BARCELONA—A single-use hydrophilic-coated polyvinyl chloride (PVC) catheter appears to be no more effective than a PVC multi-use catheter for preventing febrile urinary tract infection (UTI) in children with spina bifida using clean intermittent catheterization (CIC) on a long-term basis, Canadian investigators reported at the 43rd annual meeting of the International Continence Society.
“Although intermittent catheterization is a common procedure for patients with an incomplete bladder, UTIs are frequent and can pose a major health problem in some patients,” Katherine Moore, PhD, Professor Emeritus of Nursing at the University of Alberta in Edmonton, explained. “It has been suggested that a sterile, single-use, hydrophilic-coated catheter might reduce bacterial invasion better than a multi-use catheter washed in the standard of care manner with soap and water, air-dried, and then re-used by the same individual. However, we found no evidence to indicate that the incidence of UTI is affected by catheter type in this population.”
Dr. Moore also pointed out that while more than 25 randomized, controlled studies have examined long-term bladder management by intermittent catheterization, prior investigations have had multiple limitations. “For example, all of them were underpowered and had attrition issues,” she said. “In addition, studies had varying definitions of UTI ranging from ‘the presence of bacteria in the urine’ to ‘the presence of symptomatic UTI.’ ”
The Canadian team randomized 68 patients to 24 weeks of single-use hydrophilic or PVC multiuse catheters for CIC after which they crossed over to 24 weeks of the alternate catheter.
Study participants were children with spina bifida living in the community who either self-administered CIC or received CIC consistently by the same person at least three times a day. Symptomatic UTI was defined as positive leukocytes plus at least one of several symptoms which included fever, flank pain, increased incontinence, malaise, and cloudy or malodorous urine requiring antibiotic treatment.
Results in 46 patients over 48 weeks showed that the mean total weeks of self-reported UTI was 3.6 weeks and 2.3 weeks in the hydrophilic single-use and multi-use PVC groups, respectively. The difference between the two groups was not statistically significant on any variables, including symptoms besides fever, antibiotic use for any reason, and days missed for any activity including physician visits or school.
Elsewhere at the ICS, a team from St. George Hospital in Sydney, Australia, reported that the rate of bacterial cystitis and symptomatic UTI was not different between groups using non-coated multi-use or single-use catheters.
Dr. Moore cautioned that while her study was underpowered despite major attempts at recruitment, the findings are nonetheless clinically relevant. For children with limitations in manual dexterity, the PVC multiuse catheter was easier to use. However, several caregivers reported that they found that the hydrophilic, single-use catheter was very easy to use and also that the packaging made catheterization in a public washroom sanitary and “worry-free.”