Page 1 - CUAJ February 2019: Clean intermittent catheterization: Single use vs. reuse

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REVIEW

Clean intermittent catheterization: Single use vs. This article is CUA-accredited
for Section 3 credits of the
reuse MOC Program of the RCPSC.
Go to www.cuaj.ca for details.

Seyed Hossein Saadat, MD ; Shaun Shepherd, MSc ; Brandon Van Asseldonk, MD ; Dean S. Elterman, MD 1
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1 Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada

Cite as: Can Urol Assoc J 2019;13(2):64-9. http://dx.doi.org/10.5489/cuaj.5357 For those electing to perform IC, there are two main
options: either the traditional reuse of catheters with a form
of cleaning between uses or single-use catheterization.
Published online July 31, 2018 Single-use catheters can be either uncoated (UC), such as
those made of polyvinyl chloride (PVC), or they can be
Abstract coated with hydrophilic or gel coverings. The main argu-
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ments in choosing between these options are risk of urinary
Introduction: Intermittent catheterization (IC) is one of the funda- tract infections (UTIs), uncertain cleaning methods, social
mental aspects of managing patients with chronic urinary retention. issues, and finally the cost and quality of life (QoL). 1,4
Although reuse of catheters has been allowed to be chosen as the Although single-use catheters have been introduced to
first option for IC, the optimal method of IC and the type of cath- decrease the risk of urethral trauma and UTI, 5-8 compar-
eter has been a long-standing debate. We conducted a literature ing their outcomes with those of reusable catheters can be
review regarding risk of urinary tract infection (UTI) and the costs
associated with different methods and catheters. challenging. The difficulty in making a proper comparison
Methods: A MEDLINE search via PubMed, EMBASE, and EBSCO between different methods of catheterization results from
host was conducted in March 2018. The date of publication was inconsistency of the literature regarding study population,
limited to 2014 to present/current. UTI definition, type of catheter, cleaning methods, and fre-
Results: Single use of catheters (hydrophilic-coated [HC] or uncoat- quency of catheterization per day. Furthermore, lack of long-
ed [UC]) was considered to impose a lower risk of UTI in all studies, term followup makes the decision-making more challeng-
except in one study that included children, but did not test their ing. 4,9-11 All these uncertainties have led many physicians
dexterity to handle HC catheters. Cost-effectiveness of single-use and patients to reuse catheters. 12
catheters was confirmed by all studies during this period. In 2014, a Cochrane systematic review was published
Conclusions: Reuse of catheters exposes the patient to a plethora of by Prieto et al and supported the reuse of catheters. The
possible cleaning techniques and duration of catheter use. Patient authors concluded that multiple uses of a catheter does not
adherence to cleaning method cannot be predicted and this fur- 13
ther amplifies the risk of complications and their burden on the impose a higher risk of UTI compared to single use. Since
healthcare system. We recommend a patient-centred approach then, not only has more data become available, but also
to consider HC catheters as the first option, while considering the abovementioned Cochrane review was withdrawn from
the patient’s/caregiver’s ability to accommodate the usage tech- publication due to an independent appraisal, which identi-
nique. Single-use UC catheters, and finally reuse of catheters are fied crucial discrepancies within this publication. 14,15
considered as next options if HC catheters are found difficult to In order to draw a conclusion on whether reuse of cath-
handle (especially in children doing self-catheterization). Larger eters can still be considered the first option for CIC or not,
trials investigating this matter are required. this literature review was conducted on different IC methods
regarding their risk of UTI and their associated costs.
Introduction
Methods
Intermittent catheterization (IC) is the recommended tech-
nique for bladder drainage in patients with chronic retention A MEDLINE search via PubMed, EMBASE, and EBSCO host
resulting from different causes, such as neurogenic blad- was conducted in March 2018. The following keywords
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der (NB). Ever since the landmark paper was published by were used: [(“intermittent catheterization*”) AND (reuse*
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Lapides et al showing that clean intermittent catheterization OR re-use OR single-use)] or [(“intermittent catheteriza-
(CIC) was possible, it has been widely used and preferred tion*”) AND (reuse* OR re-use OR single-use)] or [(“intermit-
to an indwelling catheter. tent catheter*”) AND (reuse* OR re-use)] or [(“intermittent

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