Types of indwelling urinary catheters for long-term bladder drainage in adults.

BACKGROUND: Prolonged urinary catheterisation is common amongst people in long-term care settings and this carries a high risk of developing a catheter-related urinary tract infection and associated complications. A variety of different kinds of urethral catheters are available. Some have been developed specifically to lower the risk of catheter-associated infection, for example antiseptic or antibiotic impregnated catheters. Ease of use, comfort and handling for the caregivers and patients, and cost-effectiveness are also important factors influencing choice.

OBJECTIVES: The primary objective was to determine which type of in-dwelling urinary catheter is best to use for long-term bladder drainage in adults.

SEARCH STRATEGY: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 15 December 2004), MEDLINE (January 1950 to February 2005) and CINAHL (January 1982 to February 2005). We also handsearched 28 relevant journals and conference proceedings. We examined the bibliographies of relevant articles and contacted catheter manufacturers, scientific societies and experts for trials.

SELECTION CRITERIA: All randomised trials comparing types of indwelling urinary catheters for long-term catheterisation in adults. Long-term catheterisation was defined as more than 30 days.

DATA COLLECTION AND ANALYSIS: Data extraction has been undertaken by two review authors independently and simultaneously. Any disagreement has been resolved by a third review author. The included trial data were handled according to the description of the Cochrane Collaboration Reviewers' Handbook.

MAIN RESULTS: Three trials were included involving 102 adults in various settings. Two trials had a parallel group design and one was a randomised cross-over trial. Only two of the six targeted comparisons were assessed by these trials: antiseptic impregnated catheters versus standard catheters (one trial) and one type of standard catheter versus another standard catheter (two trials). The single small cross-over trial was inadequate to assess the value of silver alloy (antiseptic) impregnated catheters. In the two trials comparing different types of standard catheters, estimates of differences were all imprecise because the trials also had small sample sizes: confidence intervals were too wide to rule out clinically important differences. One trial did suggest, however, that the use of a hydrogel coated latex catheter rather than a silicone catheter may be better tolerated (RR for need for early removal 0.41, 95% CI 0.22 to 0.77).

AUTHORS' CONCLUSIONS: Very few trials have compared types of catheter for long-term bladder drainage. All were small and showed methodically weaknesses. Therefore, the evidence was not sufficient as a reliable basis for practical conclusions. Further, better quality trials are needed to address the current lack of evidence in this clinically important area.