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Campeau et al

Impact of IC catheter type and material on urethral trauma 2.2.2. Urethral strictures

Hydrophilic vs. uncoated catheters The repetitive trauma of IC may lead to urethral stricture
formation. The occurrence of strictures in this population
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There are six RCTs assessing hematuria in patients using has been estimated to be anywhere from 4.2% to as high
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either hydrophilic or standard PVC catheters. 19,29-33 Only as 25%. Due to the length of time often required for stric-
one of the RCTs identified a significant decrease in gross ture formation in this population, the available literature is
bleeding episodes with a hydrophilic catheter vs. a PVC limited. The paucity of information makes direct comparison
catheter. This difference was not reported in any of the of PVC, hydrophilic, and prelubricated catheters extremely
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other RCTs. 19,29-31,33 However, three RCTs identified a signifi- challenging. Five studies were identified in the literature
cant decrease in microscopic hematuria in patients using a that looked at stricture formation in the IC population. 19,37-40
hydrophilic catheter vs. non-hydrophilic catheter, with an
unknown clinical significance. 30,31,33 Impact of catheter type and material on urethral strictures

Hydrophilic vs. hydrophilic Hydrophilic vs. uncoated catheters

Three RCTs directly compared different types of hydro- Though the data on microscopic hematuria, bleeding epi-
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philic catheters. (Speedicath , Lofric , Easicath , and sodes, and epithelial cell counts would seem to indicate
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Flocath ). 21,34,35 No difference was seen with regards to increased trauma with the non-hydrophilic catheters, and thus
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microscopic or macroscopic hematuria. However, one study increased stricture formation, this in not actually reflected in
demonstrated a significantly higher withdrawal friction force the available literature. Four of the studies did not identify any
with Lofric vs. Speedicath using number of epithelial cells on difference in the rate of stricture formation between hydro-
the catheter after removal as a marker of urethral trauma. 34 philic and non-hydrophilic catheters. 19,38-40 The other study
did not look at a direct comparison of the two. 37
Prelubricated vs. non-prelubricated catheters
Catheter size
Two RCTs were identified in the literature comparing prelu-
bricated (Instacath) vs. uncoated PVC catheters. 22,36 In both Only one study compared stricture formation between two
studies, the results demonstrated that a gel-lubricated, non- different catheter sizes. There was no significant difference
hydrophilic catheter was superior to the PVC catheter in terms in urethral stricture rate between two most frequently used
of microscopic hematuria and epithelial cell counts. 22,36 catheter sizes (12 and 14 Fr).
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Impact of IC catheterization technique on urethral trauma Summary

Catheter practices (single-use vs. reuse) Urethral stricture formation is a complex process and trying
to isolate which catheter type may predispose to stricture
Vapnek el al compared hydrophilic-coated catheters (single-use) formation is difficult. Many of the patients in these trials
vs. PVC catheters (multiple use) and reported significant less have had indwelling catheters for substantial periods of time
hematuria in the hydrophilic-coated group (27% HC vs. 35% early in their treatment, which potentially could have an
PVC). However, this comparison includes two variables (cath- effect on subsequent rates of stricture formation. In addition,
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eter coating and reuse), which makes interpretation difficult. patients in these trials are using various sizes of catheters
and may have varying degrees of detrusor sphincter dys-
Summary synergia or prostatic enlargement, which may contribute
to catheter trauma. Though hydrophilic catheters appear to
Hydrophilic catheters may cause less urethral trauma with cause less urethral trauma, there is no data to indicate there
decreased microscopic hematuria, decreased bleeding epi- is a decreased rate of urethral strictures based on the type
sodes, and fewer epithelial cells on the removed catheter. or size of catheter used for IC.
There is no clear advantage of one hydrophilic catheter vs.
another in the literature. Furthermore, evidence concerning 3. Patient perspective
catherization practices (single-use vs. multiple-use) is inad-
equate and biased by the use of different catheter materi- IC enhances both bladder-emptying and storage function,
als. The information is still limited, and further studies are relieving associated symptoms that would otherwise impair
needed in order to enhance the data on this issue. quality of life (QOL). Furthermore, IC lessens restrictions
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E284 CUAJ • July 2020 • Volume 14, Issue 7