Ned Kinnear1, Dylan Barnett2, Michael O'Callaghan3,4,5,6, Kym Horsell6, Johan Gani1,7, Derek Hennessey1,8. 1. Department of Urology, Austin Health, Melbourne, Australia. 2. Department of Urology, Royal Adelaide Hospital, Adelaide, Australia. 3. South Australian Prostate Cancer Clinical Outcomes Collaborative, Flinders Medical Centre, Adelaide, Australia. 4. School of Medicine, University of Adelaide, Adelaide, Australia. 5. Flinders Centre for Innovation in Cancer, Adelaide, Australia. 6. Department of Urology, Flinders Medical Centre, Australia. 7. Department of Surgery, University of Melbourne, Australia. 8. Department of Urology, Mercy University Hospital, Cork, Ireland.
Abstract
AIMS: To systematically compare the impact of catheter-based bladder drainage methods on the rate of urinary tract infections (UTIs) amongst patients with neurogenic bladder. METHODS: A search of Cochrane Library, Embase, Medline, and Grey literature to February 2019 was performed using methods prepublished on PROSPERO. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Eligible studies were published in English and compared UTI incidence between neurogenic bladder patients utilizing bladder drainage methods of the indwelling urethral catheter (IUC), suprapubic catheter (SPC) or intermittent self-catheterization (ISC). The odds ratio of UTI was the sole outcome of interest. RESULTS: Eight nonrandomized observational cohort studies were identified, totaling 2321 patients who utilized either IUC, SPC, or ISC. Studies enrolled patients with neurogenic bladder due to spinal cord injury (seven studies) or from any cause (one study). UTI rates were compared between patients utilizing IUC vs SPC (four studies), IUC vs ISC (six studies), and SPC vs ISC (four studies). Compared with IUC, five of six studies suggested ISC use was associated with lower rates of UTI. Studies comparing IUC vs SPC and SPC vs ISC gave mixed results. Meta-analysis was not appropriate due to study methodology heterogeneity. CONCLUSIONS: Low-level evidence suggests amongst patients with neurogenic bladder requiring catheter-based drainage, the use of ISC is associated with lower rates of UTI than IUC. Comparisons of IUC vs SPC and SPC vs ISC gave mixed results. Future randomized trials are required to confirm these findings.
AIMS: To systematically compare the impact of catheter-based bladder drainage methods on the rate of urinary tract infections (UTIs) amongst patients with neurogenic bladder. METHODS: A search of Cochrane Library, Embase, Medline, and Grey literature to February 2019 was performed using methods prepublished on PROSPERO. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Eligible studies were published in English and compared UTI incidence between neurogenic bladderpatients utilizing bladder drainage methods of the indwelling urethral catheter (IUC), suprapubic catheter (SPC) or intermittent self-catheterization (ISC). The odds ratio of UTI was the sole outcome of interest. RESULTS: Eight nonrandomized observational cohort studies were identified, totaling 2321 patients who utilized either IUC, SPC, or ISC. Studies enrolled patients with neurogenic bladder due to spinal cord injury (seven studies) or from any cause (one study). UTI rates were compared between patients utilizing IUC vs SPC (four studies), IUC vs ISC (six studies), and SPC vs ISC (four studies). Compared with IUC, five of six studies suggested ISC use was associated with lower rates of UTI. Studies comparing IUC vs SPC and SPC vs ISC gave mixed results. Meta-analysis was not appropriate due to study methodology heterogeneity. CONCLUSIONS: Low-level evidence suggests amongst patients with neurogenic bladder requiring catheter-based drainage, the use of ISC is associated with lower rates of UTI than IUC. Comparisons of IUC vs SPC and SPC vs ISC gave mixed results. Future randomized trials are required to confirm these findings.
Authors: Vineet Gauhar; Daniele Castellani; Jeremy Yuen-Chun Teoh; Carlotta Nedbal; Giuseppe Chiacchio; Andrew T Gabrielson; Flavio Lobo Heldwein; Marcelo Langer Wroclawski; Jean de la Rosette; Rodrigo Donalisio da Silva; Andrea Benedetto Galosi; Bhaskar Kumar Somani Journal: J Clin Med Date: 2022-07-30 Impact factor: 4.964