2. UroToday Home
  3. Urinary Catheters
  4. Indwelling Catheters
  5. Complications
  6. UroToday

Intermittent Catheters

Intermittent Catheters

Trial to compare mixed-use (multi-use and single-use) intermittent catheter management with single-use management over 12 months (The MultICath Trial): protocol for a non-inferiority randomised controlled trial.

Evaluating the safety and acceptability of reusing catheters for intermittent catheterisation (IC) is one of the top 10 continence research priorities identified by the UK James Lind Alliance Priority Setting Partnership in 2008.

Clean Intermittent Catheterisation via a Mitrofanoff Is Superior to Long Term Suprapubic Catheters for Bladder Drainage.

Some children require long-term drainage of the bladder but do not tolerate clean intermittent catheterisation (CIC) urethrally. We aimed to compare long term suprapubic catheter (SPC) drainage vs Mitrofanoff conduit (allowing CIC) by comparing the survival of the drainage methods and rates of urinary tract infection (UTI).

Switching from intermittent catheterization with single-use catheter to a reusable catheter has a negative impact on quality of life

Purpose: It has been proposed that reusable catheters are more cost effective and environmentally sustainable than single-use catheters intended for intermittent catheterization (IC). However, the aspect of individuals' well-being and preference for catheter type is not considered. In this study, we investigated the impact on individuals' health-related quality of life (HR-QoL) when testing a reusable catheter.

Materials and methods: The study was an open-labeled, single-arm, multicenter investigation with a treatment period of 28 days. Forty subjects using single-use hydrophilic catheters were accustomed to a reusable catheter for managing IC. HR-QoL was evaluated by the Intermittent-Self Catheterization Questionnaire (ISC-Q). Additionally, satisfaction was evaluated by the Intermittent Catheterization Satisfaction Questionnaire (InCaSa-Q). The difference in total score was analyzed using a mixed linear model. Furthermore, preference for IC (single-use vs. reusable) was assessed and microbial evaluation of the catheters was performed.

Results: The total ISC-Q score measuring HR-QoL decreased significantly by 28% (p < 0.001). Two of the four subdomains (ease-of-use and discreetness) also decreased significantly (p < 0.001). The total InCaSa-score and all four subdomains evaluating satisfaction decreased significantly (p < 0.005). The primary study results were supported by the fact that 90.9% of subjects preferred to use a single-use catheter for IC. Furthermore, 50% of reusable catheters were contaminated with bacteria.

Conclusion: Switching from single-use to reusable IC resulted in a significant decrease in HR-QoL and satisfaction. Moreover, the vast majority preferred the single-use catheter due to handling and convenience. The users' rights to their preferred bladder management method should be acknowledged.

Julie Schnipper1, Nessn Azawi2, Zenia Størling1, Kenneth Starup Simonsen1, Karin Andersen3

  1. Clinical Strategies, Coloplast A/S, Humlebæk, Denmark.
  2. Department of Urology, Sjællands Universitetshospital, Roskilde, Denmark.
  3. Department of Urology, Odense Universitetshospital, Odense, Denmark.
Source: Julie Schnipper, Nessn Azawi, Zenia Størling et al. Switching from intermittent catheterization with single-use catheter to a reusable catheter has a negative impact on quality of life. Neurourol Urodyn. 2024 Nov;43(8):2169-2177. doi: 10.1002/nau.25556.

Urinary Catheter Management.

Family physicians often treat patients who require urinary management with the use of external urinary devices, clean intermittent catheterization, or indwelling urinary catheterization. External urinary devices are indicated for urinary incontinence (postvoid residual less than 300 mL), urine volume measurement for hospitalized patients, nonsterile urine diagnostic testing, improved comfort for patients in hospice or palliative care, and fall prevention for high-risk patients.

