Long‐term bladder management by intermittent catheterisation in adults and children

Katherine N Moore; Mandy Fader; Kathryn Getliffe

doi:10.1002/14651858.CD006008.pub2

Tratamiento vesical a largo plazo con sondaje intermitente en adultos y niños

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Referencias

Referencias de los estudios incluidos en esta revisión

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Day RA, Moore KN, Alberts MK. A pilot study comparing two methods of intermittent catheterization: Limitations and challenges. Urologic Nursing 2003;23(2):143‐7,158.

De Ridder DJMK, Everaert K, Fernandez LG, Valero JVF, Duran AB, Abrisqueta MLJ, et al. Intermittent catheterisation with hydrophilic‐coated catheters (Speedicath) reduces the risk of clinical urinary tract infection in spinal cord injured patients: a prospective randomzied parallel comparative trial. European Urology 2005;48(6):991‐5.

Duffy LM, Cleary J, Ahern S, Kuskowski MA, West M, Wheeler L, et al. Clean intermittent catheterization: Safe, Cost‐effective bladder management for male residents of VA nursing homes. Journal of the American Geriatrics Society 1995;43(8):865‐70. [1058]

Fera P. Lubricated urethral catheters with lidocaine versus gentamycin for clean intermittent catheterization. Brazilian Journal of Urology 2002;28(1):50‐6. [18009]

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Giannantoni A, Di Stasi SM, Scivoletto G, Virgili G, Dolci S, Porena M. Intermittent catheterization with a prelubricated catheter in spinal cord injured patients: a prospective randomized crossover study. Journal of Urology 2001;166(1):130‐3. [15635]

King RB, Carlson CE, Mervine J, Wu Y, Yarkony GM. Clean and sterile intermittent catheterization methods in hospitalized patients with spinal cord injury. Archives of Physical Medicine & Rehabilitation 1992;73(9):798‐802. [1360]

Google Scholar

Moore KN, Kelm M, Sinclair O, Cadrain G. Bacteriuria in intermittent catheterization users: the effect of sterile versus clean reused catheters. Rehabilitation Nursing 1993;18(5):306‐9. [1208]

Moore KN, Burt J, Voaklander D. Clean versus sterile technique for intermittent catheterisation in rehablitiation. Clinical Rehabilitation 2006;20(6):461‐8.

Pachler J, Frimodt‐Moller C. A comparison of prelubricated hydrophilic and non‐hydrophilic polyvinyl chloride catheters for urethral catheterization. BJU International 1999;83(7):767‐9.

Pachler J, Frimodt‐Moller C. Pre‐lubricated hydrophilic pvc urethral catheters compared to non‐hydrophilic pvc catheters. Proceedings of the International Continence Society (ICS), 28th Annual Meeting; 1998 Sept 14‐17; Jerusalem, Israel1998:325. [5702]

Google Scholar

Prieto‐Fingerhut T, Banovac K, Lynne CM. A study comparing sterile and nonsterile urethral catheterization in patients with spinal cord injury. Rehabilitation Nursing 1997;22(6):299‐302. [5491]

Quigley PA, Riggin OZ. A comparison of open and closed catheterization techniques in rehabilitation patients. Rehabilitation Nursing 1993;18:26‐9,33. [2345]

Schlager TA, Clark M, Anderson S. Effect of a single‐use sterile catheter for each void on the frequency of bacteriuria in children with neurogenic bladder on intermittent catheterization for bladder emptying. Pediatrics 2001;198(4):e71.

Sutherland RS, Kogan BA, Baskin LS, Mevorach RA. Clean intermittent catheterization in boys using the LoFric catheter. Journal of Urology 1996;156(6):2041‐3. [4867]

Vapnek JM, Maynard FM, Kim J. A prospective randomized trial of the LoFric hydrophilic coated catheter versus conventional plastic catheter for clean intermittent catheterization. Journal of Urology 2003;169(3):994‐8. [15588]

Referencias de los estudios excluidos de esta revisión

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Charbonneau‐Smith R. No‐touch catheterization and infection rates in a select spinal cord injured population. Rehabilitation Nursing 1993;18:296‐9,305,355‐6. [2282]

Diokno AC, Mitchell BA, Nash AJ, Kimbrough JA. Patient satisfaction and the LoFric catheter for clean intermittent catheterization. Journal of Urology 1995;153(2):349‐51.

Medical Devices Agency. Hydrophilic coated catheters for intermittent self‐catheterisation:an evaluation. Report number IN5. London: Medical Devices Agency, 2000. [9002]

Grigoleit U, Pannek J, Stohrer M. Not provided [Der Intermittierende einmalkatheterismus]. Urologe 2006;45(2):175‐182.

Hedlund H, Hjelmas K, Jonsson O, Klarskov P, Talja M. Hydrophilic versus non‐coated catheters for intermittent catheterization. Scandanavian Journal of Urology and Nephrology 2001;35:49‐53.

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Hudson E, Murahata RI. The 'no‐touch' method of intermittent urinary catheter insertion: can it reduce the risk of bacteria entering the bladder?. Spina Cord 2005;43:611‐4.

Kovindha A, Mai W, Chiang N, Madersbacher H. Reused silicone catheter for clean intermittent catheterisation (CIC): is it safe for spinal‐cord (SCI) injured men?. Spinal Cord 2004;42(11):638‐642.

Lemke JR, Kasprowicz K, Worral PS. Intermittent catheterisation for patients with a neurogenic bladder: sterile versus clean. Journal of Nursing Care Quarterly 2005;20(4):302‐6.

