Catheter policies for management of long term voiding problems in adults with neurogenic bladder disorders
Abstract
Background
Management of the neurogenic bladder has the primary objectives of maintaining continence, ensuring low bladder pressure (to avoid renal damage) and avoiding or minimising infection. Options include intermittent urethral catheterisation, indwelling urethral or suprapubic catheterisation, timed voiding, use of external catheter (for men), drug treatment, augmentation cystoplasty and urinary diversion.
Objectives
To assess the effects of using different types of urinary catheters and external (sheath) catheters in managing the neurogenic bladder, compared to alternative management strategies or interventions.
Search methods
We searched the Cochrane Incontinence Group Specialised Register (searched 1 November 2011), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and CINAHL, and handsearching of journals and conference proceedings. We sought additional trials from other sources such as reference lists of relevant articles and contacting consultants in Spinal Cord Injury Centres throughout the United Kingdom.
Selection criteria
All randomised and quasi‐randomised controlled trials comparing methods of using catheters to manage urinary voiding in people with neurogenic bladder.
Data collection and analysis
Abstracts were independently inspected by the reviewers and full papers were obtained where necessary.
Main results
Approximately 400 studies were scrutinised. No trials were found that met the inclusion criteria, and five studies were excluded from the review.
Authors' conclusions
Despite a comprehensive search no evidence from randomised or quasi‐randomised controlled trials was found. It was not possible to draw any conclusions regarding the use of different types of catheter in managing the neurogenic bladder.
PICO
Plain language summary
Catheter policies for management of long term voiding problems in adults with nerve damage affecting the bladder
People with nerve damage affecting the bladder may have incontinence (leakage of urine) or an inability to empty the bladder (voiding problem). This may cause infections or damage to the kidneys. Treatments include a permanent urinary catheter, using a catheter intermittently whenever the bladder needs to be emptied, an external sheath catheter fitted to the penis, or timed voiding which involves regular emptying of the bladder at timed intervals. Although all these methods are used in practice, the review found that there have not been any randomised trials to provide good evidence to suggest which is best and in which circumstances.
