright S, Hayter E, Spinks J, Pellowe C (2013) Intermittent self catheterisation with hydrophilic, gel reservoir, and non-coated catheters: a systematic review and cost effectiveness analysis. BMJ 346(jan08 15):e8639. https://doi.org/10.1136/bmj.e8639

    Article  PubMed  PubMed Central  Google Scholar 

  23. Rognoni C, Tarricone R (2017) Intermittent catheterisation with hydrophilic and non-hydrophilic urinary catheters: systematic literature review and meta-analyses. BMC Urol 17(1):4. https://doi.org/10.1186/s12894-016-0191-1

    Article  PubMed  PubMed Central  Google Scholar 

  24. Li L, Ye W, Ruan H, Yang B, Zhang S, Li L (2013) Impact of hydrophilic catheters on urinary tract infections in people with spinal cord injury: systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil 94(4):782–787. https://doi.org/10.1016/j.apmr.2012.11.010

    Article  PubMed  Google Scholar 

  25. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (2019) Cochrane Handbook for Systematic Reviews of Interventions. 2nd Edition. John Wiley & Sons, Chichester (UK)

  26. Prieto J, Murphy CL, Moore KN, Fader M (2014) Intermittent catheterisation for long-term bladder management. In M. Fader (Ed.), Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd. https://doi.org/10.1002/14651858.CD006008.pub3

Download references

Funding

Private funding for research was obtained as an independent research initiative, granted by Coloplast.

Author information

Authors and Affiliations

  1. Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, Piso 3, 110111, Bogotá D.C., Colombia

    Mauricio Plata, Jessica Santander, Laura Zuluaga, Camilo Torres-Sandoval, Julián Azuero & Carlos Gustavo Trujillo

  2. Universidad del Rosario, Bogotá D.C., Colombia

    Jessica Santander

  3. Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá D.C., Colombia

    Sergio Valencia

Authors
  1. Mauricio Plata
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jessica Santander
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura Zuluaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Camilo Torres-Sandoval
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sergio Valencia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Julián Azuero
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Carlos Gustavo Trujillo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MP and JS contributed to protocol/project development. MP, JS, and CT were involved in data collection or management. SV and JS contributed to data analysis. JA, LZ, CT, MP, and JS were involved in manuscript writing/editing.

Corresponding author

Correspondence to Mauricio Plata.

Ethics declarations

Conflict of interest

The authors declare not to have a potential conflict of interest.

Ethics statement

The research protocol is in accordance with the ethical standards of the Institutional Ethics Committee at Hospital Universitario Fundación Santa Fe de Bogotá and with the 1964 Helsinki Declaration.

Research involving human participants and/or animals

Not applicable.

Informed consent

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 166 KB)

Figure 2. Funnel plot

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Plata, M., Santander, J., Zuluaga, L. et al. Hydrophilic versus non-hydrophilic catheters for clean intermittent catheterization: a meta-analysis to determine their capacity in reducing urinary tract infections. World J Urol 41, 491–499 (2023). https://doi.org/10.1007/s00345-022-04235-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-022-04235-5

Keywords

Search

Navigation