Normelli H, Aaro S, Hedlund R, Svensson O, Stromberg L. Urethral catheterization in spinal surgery: A randomized prospective study. EUR SPINE J 1993;2:132‐5. [7142]

Pascoe G, Clovis S. Evaluation of two coated catheters in intermittent self‐catheterization. British Journal of Nursing 2001;10(5):325‐9. [12088]

Pickard WG, Grundy DJ. A comparison of two methods of sterile urethral catheterisation in spinal cord injured adults. Paraplegia 1996;34(1):30‐3. [2700]

Sherbondy AL, Cooper CS, Kalinowski SC, Boyt MA, Hawtrey CE. VAriability in catheter microwave sterilization techniques in a single clinic population. Journal of Urology 2002;168(2):562‐4.

Sims L, Ballard N. A comparison of two methods of catheter cleansing and storage used with clean intermittent catheterization. Rehabilitation Nursing Research 1993;2:87‐92. [2279]

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Stensballe J, Looms D, Nielsen PN, Tvede M. Hydrophilic‐coated catheters for intermittent catheterisation reduce urethral micro trauma: a prospective, randomised, participant‐blinded, crossover study of three different types of catheters. European Urology 2005;48(6):978‐83. [21523]

Terpenning MS, Allada R, Kauffman CA. Intermittent catheterization in the elderly. Journal of the American Geriatrics Society 1989;37(5):411‐6.

Koenen JH Van Kuppevelt D. Comparative randomised cross‐over evaluation of a modern catheter Speedicath with conventional catheters Lofric and Easicath. International Continence Society. Montreal Canada: ICS, 2005; Vol. Abstract 317.

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van Kuppevelt HJM, Angenot E, van Asbeck FWA, Mulder GA, Nene AV, Pons C, et al. Comparative randomised cross‐over evaluation of a modern catheter SpeediCath (trademark) with conventional catheters LoFric (trademark) and EasiCath (trademark) (Abstract). Proceedings of the 43rd Annual Meeting of the International Spinal Cord Society (ISCoS); 2004 Sept 26‐29; Athens, Greece. 2004:Poster number 77. [21318]

Google Scholar

Wu Y, Hamilton BB, Boyink MA, Nanninga JB. Reusable catheter for long‐term sterile intermittent catheterization. Arch Phys Med Rehabil 1981;62:39‐42.

Referencias de los estudios en espera de evaluación

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Cardenas DD, Hoffman JM, Kelly E. Hydrophilic catheters for the prevention of UTI: a randomized controlled trial (Abstract). Journal of Spinal Cord Medicine 2006;29(3):300‐1.

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Coloplast Denmark. A comparison of hydrophilic coated catheter (Speedicath) with single use PVC catheter (Conveen) on the incidence of UTI in SCI adults. Study in progress 2006‐2008.

Incidence of UTI in children with spina bifida using clean reused PVC or sterile single use hydrophilic catheters. Ongoing studyJanuary 2007.

Referencias adicionales

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Eckstein HB, Molyneux A. Intermittent catheterization of the bladder for neuropathic incontinence. Zeitschrift fur Kinderchirurgie 1982;37(4):143‐4.

Google Scholar

Fader M, Cottenden AM, Getliffe K. Absorbent products for light urinary incontinence in women. Cochrane Database of Systematic Reviews 2007, Issue 2. [Art. No.: CD001406. DOI: 10.1002/14651858.CD001406.pub2]

National Institute on Disability and Rehabilitation Research (NIDRR). The prevention and management of urinary tract infections among people with spinal cord injuries. National Institute on Disability and Rehabilitation Research Consensus Statement. January 27‐29, 1992. Journal of the American Paraplegia Society 1992;15(3):194‐204.

PubMed

Wyndaele JJ. Complications of intermittent catheterization: their prevention and treatment. Spinal Cord 2002;40(10):536‐41.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

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Day 2003

Methods	DESIGN: Randomised controlled trial BLINDING PROCEDURES: not stated SAMPLE CALCULATION: no (feasibility study) DURATION: 24 hours FOLLOW‐UP: 3 urine for C&S in 24 hours WITHDRAWALS/ DROPOUTS: no ITT: no GEOGRAPHICAL LOCATION: Canada SETTING: ICU
Participants	N=11 DIAGNOSIS: Neurogenic bladder due to recent SCI ELIGIBLE: 53 ENROLLED: 11 COMPLETED: 11 AGE: Adult GENDER: Male
Interventions	COATED VS UNCOATED: integrated catheter and bag system (all‐in‐one) or sterile technique with open catheter tray
Outcomes	3 urines for culture over a 24 hour period + meatal swabs
Notes	no difference between groups but sample too small and time frame too short to make any inferences
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

De Ridder 2005

Methods	DESIGN: Randomised controlled trial; ALLOCATION: done by investigator using sealed opaque envelopes. BLINDING PROCEDURES: not stated SAMPLE CALCULATION: yes DURATION: 12 months FOLLOW‐UP: Baseline, Day 15 then monthly x 12 months WITHDRAWALS/ DROPOUTS: 66 ITT: yes GEOGRAPHICAL LOCATION: Europe SETTING: rehabilitation and community
Participants	N=123 DIAGNOSIS: Neurogenic bladder due to SCI < 6 months ELIGIBLE: Unknown ENROLLED: 123 COMPLETED: 57 AGE: Adult GENDER: Male
Interventions	COATED VS UNCOATED: one catheter over another; assessed at Day 15 then monthly x 12 m.
Outcomes	Primary: UTI Secondary: haematuria strictures, convenience; 82% PVC had UTI; 64% Speedicath; no diff in haematuria.
Notes	UTI described as "clinical infection with Sx of UTI and for which treatment was prescribed", however, lab analyses did not differ between groups. significant challenges in retaining subjects illustrating the difficulty of conducting trials in this group.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Duffy 1995

