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Meta-Analysis
. 2017 Aug 8;8(8):CD006008.
doi: 10.1002/14651858.CD006008.pub4.

WITHDRAWN: Intermittent catheterisation for long-term bladder management

Jacqui Prieto  1 , Catherine L Murphy, Katherine N Moore, Mandy Fader
Affiliations
Meta-Analysis

WITHDRAWN: Intermittent catheterisation for long-term bladder management

Jacqui Prieto et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Intermittent catheterisation is a commonly recommended procedure for people with incomplete bladder emptying. There are now several designs of intermittent catheter (e.g. different lengths, 'ready to use' presentation) with different materials (e.g. PVC-free) and coatings (e.g. hydrophilic). The most frequent complication of intermittent catheterisation is urinary tract infection (UTI), but satisfaction, preference and ease of use are also important to users. It is unclear which catheter designs, techniques or strategies affect the incidence of UTI, which are preferable to users and which are most cost effective.

Objectives: To compare one type of catheter design versus another, one type of catheter material versus another, aseptic catheterisation technique versus clean technique, single-use (sterile) catheters versus multiple-use (clean) catheters, self-catheterisation versus catheterisation by others and any other strategies designed to reduce UTI and other complications or improve user-reported outcomes (user satisfaction, preference, ease of use) and cost effectiveness in adults and children using intermittent catheterisation for incomplete bladder emptying.

Search methods: We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, and handsearching of journals and conference proceedings (searched 30 September 2013), the reference lists of relevant articles and conference proceedings, and we attempted to contact other investigators for unpublished data or for clarification.

Selection criteria: Randomised controlled trials (RCTs) or randomised cross-over trials comparing at least two different catheter designs, catheterisation techniques or strategies.

Data collection and analysis: Two review authors assessed the methodological quality of trials and abstracted data. For dichotomous variables, risk ratios and 95% confidence intervals were derived for each outcome where possible. For continuous variables, mean differences and 95% confidence intervals were calculated for each outcome. Because of trial heterogeneity, it was not always possible to combine data to give an overall estimate of treatment effect.

Main results: Thirty-one trials met the inclusion criteria, including 13 RCTs and 18 cross-over trials. Most were small (less than 60 participants completed), although five trials had more than 100 participants. There was considerable variation in length of follow-up and definitions of UTI. Participant dropout was a problem for several trials, particularly where there was long-term follow-up to measure incidence of UTI. Fifteen trials were more than 10 years old and focused mainly on comparing different catheterisation techniques (e.g. single versus multiple-use) on clinical outcomes whereas, several more recent trials have focused on comparing different types of catheter designs or materials, especially coatings, and user preference. It was not possible to combine data from some trials owing to variations in the catheters tested and in particular the catheter coatings. Where there were data, confidence intervals around estimates were wide and hence clinically important differences in UTI and other outcomes could neither be identified nor reliably ruled out. No study assessed cost-effectiveness.

Authors' conclusions: Despite a total of 31 trials, there is still no convincing evidence that the incidence of UTI is affected by use of aseptic or clean technique, coated or uncoated catheters, single (sterile) or multiple-use (clean) catheters, self-catheterisation or catheterisation by others, or by any other strategy. Results from user-reported outcomes varied. The current research evidence is weak and design issues are significant. More well-designed trials are strongly recommended. Such trials should include analysis of cost-effectiveness because there are likely to be substantial differences associated with the use of different catheter designs, catheterisation techniques and strategies.

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Conflict of interest statement

Katherine Moore was a co‐investigator on a trial sponsored by Coloplast (Cardenas 2011) and received product from Coloplast for another trial (Moore 2013). Mandy Fader has received intermittent catheter products for research purposes from Astra Tech AB.

