A randomized trial found no difference between single-use polyvinylchloride (PVC) catheters and reused PVC catheters for patients with neurogenic bladder due to spina bifida.
Urinary tract infections (UTIs) are a common and severe complication of spina bifida.
“Urological management includes intermittent catheterization, either clean or sterile, with either single-use or reused catheters, pharmacologic suppression of detrusor hyperactivity, and antibiotic prophylaxis. There is insufficient evidence to recommend either technique, or reutilization of catheters,” said Pedro A. Madero-Morales, MD, of Hospital Universitario Dr José Eleuterio Gonzalez in Monterrey, Mexico.
Dr. Madero-Morales presented results of a randomized study conducted along with senior author Adrián Gutiérrez-Gonzalez, MD, PhD, at the AUA annual meeting in Chicago. The study included a total of 75 patients with neurogenic bladder caused by spina bifida, randomized to intermittent catheterization with either sterile, single-use PVC catheters (37 patients) or reusable catheters (38 patients) washed with water and soap and stored in a container with a 0.5% benzalkonium chloride solution.
There were 29 male and 46 female patients, and the mean age in the study was 12.7 years. Urinary symptoms began at a mean age of 2.1 years, and intermittent catheterization was started at a mean age of 4.1 years. Forty-one patients were unable to walk, and 38 patients could self-catheterize. The mean number of catheterizations per day was 3.59. Fifty percent of the cohort was receiving antimuscarinic therapy, and 54% received UTI prophylaxis. About one quarter of the cohort (23%) had bladder diverticula, and 19% had a history of vesicoureteral reflux of grade 2 or higher.
At baseline, 35.1% of the single-use group and 39.5% of the reusable group had asymptomatic bacteriuria based on a urine culture. At the follow-up assessment, 32.4% of the single-use group and 23.7% of the reusable group had bacteriuria, for an odds ratio of 0.65 (95% CI [0.23, 1.82]).
UTI was defined in the study as a positive urine culture along with fever, flank pain, malaise, and cloudy or odorous urine. The rate of UTI seen at follow-up was 35.2% with single-use catheters and 36.8% with reusable catheters, for an OR of 0.877 (95% CI [0.42, 2.76]).