Methods	DESIGN: Randomised controlled trial ALLOCATION: not described but did stratify subjects according to presence/ absence of UTI and study site. BLINDING PROCEDURES: unclear SAMPLE CALCULATION: yes post hoc DURATION: 3 months FOLLOW‐UP: days 2, 4, 6, 10, 15, 60 & 90 WITHDRAWALS/ DROPOUTS: 2 ITT: not clear GEOGRAPHICAL LOCATION: USA SETTING: 3 longterm care Veterans Administration Medical Centre Nursing Homes
Participants	N=80 DIAGNOSIS: Incomplete bladder emptying due to prostate obstruction ELIGIBLE: 203 ENROLLED: 82 COMPLETED: 80 to day 15; 39 completed to Day 90) AGE: Elderly GENDER: Male
Interventions	STERILE TECHNIQUE VS CLEAN TECHNIQUE (ALSO SINGLE VS MULTIPLE USE): sterile equipment and procedure, cleaning with betadine; Clean techique: catheter washed with soap and water and reused x 1 week.
Outcomes	Number of treatment episodes for UTI + urinalysis, and cost up to 90 days.
Notes	Some subjects had indwelling catheters prior to enrolment in the study (unstated how many); weeks to onset of symptomatic UTI was 3.11 (3.12) for Treatment and 3.5 (3.02) for control. Dropout rate high after Day 15 with only 39 completing data collection to Day 90.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Fera 2002

Methods	DESIGN: Randomised controlled trial ALLOCATION: not described BLINDING PROCEDURES: unclear SAMPLE CALCULATION: no DURATION: 4 months FOLLOW‐UP: urine culture every 3 weeks for 4 months (5 samples) WITHDRAWALS/ DROPOUTS: 0 ITT: not clear GEOGRAPHICAL LOCATION: Brazil SETTING: General School Hospital
Participants	N=20 DIAGNOSIS: Variable, mielomeningocele most common (25%) ELIGIBLE: Not stated ENROLLED: 20 COMPLETED: 20 AGE: Mixed adults and children 2‐79 years (mean not stated) GENDER: 12 male and 8 female
Interventions	OTHER STRATEGIES DESIGNED TO REDUCE INFECTION: Gentamycin cream (0.1%) versus lidocaine jelly used as separate lubricant for IC
Outcomes	Number of episodes of asymptomatic bacteriuria (>= 100,000 CFU/ml) , number of patients with symptomatic UTI
Notes	Repeated measures of asymptomatic bacteriuria reported for each participant. Final measure used in table of results. Asymptomatic bacteriuria similar in both groups 8/10 in gentamycin group 6/10 in lidocaine group. 1/10 developed symptomatic UTI in gentamycin group, 2/10 in Lidocaine group.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D ‐ Not used

Giannantoni 2001

Methods	DESIGN: Randomised controlled cross over trial BLINDING PROCEDURES: not clear SAMPLE CALCULATION: no DURATION: 7 weeks each arm FOLLOW‐UP: urine for C&S at 2, 4, 7 weeks WITHDRAWALS/ DROPOUTS: not stated ITT: unclear GEOGRAPHICAL LOCATION: Italy SETTING: Rehabilitation Hospital
Participants	N=18 DIAGNOSIS: Neurogenic bladder due to recent SCI ELIGIBLE: Unknown ENROLLED: 18 COMPLETED: 18 AGE: Adult GENDER: 16 male & 2 female
Interventions	COATED VS UNCOATED: Single use PVC (Nelaton) catheter vs pre lubricated non‐hydrophilic catheter; one catheter x 7 wks then crossover to other group.
Outcomes	UTI measured by C&S at 2, 4 & 7 weeks; Urethral wall trauma by counting cells on catheter surface; VAS re: satisfaction with catheters
Notes	UTI defined as cloudy, odourous urine, onset of UI, increase autonomic dysreflexia, pyuria, bacteriuria; SS too small to draw conclusions. Attempted randomisation concealment; higher % of UTI in PVC group; no difference in urethral cell count; Unable to use data in Table of Comparisons because of cross‐over design and no mid‐point data.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

King 1992

Methods	DESIGN: Randomised controlled trial BLINDING PROCEDURES: not clear SAMPLE CALCULATION: no DURATION: 28 days FOLLOW‐UP: daily urine dipslides WITHDRAWALS/ DROPOUTS: 11 ITT: unclear GEOGRAPHICAL LOCATION: USA SETTING: Rehabilitation Hospital
Participants	N=46 DIAGNOSIS: Neurogenic bladder due to recent SCI ELIGIBLE: 58 ENROLLED: 46 COMPLETED: 35 AGE: Adult GENDER: Male
Interventions	STERILE VS CLEAN TECHNIQUE (also Single Use vs Multiple Use) catheterisation kit and sterile single use catheter, meatus cleansed with povidone iodine. Clean technique: sterile catheter reused for one day after being washed with soap and water, non sterile gloves and container.
Outcomes	daily urine dipslides + symptomatic UTI
Notes	No statistically significant differences between urine cultures or Sx UTI; weeks to onset of UTI was 1.1 (0.87) for treatment and 1.2 (1.0) for control. Number of days in study varied from 1 to 28 with only
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Moore 1993

Methods	DESIGN: Randomised controlled cross‐over trial with each arm 6 months BLINDING PROCEDURES: not stated SAMPLE CALCULATION: No DURATION: 6 months FOLLOW‐UP: monthly WITHDRAWALS/ DROPOUTS: nil ITT: no GEOGRAPHICAL LOCATION: Canada SETTING: community
Participants	N=30 DIAGNOSIS: Neurogenic bladder due to spina bifida ELIGIBLE: Unknown ENROLLED: 30 COMPLETED: 30 AGE: Children GENDER: 15 males & 15 females
Interventions	SINGLE VS MULTI USE:sterile single use PVC or reused PVC
Outcomes	Bacteriuria > 10x3 CFU/ml obtained monthly; no difference between groups.
Notes	Symptomatic UTI defined as + symptoms; catheters washed with liquid soap and water, air dried and reused (does not indicate length of reuse); several subjects took prophylactic antibiotics.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Moore 2006