A Narrative Review of Micro-hole Zone Technology: An innovation in clean intermittent self-catheterisation

Clean intermittent self-catheterisation (CISC) is a very common and largely well-tolerated intervention for people with neurological and urological voiding dysfunction; however, catheter-associated urinary tract infections (CAUTIs) are a troublesome and potentially major complication. The main risk factors predisposing to CAUTI associated with CISC are poor patient compliance, failure to achieve complete bladder emptying resulting in residual urine, and microtrauma during catheterisation, potentially weakening the bladder’s defences against UTI. An innovative development in the design of CISC catheters is Micro-hole Zone Technology (MHZT) used in the novel Luja™ CISC catheter, which aims to overcome some of the problems associated with conventional CISC catheters. Through a narrative review of the literature undertaken by a multi-disciplinary panel of experts, specialists and patient advocate, who reviewed all major factors contributing to CAUTI and the potential benefits of MHZT catheters over conventional two-eyelet CISC catheters (CECs). MHZT catheters potentially confer the following advantages over CECs in male and female patients: (1) more effective bladder drainage in one continuous flow; (2) reduced risk of blockages by preventing the occlusion of the catheter end-eyelets by bladder mucosa; (3) reduced risk of bladder mucosal microtrauma; and (4) reduced intra-catheter pressure if any flow stop occurs, hence minimising the unpleasant dragging sensation. These benefits are likely to improve the patient’s comfort, quality of life and compliance. However, the panel acknowledged the lack of robust clinical data as to whether MHZT catheters reduced the incidence of CAUTI. Hence, comparative studies between MHZT and CECs are needed before definitive conclusions can be drawn.

Thomas B.L. Lama,b, Altaf Mangerac, Paul Abramsd,e,f, Mohammed Belalg,h, Carmel Curtisi, Jacqueline Emkesj,k, Jonathan Charles Goddard,l, Sarah Hillerym,n, Karen Irwino, Karen Loganp, Nikesh Thiruchelvamq, Polly Westonr,s, Ann Yatest, Christopher Chappleu,v,w

  1. Aberdeen Royal Infirmary, Aberdeen, UK
  2. Academic Urology Unit, University of Aberdeen, Aberdeen, UK
  3. Spinal Injuries Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  4. University of Bristol, Bristol, UK
  5. Bristol Urological Institute, Southmead Hospital, Bristol, UK
  6. Bristol Health Research Charity, Bristol, UK
  7. University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  8. The British Association of Urological Surgeons, London, UK
  9. King’s College Hospital NHS Foundation Trust, London, UK
  10. National Bladder and Bowel Health Project NHS England and Excellence in Continence Care Board – Chair Patient and Carer forum, Manchester, UK
  11. Bladder Health UK, Birmingham, UK
  12. Leicester General Hospital, Leicester, UK
  13. York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
  14. The British Association of Urological Nurses, Bathgate, UK
  15. Bladder & Bowel UK, Manchester, UK
  16. Aneurin Bevan University Health Board, Newport, UK
  17. Addenbrooke’s Hospital, Cambridge, UK
  18. University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, UK
  19. Association for Continence Professionals, Bathgate, UK
  20. Cardiff & Vale University Health Board, Cardiff, UK
  21. Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  22. University of Sheffield, Sheffield, UK
  23. Sheffield Hallam University, Sheffield, UK
Source: Thomas B.L. Lam, Altaf Mangera, Paul Abrams, Mohammed Belal, Carmel Curtis, Jacqueline Emkes, Jonathan Charles Goddard, Sarah Hillery, Karen Irwin, Karen Logan, Nikesh Thiruchelvam, Polly Weston, Ann Yates, Christopher Chapple, A Narrative Review of Micro-hole Zone Technology: An innovation in clean intermittent self-catheterisation, Continence, Volume 11, 2024, 101332, ISSN 2772-9737, https://doi.org/10.1016/j.cont.2024.101332.

Bladder irrigation with tap water to reduce antibiotic use for urinary tract infections in catheter users.

