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CUA BEST PRACTICE REPORT

Canadian Urological Association Best Practice Report: Catheter use

Lysanne Campeau, MDCM, PhD ; Samer Shamout, MDCM, PhD ; Richard J. Baverstock, MD ;
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Kevin V. Carlson, MD ; Dean S. Elterman, MD ; Duane R. Hickling, MD ; Stephen S. Steele, MD ; Blayne Welk, MD 6
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1 Division of Urology, Department of Surgery, Montreal Jewish General Hospital, McGill University, Montreal, QC, Canada; vesia [Alberta Bladder Centre] and Division of Urology, Department of Surgery,
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University of Calgary, Calgary, AB, Canada; Division of Urology, University Health Network, Toronto, ON, Canada; Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada;
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5 Department of Urology,Queen’s University, Kingston, ON, Canada; Division of Urology, Department of Surgery, University of Western Ontario, London, ON, Canada
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Cite as: Can Urol Assoc J 2020;14(7):E281-9. http://dx.doi.org/10.5489/cuaj.6697 data obtained from numerous published meta-analyses and
original studies identified through a literature search using
PubMed, Medline, and the Cochrane Library database. The
Published online May 8, 2020 bibliographies of relevant articles were also searched to avoid
exclusion of important studies. The following narrative review
concentrates on systematic reviews, related guidelines, and
Introduction comparative studies. Articles included in this statement were
reviewed using methodology consistent with the Grading of
Catheters are widely used for urinary retention or incon- Recommendations Assessment, Development, and Evaluation
tinence and neurogenic lower urinary tract dysfunction (GRADE) for evidence synthesis and recommendations.
(NLUTD). This includes intermittent catheterization (IC),
indwelling urethral catheters, and suprapubic catheters. Both 1. Types of catheters
intermittent and indwelling catheterization provide means
for long-term, effective urinary drainage with the aim to The indications for urinary catheterization may be prolonged
protect the upper urinary tract, improve urinary continence, and sometimes irreversible (Table 1). There are two important
and minimize urinary tract complications. However, urinary populations that tend to require catheters. First, approxi-
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catheters can be associated with an increased risk of urinary mately 5–10% of residents of long-term care facilities in
tract infections, incontinence, calculi, and compromised kid- Canada have bladder dysfunction managed with chronic
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ney function. catheterization. Second, people with NLUTD from a neu-
IC is generally the gold standard method of bladder rologic lesion may need catheters because of failure to store
drainage. Although technology has progressed in the field and/or empty urine from the bladder (which results in incon-
of catheter design, material, and technique, there is lim- tinence and/or urinary retention).
ited high-quality evidence and few good practice recom-
mendations around catheter usage in chronic conditions 1.1. Indwelling catheterization (urethral or suprapubic)
such as NLUTD. Our objective was to review the evidence
around the use of long-term urinary catheters in patients with Optimal bladder management is selected according to ana-
chronic conditions and make practice recommendations for tomical factors and patients’ preferences. Indwelling cath-
physicians in Canada who manage catheters in this popula- eters are often used initially after a spinal cord injury (SCI),
tion. We pay specific attention to the current best evidence however, patients are recommended to transition to IC if
of the available techniques, design, material, and practices possible. Despite the problems associated with indwelling
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of intermittent self-catheterization and its position in the catheters, many patients with a SCI adopt these catheters
treatment pathway. over time. Long-term use of indwelling catheters is often rec-
ommended as the last resort, except for quadriplegic patients
Methods with impaired dexterity or those who are bedridden, or in
situations where IC is difficult or impossible.
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This best practice report provides a brief and comprehensive Suprapubic catheterization (SPC) offers certain advan-
discussion of studies examining catheter management for tages compared to urethral catheters: it may improve inde-
impaired bladder emptying in the setting of neurogenic and pendence, facilitate engagement in sexual activities, and
non-neurogenic lower urinary tract dysfunction. It is based on decrease the risk of epididymitis. Some studies have sug-
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