Methods	DESIGN: Randomised controlled trial ALLOCATION: by third party using sealed opaque envelopes. BLINDING PROCEDURES: Data entry blinded SAMPLE CALCULATION: yes DURATION: up to 12 months FOLLOW‐UP: weekly urinalysis WITHDRAWALS/ DROPOUTS: none ITT: yes GEOGRAPHICAL LOCATION: Canada SETTING: Rehabilitation Hospital
Participants	N=36 DIAGNOSIS: Neurogenic bladder due to recent high SCI injury; neurogenic bladder. ELIGIBLE: 50 ENROLLED: 36 COMPLETED: 36 AGE: Adult GENDER: 28 male & 8 female
Interventions	STERILE TECHNIQUE VS CLEAN TECHNIQUE Sterile single use PVC catheter with sterile technique or sterile single use PVC catheter with clean technique (clean gloves, clean container, non‐sterile wipes for cleansing pre catheterisation)
Outcomes	Days to onset of symptomatic UTI
Notes	UTI defined as >= 10x5 CFU/ml, pyuria + accompanying symptoms; no difference between groups.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Pachler 1999

Methods	DESIGN: Randomised controlled crossover trial BLINDING PROCEDURES: not stated SAMPLE CALCULATION: no DURATION: 3 weeks each arm FOLLOW‐UP: 3 weeks WITHDRAWALS/ DROPOUTS: not stated ITT: not stated GEOGRAPHICAL LOCATION: Denmark SETTING: community
Participants	N=32 DIAGNOSIS: Retention due to BPH ELIGIBLE: not stated ENROLLED: 32 COMPLETED: 32 AGE: Adult GENDER: Male
Interventions	COATED VS UNCOATED (ALSO SINGLE USE STERILE VS MULTIUSE CLEAN) hydrophilic (Lofric) single use) or PVC (multiple use) x 3 weeks each
Outcomes	Urine for C&S at baseline and each 3 week point; haematuria; responses to catheter use questionnaire
Notes	UTI defined as > 10 x 4 CFU/ml. No differences between groups in questionnaire response, bacteriuria or haematuria but short follow up and small sample size. Unable to use data in Table of Comparisons because of cross‐over design and no mid‐point data.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

PrietoFingerhut 1999

Methods	DESIGN: Randomised controlled trial BLINDING PROCEDURES: not stated SAMPLE CALCULATION: no DURATION: unclear FOLLOW‐UP: unclear WITHDRAWALS/ DROPOUTS: not stated ITT: no GEOGRAPHICAL LOCATION: USA SETTING: Rehabiltiation
Participants	N=29 DIAGNOSIS: Neurogenic bladder due to SCI ELIGIBLE: Unknown ENROLLED: 29 COMPLETED: unclear AGE: Adult GENDER: 16 male; 13 female
Interventions	SINGLE USE (STERILE) VS MULTIUSE (CLEAN) (also COATED VS UNCOATED) clean reused red rubber catheter (x 1 week) or integrated catheter + bag system
Outcomes	UTI Urine for C&S collected weekly x X wks ‐‐ unclear on study time frame or endpoint.
Notes	UTI as defined by NIDRR (1992); higher % of UTI in closed system (42% vs 29%)
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Quigley 1993

Methods	DESIGN: Randomised controlled trial BLINDING PROCEDURES: not stated SAMPLE CALCULATION: no DURATION: 4 days FOLLOW‐UP: WITHDRAWALS/ DROPOUTS: 10 ITT: GEOGRAPHICAL LOCATION: SETTING: Rehabilitation
Participants	N=30 DIAGNOSIS: Neurogenic bladder due to recent SCI or stroke ELIGIBLE: Unknown ENROLLED: 30 COMPLETED: 20 AGE: Adult GENDER: Unclear
Interventions	COATED VS UNCOATED: Integrated catheter + bag system or open sterile system
Outcomes	UTI >10x5 CFU/ml + symptoms (fever, CV or SP tenderness)
Notes	data only collected for 4 days
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Schlager 2001

Methods	DESIGN: Randomised controlled cross over. BLINDING PROCEDURES:not stated SAMPLE CALCULATION: no DURATION: each arm was 4 months FOLLOW‐UP: weekly home visit for urine for C&S, catheter count, medication use and symptoms or signs of UTI WITHDRAWALS/ DROPOUTS: none ITT: no GEOGRAPHICAL LOCATION: USA SETTING: community
Participants	N=10 DIAGNOSIS: Neurogenic bladder due to spina bifida ELIGIBLE: 12 ENROLLED:10 COMPLETED: 10 AGE: children GENDER: 4 male; 6 female
Interventions	SINGLE VS MULTIUSE sterile 1 x use PVC or reused
Outcomes	UTI weekly urine for C&S x 4 months
Notes	UTI defined as + or > than 10x4 CFU/ml plus symptoms (fever, pain, change in continence, change in colour or odour of urine); No differences between groups (2 Sx UTI each). SS too small to draw any conclusions about effectiveness. Catheter cleaning: PVC rinsed with tap water, air dried, then boiled x 3 minutes, air dried and stored in clean bag.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Sutherland 1996

Methods	DESIGN: Randomised controlled trial BLINDING PROCEDURES: not stated SAMPLE CALCULATION: No DURATION: 8 weeks FOLLOW‐UP: weekly urine C&S and microscopy x 8 weeks. WITHDRAWALS/ DROPOUTS: 3 ITT: not stated GEOGRAPHICAL LOCATION: USA SETTING: community
Participants	N=33 DIAGNOSIS: neurogenic bladder due to SCI, Hinman syndrome, spinal dysraphism; ELIGIBLE: not stated ENROLLED: 33 COMPLETED: 30 AGE: Children GENDER: Males
Interventions	SINGLE VS MULTIUSE: hydrophilic (Lofric) (single use) or PVC reused catheter. Method of cleaning catheter and length of reuse not described.
Outcomes	UTI haematuria> 3 RBC per HPF; VAS for satisfaction;
Notes	UTI defined as 10x5 CFU/ml + Sx (not defined); subjects with positive cultures were treated and reentered into the trial; no diff in bacteriuria b/w groups; haematuria lower in Lofric group but SS too small to draw conclusions and groups included gastric augmentation as well.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Vapnek 2003