To evaluate the safety and effectiveness of bladder irrigation (BI) with tap water to reduce antibiotic use for the treatment of urinary tract infections (UTIs) in patients with recurrent UTI symptoms and to assess the treatment satisfaction of BI.

Cross-cultural adaptation and psychometric properties of the Chinese version of the Intermittent Self-Catheterization Questionnaire (ISC-Q).

The intermittent self-catheterization questionnaire (ISC-Q) is a valid and reliable tool to assess the quality of life (QOL) in patients with neurogenic lower urinary tract dysfunction (NLUTD) who engage in ISC.

Intermittent Self-catheterization for Bladder Dysfunction After Deep Endometriosis Surgery: Duration and Factors that Might Affect the Recovery Process

Study objective: To assess the duration needed for regaining normal bladder voiding function in patients with postoperative bladder dysfunction requiring intermittent self-catheterization after deep endometriosis surgery and identify risk factors that might affect the recovery process.

Design: Retrospective study based on data recorded in a large prospective database.

Setting: Endometriosis referral center.

Patients: From September 2018 to June 2022, 1900 patients underwent excision of deep endometriosis in our center; 61 patients were discharged with recommendation for intermittent self-catheterization and were thus included in the study.

Interventions: Intermittent self-catheterization after endometriosis surgery.

Measurements and main results: A total of 43 patients (70.5%) stopped self-catheterization during the follow-up period. Median follow-up was 25 weeks (range, 7-223 wk). Surgery was performed laparoscopically in 48 patients (78.7%) and robotically in 13 (21.3%); 47 patients (77%) had nodules involving the digestive tract, 11 (18%) had urinary tract involvement, 29 had parametrial nodules (47.5%), and 13 (21.3%) had sacral plexus involvement. The probability of bladder voiding function recovery and arrest of self-catheterization was 24.5%, 54%, 59%, 72%, and 77% at 4, 8, 12, 52, and 78 weeks, respectively. Cox's multivariate model identified preoperative bladder dysfunction as the only statistically significant independent predictor for arrest of self-catheterization (hazard ratio, 0.36; 95% confidence interval, 0.15-0.83).

Conclusion: Patients requiring intermittent self-catheterization for bladder dysfunction after deep endometriosis excision may spontaneously recover bladder function in 77% of cases. Symptoms suggesting preoperative bladder voiding dysfunction should be reviewed before planning surgery, and patients should be informed of the higher postoperative risk of long-term bladder voiding dysfunction.

Sari Boulus,1 Benjamin Merlot,2 Isabella Chanavaz-Lacheray,1 Sophia Braund,3 Sandesh Kade,4 Thomas Dennis,1 Horace Roman5

  1. Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos (Drs. Boulus, Merlot, Chanavaz-Lacheray, Dennis, and Roman), Bordeaux, France.
  2. Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos (Drs. Boulus, Merlot, Chanavaz-Lacheray, Dennis, and Roman), Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic (Drs. Merlot, Kade, and Roman), Burjeel Medical City, Abu Dhabi, United Arab Emirates.
  3. Expert Center in Multidisciplinary Endometriosis Management (Dr. Braund), Rouen University Hospital, Rouen, France.
  4. Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic (Drs. Merlot, Kade, and Roman), Burjeel Medical City, Abu Dhabi, United Arab Emirates.
  5. Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos (Drs. Boulus, Merlot, Chanavaz-Lacheray, Dennis, and Roman), Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic (Drs. Merlot, Kade, and Roman), Burjeel Medical City, Abu Dhabi, United Arab Emirates; Department of Gynecology and Obstetrics (Dr. Roman), Aarhus University Hospital, Denmark. Electronic address: .
Source: Boulus S., Merlot B., Chanavaz-Lacheray I. et al. Intermittent Self-catheterization for Bladder Dysfunction After Deep Endometriosis Surgery: Duration and Factors that Might Affect the Recovery Process. J Minim Invasive Gynecol. 2024 Apr;31(4):341-349. doi: 10.1016/j.jmig.2024.01.014.