Figures

Figure 1
Figure 1
PRISMA study flow diagram
Figure 2
Figure 2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figure 3
Figure 3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Analysis 1.1
Analysis 1.1
Comparison 1 Aseptic technique versus clean/other aseptic technique, Outcome 1 Number with asymptomatic bacteriuria.
Analysis 1.2
Analysis 1.2
Comparison 1 Aseptic technique versus clean/other aseptic technique, Outcome 2 Number with symptomatic UTI.
Analysis 1.3
Analysis 1.3
Comparison 1 Aseptic technique versus clean/other aseptic technique, Outcome 3 Weeks to onset of symptomatic UTI.
Analysis 2.1
Analysis 2.1
Comparison 2 Single‐ise (sterile) catheter versus multiple‐use (clean) catheter, Outcome 1 Number with asymptomatic bacteriuria.
Analysis 2.2
Analysis 2.2
Comparison 2 Single‐ise (sterile) catheter versus multiple‐use (clean) catheter, Outcome 2 Number with symptomatic UTI.
Analysis 2.3
Analysis 2.3
Comparison 2 Single‐ise (sterile) catheter versus multiple‐use (clean) catheter, Outcome 3 Weeks to onset of symptomatic UTI.
Analysis 2.4
Analysis 2.4
Comparison 2 Single‐ise (sterile) catheter versus multiple‐use (clean) catheter, Outcome 4 Number with microscopic haematuria.
Analysis 2.5
Analysis 2.5
Comparison 2 Single‐ise (sterile) catheter versus multiple‐use (clean) catheter, Outcome 5 Number with urethral trauma/bleeding/macroscopic haematuria.
Analysis 2.6
Analysis 2.6
Comparison 2 Single‐ise (sterile) catheter versus multiple‐use (clean) catheter, Outcome 6 Number reporting overall satisfaction.
Analysis 2.7
Analysis 2.7
Comparison 2 Single‐ise (sterile) catheter versus multiple‐use (clean) catheter, Outcome 7 Mean satisfaction.
Analysis 2.8
Analysis 2.8
Comparison 2 Single‐ise (sterile) catheter versus multiple‐use (clean) catheter, Outcome 8 Number reporting ease of handling.
Analysis 2.9
Analysis 2.9
Comparison 2 Single‐ise (sterile) catheter versus multiple‐use (clean) catheter, Outcome 9 Mean ease of handling.
Analysis 2.10
Analysis 2.10
Comparison 2 Single‐ise (sterile) catheter versus multiple‐use (clean) catheter, Outcome 10 Number reporting ease of insertion.
Analysis 2.11
Analysis 2.11
Comparison 2 Single‐ise (sterile) catheter versus multiple‐use (clean) catheter, Outcome 11 Mean ease of insertion.
Analysis 2.12
Analysis 2.12
Comparison 2 Single‐ise (sterile) catheter versus multiple‐use (clean) catheter, Outcome 12 Number reporting comfort.
Analysis 2.13
Analysis 2.13
Comparison 2 Single‐ise (sterile) catheter versus multiple‐use (clean) catheter, Outcome 13 Number reporting convenience of product.
Analysis 2.14
Analysis 2.14
Comparison 2 Single‐ise (sterile) catheter versus multiple‐use (clean) catheter, Outcome 14 Mean convenience of product.
Analysis 3.1
Analysis 3.1
Comparison 3 Hydrophilic‐coated or other pre‐lubricated catheter versus other catheter (pre‐lubricated, coated or uncoated), Outcome 1 Number with asymptomatic bacteriuria.
Analysis 3.2
Analysis 3.2
Comparison 3 Hydrophilic‐coated or other pre‐lubricated catheter versus other catheter (pre‐lubricated, coated or uncoated), Outcome 2 Number with symptomatic UTI.
Analysis 3.3
Analysis 3.3
Comparison 3 Hydrophilic‐coated or other pre‐lubricated catheter versus other catheter (pre‐lubricated, coated or uncoated), Outcome 3 Number of UTIs per month of use.
Analysis 3.4
Analysis 3.4
Comparison 3 Hydrophilic‐coated or other pre‐lubricated catheter versus other catheter (pre‐lubricated, coated or uncoated), Outcome 4 Number with urethral trauma/bleeding/macroscopic haematuria.
Analysis 3.5
Analysis 3.5
Comparison 3 Hydrophilic‐coated or other pre‐lubricated catheter versus other catheter (pre‐lubricated, coated or uncoated), Outcome 5 Number with microscopic haematuria.
Analysis 3.6
Analysis 3.6
Comparison 3 Hydrophilic‐coated or other pre‐lubricated catheter versus other catheter (pre‐lubricated, coated or uncoated), Outcome 6 Mean microscopic haematuria.
Analysis 3.7
Analysis 3.7
Comparison 3 Hydrophilic‐coated or other pre‐lubricated catheter versus other catheter (pre‐lubricated, coated or uncoated), Outcome 7 Number with stricture formation.
Analysis 3.8
Analysis 3.8
Comparison 3 Hydrophilic‐coated or other pre‐lubricated catheter versus other catheter (pre‐lubricated, coated or uncoated), Outcome 8 Number reporting overall satisfaction.
Analysis 3.9
Analysis 3.9
Comparison 3 Hydrophilic‐coated or other pre‐lubricated catheter versus other catheter (pre‐lubricated, coated or uncoated), Outcome 9 Mean Overall satisfaction.
Analysis 3.10
Analysis 3.10
Comparison 3 Hydrophilic‐coated or other pre‐lubricated catheter versus other catheter (pre‐lubricated, coated or uncoated), Outcome 10 Number reporting preference.
Analysis 3.11
Analysis 3.11
Comparison 3 Hydrophilic‐coated or other pre‐lubricated catheter versus other catheter (pre‐lubricated, coated or uncoated), Outcome 11 Number reporting convenience of product.
Analysis 3.12
Analysis 3.12
Comparison 3 Hydrophilic‐coated or other pre‐lubricated catheter versus other catheter (pre‐lubricated, coated or uncoated), Outcome 12 Mean convenience of product.
Analysis 3.13
Analysis 3.13
Comparison 3 Hydrophilic‐coated or other pre‐lubricated catheter versus other catheter (pre‐lubricated, coated or uncoated), Outcome 13 Number reporting ease of handling.
Analysis 3.14
Analysis 3.14
Comparison 3 Hydrophilic‐coated or other pre‐lubricated catheter versus other catheter (pre‐lubricated, coated or uncoated), Outcome 14 Mean ease of handling.
Analysis 3.15
Analysis 3.15
Comparison 3 Hydrophilic‐coated or other pre‐lubricated catheter versus other catheter (pre‐lubricated, coated or uncoated), Outcome 15 Number reporting ease of insertion.
Analysis 3.16
Analysis 3.16
Comparison 3 Hydrophilic‐coated or other pre‐lubricated catheter versus other catheter (pre‐lubricated, coated or uncoated), Outcome 16 Mean ease of insertion.
Analysis 3.17
Analysis 3.17
Comparison 3 Hydrophilic‐coated or other pre‐lubricated catheter versus other catheter (pre‐lubricated, coated or uncoated), Outcome 17 Number reporting comfort.
Analysis 3.18
Analysis 3.18
Comparison 3 Hydrophilic‐coated or other pre‐lubricated catheter versus other catheter (pre‐lubricated, coated or uncoated), Outcome 18 Mean ease of removal.
Analysis 4.1
Analysis 4.1
Comparison 4 Standard catheter versus shorter catheter length, Outcome 1 Number reporting ease of handling.
Analysis 4.2
Analysis 4.2
Comparison 4 Standard catheter versus shorter catheter length, Outcome 2 Number reporting ease of insertion.
Analysis 4.3
Analysis 4.3
Comparison 4 Standard catheter versus shorter catheter length, Outcome 3 Number reporting product discretion.
Analysis 4.4
Analysis 4.4
Comparison 4 Standard catheter versus shorter catheter length, Outcome 4 Number reporting preference.
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Update of