Methods	DESIGN: Randomised controlled trial BLINDING PROCEDURES: not stated SAMPLE CALCULATION: no DURATION: 12 months FOLLOW‐UP: urine C&S every 3 months WITHDRAWALS/ DROPOUTS: 13 ITT: not stated GEOGRAPHICAL LOCATION: 3 sites in USA SETTING: Community
Participants	N=62 DIAGNOSIS: neurogenic bladder (cause not stated) ELIGIBLE: not stated ENROLLED: 62 COMPLETED: 49 AGE: Adult GENDER: Male
Interventions	COATED VS UNCOATED; ALSO SINGLE VS MULTIUSE: hydrophilic coated catheter (Lofric) (single use) vs PVC clean reused times 24 hours.
Outcomes	UTI; pyuria; haematuria; satisfaction.
Notes	UTI defined as 10x5 CFU/ml + at least one clinical symptom (fever, chills, malodorous urine, increased spasticity, malaise). Catheter cleaning not described; used 1 reused catheter per day. no statistically significant group differences were noted; unclear how long subjects were using IC before entering study; pre study UTI based on subject recall.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Characteristics of excluded studies [ordered by study ID]

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Study	Reason for exclusion
Charbonneau 1993	Retrospective chart review of incidence of UTI in patients using standard practice IC in rehabilitation from 1985‐1988 then evaluation of UTI in 18 subjects of a closed catheter/bag system. Not an RCT.
Diokno 1995	Patient satisfaction evaluated only; not randomized; does not evaluate UTI.
Fader 2001b	Report on study published in British Journal of Urology 2001 comparing user impressions of different hydrophilic coated catheters available on the market at the time; does not compare PVC to hydrophilic or incidence of UTI ADRIAN: ? NOT RANDOMISED?
Grigoleit 2006	Article in German; appears to be a review of catheterisation methods (based on short English Abstract)
Hedlund	Review of the literature
Hudson 2005	Laboratory study evaluating the likelihood of catheter contamination based on catheter design; did not compare incidence of UTI. Not an RCT
Kovindha 2004	Survey of catheter users who reused a silicone catheter ‐ does not compare different products or provide quantitative measure of UTI. Not an RCT
Lemke	Review article discussing various catheterisation methods.
Normelli 1993	Indwelling catheterisation vs no indwelling catheter but IC in patients undergoing spina fusion. Not a suitable comparison.
Pascoe 2001	Not an RCT
Pickard 1996	Hand washing comparison (30 s + double gloving) or 3 minutes hand to elbow + sterile gown on incidence of UTI in patients receiving indwelling catheterisation. IC not used.
Sherbondy 2002	Survey of individuals using intermittent catheterisation and reusing the catheter. Not an RCT.
Sims 1993	Chart review of two difference cleaning methods and comparison of UTI (wash with soap and water then soak in povidone iodine or allow to air dry) . Not an RCT.
Stensballe 2005	Laboratory evaluation of friction force of 2 hydrophilic catheters and one non‐hydrophilic catheter. Not an RCT.
Terpenning 1989	Observational study of the incidence and time to onset of UTI in elderly in a Veterans Administration Centre (USA). Not an RCT.
van Kuppevelt 2004	Abstract in ICS 2004 unpublished proceedings. Unable to reach author for further information on the study. No usable data.
Wu 1981	Case report of one type of catheter proposed by the authors "Wu Reusable Catheter". Not an RCT.

Characteristics of ongoing studies [ordered by study ID]

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estudios excluidos

Coloplast A/S

Trial name or title	Multicentre trial comparing occurrence of UTI in patients with SCI using either coated or uncoated intermittent catheterisation
Methods
Participants	newly SCI adults requiring self or health care provider intermittent cahteterisation
Interventions	randomized to sterile single use PVC or sterile single use hydrophilic catheters (Speedicath)
Outcomes	incidence of symptomatic UTI, haematuria, satisfaction with products by subject and staff; antibiotic use; appointments missed
Starting date	July 2006
Contact information	Darin Hurninan Coloplast Canada
Notes

Moore KN 2007

Trial name or title	Incidence of UTI in children with spina bifida using clean reused PVC or sterile single use hydrophilic catheters
Methods
Participants	children with spina bifida requiring intermittent catheterisation
Interventions	sterile single use hydrophilic or standard care (clean reused PVC catheter)
Outcomes	incidence of symptomatic UTI; haematuria; antibiotic use, days missed from school, physician appointments, subject satisfaction
Starting date	January 2007
Contact information	Katherine Moore University of Alberta, Canada
Notes

Data and analyses

Open in table viewer

Comparison 1. Sterile technique versus clean technique

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Number with asymptomatic bacteriuria Show forest plot	1	36	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.47, 2.03]
Open in figure viewer Analysis 1.1 Comparison 1 Sterile technique versus clean technique, Outcome 1 Number with asymptomatic bacteriuria.
1.1 uncoated (sterile catheter) both arms	1	36	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.47, 2.03]
1.2 single use (uncoated, sterile catheter) versus multiple use (uncoated, clean catheter)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Number with symptomatic UTI Show forest plot	3		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.2 Comparison 1 Sterile technique versus clean technique, Outcome 2 Number with symptomatic UTI.
2.1 uncoated (sterile catheter) both arms	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 single use (uncoated, sterile catheter) versus multiple use (uncoated, clean catheter)	2		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Number with urethral trauma/bleeding	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.1 uncoated (sterile catheter) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Number with stricture formation	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.1 uncoated (sterile catheter) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Number with microscopic haematuria	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.1 uncoated (sterile catheter) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Number with urethritis, epididymitis, or orchitis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.1 uncoated (sterile catheter) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Weeks to onset of symptomatic UTI Show forest plot	3		Mean Difference (IV, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.7 Comparison 1 Sterile technique versus clean technique, Outcome 7 Weeks to onset of symptomatic UTI.
7.1 uncoated (sterile catheter) both arms	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.2 single use (uncoated) versus multiple use (uncoated)	2		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Number reporting satisfaction with catheter product	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.1 uncoated (sterile catheter) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Number reporting comfort and ease of insertion	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.1 uncoated (sterile catheter) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Number reporting preference	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.1 uncoated (sterile catheter) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Open in table viewer