Evaluating the impact of a new clean intermittent self-catheterisation device: experiences of male patients.

Urinary incontinence is common and has many causes. A main one is urinary retention, and clean intermittent self-catheterisation is the gold standard for managing it. There are, however, complications associated with performing this, which affect patient experience, quality of life and compliance with the procedure.

Intermittent catheterisation.

When an individual has voiding difficulties, the person may require a urinary catheter. Enabling the person to choose an appropriate method of catheterisation and supporting them can have an enormous impact on the individual's health and wellbeing.

Real-World Experience and Complications with Intermittent Balloon Catheters : A Predictor Analysis.

Intermittent balloon catheterization with a reusable and temporary balloon catheter that could be implanted and removed by the patient was developed in Japan in 1995. Although the intermittent balloon catheter has the potential to improve the patient's quality of life (QOL), appropriate information and guidelines are needed to prevent complications such as hematuria and urinary tract infection.

The bacterial displacement test: an in vitro microbiological test for the evaluation of intermittent catheters and urinary tract infection.

Intermittent catheters (ICs) are commonly used in bladder management but catheter-associated urinary tract infections (CAUTIs) remain challenging. Insertion tips may reduce the risk of CAUTIs by minimizing bacterial transfer along the urinary tract.

Evaluating the effectiveness of early urethral catheter removal combined with intermittent catheterization for promoting early recovery of bladder function after laparoscopic radical hysterectomy: a study protocol for a randomized controlled trial.

Bladder dysfunction, notably urinary retention, emerges as a significant complication for cervical cancer patients following radical hysterectomy, predominantly due to nerve damage, severely impacting their postoperative quality of life.

Initial Antimicrobial Testing of a Novel Reusable Intermittent Urinary Catheter System and Catheter Reprocessing Device.

To evaluate the efficacy of the Aurie System, a preclinical prototype allowing for standardized intermittent catheter (IC) reuse of novel reusable no-touch ICs. Individuals with neurogenic bladder often require single-use ICs to urinate, but urinary tract infection (UTI) is a common cause of morbidity for IC users.

Can we define the optimal postvoid residual volume at which intermittent catheterization should be recommended, and are there other measures that could guide an intermittent catheterization protocol: ICI‐RS 2023

Aims: The postvoid residual (PVR) volume of urine in the bladder is widely used in clinical practice as a guide to initiate treatment, including clean-intermittent self-catheterization (CISC). It is often believed that an elevated PVR causes complications such as recurrent urinary tract infections (UTI) and renal failure. However, evidence for this is limited and identifying alternative measures to guide treatment decisions may optimize patient care. At the International Consultation on Incontinence Research Society (ICI-RS) meeting in 2023 a Think Tank addressed the question of whether we can define the optimal PVR at which CISC should be recommended, and whether there are other measures that could guide a CISC protocol.

Methods: The Think Tank conducted a literature review and expert consensus meeting focusing on current limitations in defining and measuring PVR, and highlighting other measures that may optimize selection for, and persistence with, CISC.

Results: There is no consensus on the threshold value of PVR that is considered “elevated” or “significant.” There is a lack of standardization on terminology, and the normal range of PVR in different populations of different ages remains to be well-studied. The measurement of PVR is influenced by several factors, including intraindividual variation, timing and method of measurement. Furthermore, the evidence linking an elevated PVR with complications such as UTI and renal failure is mixed. Other measures, such as bladder voiding efficiency or urodynamic parameters, may be better at predicting such complications, and therefore may be more relevant at guiding a CISC protocol.

Conclusions: There is a lack of high quality evidence to support PVR as a predictor for complications of UTI or renal failure. Threshold values for normal PVR in different populations are unknow, and so threshold values for “elevated” or “significant” PVR cannot be determined. Other factors, such as urodynamic findings, may be better at predicting complications and therefore guiding management decisions, and this remains to be studied. Areas for further research are proposed.

