From the Guidelines
Long-term catheterization for urinary retention should prioritize intermittent self-catheterization over indwelling catheters to minimize the risk of catheter-associated urinary tract infections and other complications. When considering long-term catheter options for urinary retention, it's crucial to weigh the benefits and risks of each type, focusing on minimizing morbidity, mortality, and improving quality of life.
- Intermittent self-catheterization is preferred due to its lower infection rates and fewer complications compared to indwelling catheters, as highlighted in a systematic review and cost-effectiveness analysis published in the BMJ 1.
- The choice between different materials for intermittent self-catheterization, such as hydrophilic, gel reservoir, and non-coated catheters, should be based on individual patient factors and preferences, considering the effectiveness and cost-effectiveness of each option, as discussed in the same BMJ study 1.
- For patients who cannot manage intermittent self-catheterization, indwelling catheters, such as Foley catheters made of silicone or latex coated with silicone, may be necessary, with regular changes every 4-12 weeks depending on the material and patient factors.
- Suprapubic catheters are another alternative, offering potential comfort and ease of maintenance advantages for some patients.
- Regardless of the catheter type, maintaining adequate hydration (2-3 liters daily), practicing meticulous hygiene around the catheter insertion site, and monitoring for signs of urinary tract infection (such as fever, cloudy urine, or increased discomfort) are essential for all catheter users.
- Regular follow-up with a healthcare provider is critical to monitor for complications, including urinary tract infections, blockage, bladder stones, and reduced bladder capacity over time, and to reassess the ongoing need for catheterization, considering alternative interventions like medications or surgery when appropriate.
From the Research
Long Term Catheter for Urinary Retention
- The use of long term catheters for urinary retention is a common practice, with various types of catheters available, including intermittent catheters and indwelling catheters 2.
- Intermittent catheterization is considered the method of choice for bladder emptying when neurological or non-neurological causes make normal voiding impossible or incomplete, with overall good outcomes in the long-term 3.
- The most frequent complication of long term catheter use is urinary tract infection (UTI), with studies differing in definition criteria, methods for evaluation, and prophylaxis 3.
Types of Catheters
- Hydrophilic-coated catheters and uncoated catheters have been compared in terms of UTI risk, with uncertain evidence due to low-certainty and imprecision 4.
- Single-use (sterile) catheters and multiple-use (clean) catheters have also been compared, with uncertain evidence regarding UTI risk and adverse events 4.
- Prelubricated catheters (hydrophilic, gel reservoir) and noncoated catheters have been evaluated in terms of effectiveness, safety, patient preference, cost-effectiveness, and budget impact, with no definitive conclusions due to low quality of evidence 5.
Management and Prevention
- Guidelines for preventing urinary retention and bladder damage during hospital care have been developed, emphasizing the importance of identifying risk factors, managing patients at risk, and using bladder ultrasonography to reduce bladder damage and UTI risk 6.
- Urologist referral is indicated for patients requiring urinary management who have recurrent UTIs, acute infectious urinary retention, suspected urethral injury, or substantial urethral discomfort, or if long-term catheterization is being considered 2.
- Patient education and documentation are crucial in managing long-term bladder conditions, with patients reporting financial burden and preference for not reusing single-use catheters 5.