Comparison 2. Coated versus uncoated catheter

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Number with asymptomatic bacteriuria Show forest plot	1	11	Risk Ratio (M‐H, Fixed, 95% CI)	0.17 [0.01, 2.92]
Open in figure viewer Analysis 2.1 Comparison 2 Coated versus uncoated catheter, Outcome 1 Number with asymptomatic bacteriuria.
1.1 sterile technique and catheter (both arms)	1	11	Risk Ratio (M‐H, Fixed, 95% CI)	0.17 [0.01, 2.92]
1.2 clean technique (sterile catheter) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Number with symptomatic UTI Show forest plot	4		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.2 Comparison 2 Coated versus uncoated catheter, Outcome 2 Number with symptomatic UTI.
2.1 sterile technique and catheter (both arms)	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 sterile catheter (clean technique) both arms	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	2		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Number with urethral trauma/bleeding	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.1 sterile technique and catheter (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.2 sterile catheter (clean technique) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Number with stricture formation Show forest plot	1	58	Risk Ratio (M‐H, Fixed, 95% CI)	3.92 [0.17, 92.43]
Open in figure viewer Analysis 2.4 Comparison 2 Coated versus uncoated catheter, Outcome 4 Number with stricture formation.
4.1 sterile technique and catheter (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 sterile catheter (clean technique) both arms	1	58	Risk Ratio (M‐H, Fixed, 95% CI)	3.92 [0.17, 92.43]
4.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Number with microscopic haematuria Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.5 Comparison 2 Coated versus uncoated catheter, Outcome 5 Number with microscopic haematuria.
5.1 sterile technique and catheter (both arms)	0		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.2 sterile catheter (clean technique) both arms	0		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Number with urethritis, epididymitis, or orchitis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.1 sterile technique and catheter (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.2 sterile catheter (clean technique) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Weeks to onset of symptomatic UTI	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.1 sterile technique and catheter (both arms)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.2 sterile catheter (clean technique) both arms	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Number reporting satisfaction with catheter product	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.1 sterile technique and catheter (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.2 sterile catheter (clean technique) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Number reporting comfort and ease of insertion	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.1 sterile technique and catheter (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.2 sterile catheter (clean technique) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Number reporting preference Show forest plot	1	58	Risk Ratio (M‐H, Fixed, 95% CI)	1.70 [0.73, 3.93]
Open in figure viewer Analysis 2.10 Comparison 2 Coated versus uncoated catheter, Outcome 10 Number reporting preference.
10.1 sterile technique and catheter (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.2 sterile catheter (clean technique) both arms	1	58	Risk Ratio (M‐H, Fixed, 95% CI)	1.70 [0.73, 3.93]
10.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

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Comparison 3. Single use (sterile) versus multiple use (clean) catheter

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Number with asymptomatic bacteriuria Show forest plot	1	66	Risk Ratio (M‐H, Fixed, 95% CI)	1.06 [0.66, 1.72]
Open in figure viewer Analysis 3.1 Comparison 3 Single use (sterile) versus multiple use (clean) catheter, Outcome 1 Number with asymptomatic bacteriuria.
1.1 uncoated catheter, clean technique (both arms)	1	66	Risk Ratio (M‐H, Fixed, 95% CI)	1.06 [0.66, 1.72]
1.2 coated versus uncoated (clean technique both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 sterile technique versus clean technique (uncoated catheter both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Number with symptomatic UTI Show forest plot	4		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 3.2 Comparison 3 Single use (sterile) versus multiple use (clean) catheter, Outcome 2 Number with symptomatic UTI.
2.1 uncoated catheter, clean technique (both arms)	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 coated versus uncoated (clean technique both arms)	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 sterile technique versus clean technique (uncoated catheter both arms)	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.4 coated (sterile technique) versus uncoated (clean technique)	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Number with urethral trauma/bleeding	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.1 uncoated catheter, clean technique (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.2 coated versus uncoated (clean technique both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.3 sterile technique versus clean technique (uncoated catheter both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Number with stricture formation	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.1 uncoated catheter, clean technique (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 coated versus uncoated (clean technique both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.3 sterile technique versus clean technique (uncoated catheter both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Number with microscopic haematuria Show forest plot	1	30	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.24, 0.95]
Open in figure viewer Analysis 3.5 Comparison 3 Single use (sterile) versus multiple use (clean) catheter, Outcome 5 Number with microscopic haematuria.
5.1 uncoated catheter, clean technique (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.2 coated versus uncoated (clean technique both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.3 sterile technique versus clean technique (uncoated catheter both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.4 coated versus uncoated	1	30	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.24, 0.95]
6 Number with urethritis, epididymitis, or orchitis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.1 uncoated catheter, clean technique (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.2 coated versus uncoated (clean technique both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.3 sterile technique versus clean technique (uncoated catheter both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Weeks to onset of symptomatic UTI Show forest plot	2	85	Mean Difference (IV, Fixed, 95% CI)	‐0.11 [‐0.64, 0.43]
Open in figure viewer Analysis 3.7 Comparison 3 Single use (sterile) versus multiple use (clean) catheter, Outcome 7 Weeks to onset of symptomatic UTI.
7.1 uncoated catheter, clean technique (both arms)	1	39	Mean Difference (IV, Fixed, 95% CI)	0.38 [‐1.55, 2.31]
7.2 coated versus uncoated (clean technique both arms)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.3 sterile technique versus clean technique (uncoated catheter both arms)	1	46	Mean Difference (IV, Fixed, 95% CI)	‐0.15 [‐0.71, 0.41]
8 Number reporting satisfaction with catheter product	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.1 uncoated catheter, clean technique (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.2 coated versus uncoated (clean technique both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.3 sterile technique versus clean technique (uncoated catheter both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Number reporting comfort and ease of insertion	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.1 uncoated catheter, clean technique (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.2 coated versus uncoated (clean technique both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.3 sterile technique versus clean technique (uncoated catheter both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Number reporting preference	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.1 uncoated catheter, clean technique (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.2 coated versus uncoated (clean technique both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.3 sterile technique versus clean technique (uncoated catheter both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.4 coated versus uncoated	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 Preference score Show forest plot	1	30	Mean Difference (IV, Fixed, 95% CI)	‐1.60 [‐3.57, 0.37]
Open in figure viewer Analysis 3.11 Comparison 3 Single use (sterile) versus multiple use (clean) catheter, Outcome 11 Preference score.
11.1 uncoated catheter, clean technique (both arms)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
11.2 coated versus uncoated (clean technique both arms)	1	30	Mean Difference (IV, Fixed, 95% CI)	‐1.60 [‐3.57, 0.37]