Sachin Malde,1 Mo Belal,2 Rayan Mohamed‐Ahmed,3 William Gibson,4 Barbara Padilla‐Fernandez,5 Angela Rantell,3 Caroline Selai,6 Eskinder Solomon,1 Paul Abrams7

  1. Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
  2. Department of Urology, Queen Elizabeth Hospital, Birmingham, UK
  3. Department of Urogynaecology, King's College Hospital, London, UK
  4. Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
  5. Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
  6. Department of Uro‐Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
  7. Bristol Urological Institute, Bristol, UK
Source: Malde S, Belal M, Mohamed‐Ahmed R, et al. Can we define the optimal postvoid residual volume at which intermittent catheterization should be recommended, and are there other measures that could guide an intermittent catheterization protocol: ICI‐RS 2023. Neurourol Urodyn. 2024;43: 1353‐1362. doi:10.1002/nau.25324.

Intermittent Catheterization Continuity Care on Bladder Function Recovery and Quality of Life in Patients After Radical Hysterectomy for Cervical Cancer: A Quasi-Experimental Study.

Bladder dysfunction is a common complication following radical hysterectomy, affecting patients' QOL. Exploring interventions, particularly IC continuity care, is crucial for identifying strategies to enhance postoperative outcomes.

Reduction in lower urinary tract mucosal microtrauma as an effect of reducing eyelet sizes of intermittent urinary catheters.

Intermittent catheterization (IC) utilizing conventional eyelets catheters (CECs) for bladder drainage has long been the standard of care. However, when the tissue of the lower urinary tract comes in close proximity to the eyelets, mucosal suction often occurs, resulting in microtrauma.

Analysis of the urine flow characteristics inside catheters for intermittent catheter selection.

In this study, we conducted a numerical analysis on catheter sizes using computational fluid dynamics to assess urinary flow rates during intermittent catheterization (IC). The results revealed that the fluid (urine) movement within a catheter is driven by intravesical pressure, with friction against the catheter walls being the main hindrance to fluid movement.

Comparing an Integrated Amphiphilic Surfactant to Traditional Hydrophilic Coatings for the Reduction of Catheter-Associated Urethral Microtrauma.

Hydrophilic-coated intermittent catheters have improved the experience of intermittent urinary catheterization for patients compared to conventional gel-lubricated uncoated catheters. However, the incorporation of polyvinylpyrrolidone (PVP) within hydrophilic coatings can lead to significant issues with coating dry-out.

Perspectives on technology: Single-use catheters – evidence and environmental impact

Objective: To explore the data comparing single- vs multi-use catheters for clean intermittent catheterisation (CIC), consider if the widespread use of single-use catheters is warranted given the cost and environmental impact, and put forth ideas for future consideration.

Methods: A primary literature review was performed in PubMed over the past 50 years. Studies that performed comparative analysis of single- and multi-use catheters were included in our review. All studies that reported on primary data were narratively summarised.

Results: A total of 11 studies were identified that reported on primary data comparing single- and multi-use catheters. There was no appreciable evidence suggesting reusable multi-use catheters were inferior to single-use catheters from an infection or usability standpoint. In addition, the environmental and monetary burden of single-use catheters is significant.

Conclusions: The intermittent catheter landscape in the USA has a complex past: defined by policy, shaped by industry, yet characterised by a paucity of data demonstrating superiority of single-use over multi-use catheters. We believe that the aversion to reusable catheters by many patients and healthcare professionals is unwarranted, especially given the cost and environmental impact. Moving forward, better comparative data and more sustainable practices are needed.

Calvin C. Zhao,1 Craig V. Comiter,1 Christopher S. Elliott1,2

  1. Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
  2. Division of Urology, Santa Clara Valley Medical Center, San Jose, CA, USA
Source: Calvin C. Zhao, Craig V. Comiter, Christopher S. Elliott. Perspectives on technology: Single-use catheters – evidence and environmental impact. BJU International. 2024.  https://doi.org/10.1111/bju.16313.