References

References to studies included in this review

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Additional references

    1. Bermingham S, Hodgkinson S, Wright S, Hayter E, Spinks J, Pellowe C. Intermittent self catheterisation with hydrophilic, gel reservoir, and non‐coated catheters: a systematic review and cost effectiveness analysis. BMJ2013; Vol. 346, issue e8639:e1‐e16. [DOI: 10.1136/bmj.e8639] - DOI - PMC - PubMed
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    1. Cottenden A, Bliss DZ, Buckley B, Fader M, Gartley C, Hayder D, et al. Management using continence products. In: Abrams P, Cardozo L, Khoury S, Wein A editor(s). Incontinence: 5th International Consultation on Incontinence. Recommendations of the International Scientific Committee: Evaluation and Treatment of Urinary Incontinence, Pelvic Organ Prolapse and Faecal Incontinence; 2012 Feb 23‐25; Paris. 5th Edition. Belgium: International Consultation on Urological Diseases (ICUD), 2013:1651‐786.
    1. Li L, Ye W, Ruan H, Yang B, Zhang S, Li L. Impact of hydrophilic catheters on urinary tract infections in people with spinal cord injury: systematic review and meta‐analysis of randomized controlled trials. Archives of Physical Medicine and Rehabilitation 2013;94(4):782‐7. - PubMed
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References to other published versions of this review

    1. Moore KN, Fader M, Getliffe K. Long‐term bladder management by intermittent catheterisation in adults and children. Cochrane Database of Systematic Reviews 2007, Issue 4. [DOI: 10.1002/14651858.CD006008.pub2] - DOI - PubMed
    1. Prieto J, Murphy CL, Moore KN, Fader M. Intermittent catheterisation for long‐term bladder management. Cochrane Database of Systematic Reviews 2014, Issue 9. [DOI: 10.1002/14651858.CD006008.pub3] - DOI - PubMed

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