Analysis 1.1

Comparison 1 Sterile technique versus clean technique, Outcome 1 Number with asymptomatic bacteriuria.

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Analysis 1.2

Comparison 1 Sterile technique versus clean technique, Outcome 2 Number with symptomatic UTI.

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Analysis 1.7

Comparison 1 Sterile technique versus clean technique, Outcome 7 Weeks to onset of symptomatic UTI.

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Analysis 2.1

Comparison 2 Coated versus uncoated catheter, Outcome 1 Number with asymptomatic bacteriuria.

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Analysis 2.2

Comparison 2 Coated versus uncoated catheter, Outcome 2 Number with symptomatic UTI.

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Analysis 2.4

Comparison 2 Coated versus uncoated catheter, Outcome 4 Number with stricture formation.

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Analysis 2.5

Comparison 2 Coated versus uncoated catheter, Outcome 5 Number with microscopic haematuria.

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Analysis 2.10

Comparison 2 Coated versus uncoated catheter, Outcome 10 Number reporting preference.

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Analysis 3.1

Comparison 3 Single use (sterile) versus multiple use (clean) catheter, Outcome 1 Number with asymptomatic bacteriuria.

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Analysis 3.2

Comparison 3 Single use (sterile) versus multiple use (clean) catheter, Outcome 2 Number with symptomatic UTI.

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Analysis 3.5

Comparison 3 Single use (sterile) versus multiple use (clean) catheter, Outcome 5 Number with microscopic haematuria.

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Analysis 3.7

Comparison 3 Single use (sterile) versus multiple use (clean) catheter, Outcome 7 Weeks to onset of symptomatic UTI.

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Analysis 3.11

Comparison 3 Single use (sterile) versus multiple use (clean) catheter, Outcome 11 Preference score.

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Comparison 1. Sterile technique versus clean technique

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Number with asymptomatic bacteriuria Show forest plot	1	36	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.47, 2.03]

1.1 uncoated (sterile catheter) both arms	1	36	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.47, 2.03]
1.2 single use (uncoated, sterile catheter) versus multiple use (uncoated, clean catheter)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Number with symptomatic UTI Show forest plot	3		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2.1 uncoated (sterile catheter) both arms	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 single use (uncoated, sterile catheter) versus multiple use (uncoated, clean catheter)	2		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Number with urethral trauma/bleeding	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.1 uncoated (sterile catheter) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Number with stricture formation	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.1 uncoated (sterile catheter) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Number with microscopic haematuria	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.1 uncoated (sterile catheter) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Number with urethritis, epididymitis, or orchitis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.1 uncoated (sterile catheter) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Weeks to onset of symptomatic UTI Show forest plot	3		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

7.1 uncoated (sterile catheter) both arms	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.2 single use (uncoated) versus multiple use (uncoated)	2		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Number reporting satisfaction with catheter product	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.1 uncoated (sterile catheter) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Number reporting comfort and ease of insertion	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.1 uncoated (sterile catheter) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Number reporting preference	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.1 uncoated (sterile catheter) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 1. Sterile technique versus clean technique

Ir a la tabla de la revisión

Comparison 2. Coated versus uncoated catheter

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Number with asymptomatic bacteriuria Show forest plot	1	11	Risk Ratio (M‐H, Fixed, 95% CI)	0.17 [0.01, 2.92]

1.1 sterile technique and catheter (both arms)	1	11	Risk Ratio (M‐H, Fixed, 95% CI)	0.17 [0.01, 2.92]
1.2 clean technique (sterile catheter) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Number with symptomatic UTI Show forest plot	4		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2.1 sterile technique and catheter (both arms)	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 sterile catheter (clean technique) both arms	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	2		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Number with urethral trauma/bleeding	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.1 sterile technique and catheter (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.2 sterile catheter (clean technique) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Number with stricture formation Show forest plot	1	58	Risk Ratio (M‐H, Fixed, 95% CI)	3.92 [0.17, 92.43]

4.1 sterile technique and catheter (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 sterile catheter (clean technique) both arms	1	58	Risk Ratio (M‐H, Fixed, 95% CI)	3.92 [0.17, 92.43]
4.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Number with microscopic haematuria Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

5.1 sterile technique and catheter (both arms)	0		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.2 sterile catheter (clean technique) both arms	0		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Number with urethritis, epididymitis, or orchitis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.1 sterile technique and catheter (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.2 sterile catheter (clean technique) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Weeks to onset of symptomatic UTI	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.1 sterile technique and catheter (both arms)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.2 sterile catheter (clean technique) both arms	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Number reporting satisfaction with catheter product	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.1 sterile technique and catheter (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.2 sterile catheter (clean technique) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Number reporting comfort and ease of insertion	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.1 sterile technique and catheter (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.2 sterile catheter (clean technique) both arms	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Number reporting preference Show forest plot	1	58	Risk Ratio (M‐H, Fixed, 95% CI)	1.70 [0.73, 3.93]

10.1 sterile technique and catheter (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.2 sterile catheter (clean technique) both arms	1	58	Risk Ratio (M‐H, Fixed, 95% CI)	1.70 [0.73, 3.93]
10.3 single use (sterile catheter) clean technique versus multiple use (clean catheter) clean technique	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 2. Coated versus uncoated catheter

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Comparison 3. Single use (sterile) versus multiple use (clean) catheter

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Number with asymptomatic bacteriuria Show forest plot	1	66	Risk Ratio (M‐H, Fixed, 95% CI)	1.06 [0.66, 1.72]

1.1 uncoated catheter, clean technique (both arms)	1	66	Risk Ratio (M‐H, Fixed, 95% CI)	1.06 [0.66, 1.72]
1.2 coated versus uncoated (clean technique both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 sterile technique versus clean technique (uncoated catheter both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Number with symptomatic UTI Show forest plot	4		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2.1 uncoated catheter, clean technique (both arms)	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 coated versus uncoated (clean technique both arms)	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 sterile technique versus clean technique (uncoated catheter both arms)	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.4 coated (sterile technique) versus uncoated (clean technique)	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Number with urethral trauma/bleeding	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.1 uncoated catheter, clean technique (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.2 coated versus uncoated (clean technique both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.3 sterile technique versus clean technique (uncoated catheter both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Number with stricture formation	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.1 uncoated catheter, clean technique (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 coated versus uncoated (clean technique both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.3 sterile technique versus clean technique (uncoated catheter both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Number with microscopic haematuria Show forest plot	1	30	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.24, 0.95]

5.1 uncoated catheter, clean technique (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.2 coated versus uncoated (clean technique both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.3 sterile technique versus clean technique (uncoated catheter both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.4 coated versus uncoated	1	30	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.24, 0.95]
6 Number with urethritis, epididymitis, or orchitis	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.1 uncoated catheter, clean technique (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.2 coated versus uncoated (clean technique both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.3 sterile technique versus clean technique (uncoated catheter both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Weeks to onset of symptomatic UTI Show forest plot	2	85	Mean Difference (IV, Fixed, 95% CI)	‐0.11 [‐0.64, 0.43]

7.1 uncoated catheter, clean technique (both arms)	1	39	Mean Difference (IV, Fixed, 95% CI)	0.38 [‐1.55, 2.31]
7.2 coated versus uncoated (clean technique both arms)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.3 sterile technique versus clean technique (uncoated catheter both arms)	1	46	Mean Difference (IV, Fixed, 95% CI)	‐0.15 [‐0.71, 0.41]
8 Number reporting satisfaction with catheter product	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.1 uncoated catheter, clean technique (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.2 coated versus uncoated (clean technique both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.3 sterile technique versus clean technique (uncoated catheter both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Number reporting comfort and ease of insertion	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.1 uncoated catheter, clean technique (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.2 coated versus uncoated (clean technique both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.3 sterile technique versus clean technique (uncoated catheter both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Number reporting preference	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.1 uncoated catheter, clean technique (both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.2 coated versus uncoated (clean technique both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.3 sterile technique versus clean technique (uncoated catheter both arms)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.4 coated versus uncoated	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 Preference score Show forest plot	1	30	Mean Difference (IV, Fixed, 95% CI)	‐1.60 [‐3.57, 0.37]

11.1 uncoated catheter, clean technique (both arms)	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
11.2 coated versus uncoated (clean technique both arms)	1	30	Mean Difference (IV, Fixed, 95% CI)	‐1.60 [‐3.57, 0.37]

Comparison 3. Single use (sterile) versus multiple use (clean) catheter

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Referencias

Referencias de los estudios incluidos en esta revisión

Day 2003 {published data only}

De Ridder 2005 {published and unpublished data}

Duffy 1995 {published data only}

Fera 2002 {published data only}

Giannantoni 2001 {published data only}

King 1992 {published data only}

Moore 1993 {published data only}

Moore 2006 {published data only}

Pachler 1999 {published data only}

PrietoFingerhut 1999 {published data only}

Quigley 1993 {published data only}

Schlager 2001 {published data only}

Sutherland 1996 {published data only}

Vapnek 2003 {published data only}

Referencias de los estudios excluidos de esta revisión

Charbonneau 1993 {published data only}

Diokno 1995 {published data only}

Fader 2001b {published data only}

Grigoleit 2006 {published data only}

Hedlund {published data only}

Hudson 2005 {published data only}

Kovindha 2004 {published data only}

Lemke {published data only}

Normelli 1993 {published data only}

Pascoe 2001 {published data only}

Pickard 1996 {published data only}

Sherbondy 2002 {published data only}

Sims 1993 {published data only}

Stensballe 2005 {published data only}

Terpenning 1989 {published data only}

van Kuppevelt 2004 {published data only}

Wu 1981 {published data only}

Referencias de los estudios en espera de evaluación

Cardenas 2006 {published data only}

Referencias de los estudios en curso

Coloplast A/S {unpublished data only}

Moore KN 2007 {published data only (unpublished sought but not used)}

Referencias adicionales

Eckstein 1982

Fader 2007

NIDRR 1992

Wyndaele 2002

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Characteristics of ongoing studies [ordered by study ID]

Data and analyses

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Usuarios institucionales

Instituciones a las que se accedió previamente

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