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Scientific Review of Urinary Tract Infection (UTI) and hydro­philic catheters

Bladder management with intermittent catheterisation is associated with complications. The most severe and common one is UTI. Single-use, hydrophilic-coated catheters lower the risk of UTIs and have been reported as both convenient and the preferred choice for people who rely on intermittent catheterisation as their bladder management.1 As a result, hydrophilic-coated catheters are identified as a cost-effective contributor in UTI prevention.2

Single-use hydrophilic-coated catheters were developed in the early 1980s to address the long-term complications of intermittent catheterisation seen from reusing non-coated plastic catheters.

As reported by Wyndaele and Maes3 and Perrouin-Verbé et al.4, the majority of complications related to intermittent catheterisation occurs after long-term use and as a result of repeated damage to the urethral wall. These long-term complications can, however, be prevented by use of hydrophilic-coated catheters.5-7

There is today extensive high-level evidence supporting hydrophilic catheters’ ability to prevent urethral trauma1,8-11 and to reduce the risk of UTIs.1,10,12-17

For example, a risk reduction of hematuria between 43-48% has been reported.10,18 The UTI risk reduction associated with hydrophilic catheter varies between reports, and figures between 16-64%10,12-15 have been presented in recent meta-analyses. Also, observational data suggest a UTI incidence of 40%-60% for users of single-use hydrophilic catheters as compared to 70%-80% for users of non-hydrophilic catheters.6,19 This translates to an expected UTI risk reduction between 21-37% after real life long-term use.6

It should be noted that studies investigating UTI incidence are compromised by the facts that different UTI definitions are used, different populations are studied (e.g. neurogenic and non-neurogenic bladder), and different research perspectives are utilised (for example, observational surveys, randomized controlled trials). To facilitate comparisons, standardized definitions of UTI are proposed.20,21 Also, there is still a need for more research evidence about impact of different types of hydrophilic-coated catheters and less common complications associated with intermittent catheterization (for example, epididymitis and urethral strictures).1

It is recognised that the risk of UTI is not the only important criterion to consider when choosing a catheter for intermittent catheterisation.2,22 Patient experienced comfort, satisfaction, and ease of use, are all essential to ensure long-term adherence to intermittent catheterisation.1,2 Poor adherence can be the cause of urinary and renal complications11,23 and that is why an individualised catheter choice is recommended standard practice.2,11,12,16,24

Hydrophilic catheters are known to be easy to use and comfortable.8,25 As a result, many users prefer hydrophilic catheters when they have the choice.1,8,26,27 Catheters that fit the needs and preferences of users also seem to improve the quality of life for people who rely on intermittent catheterisation.28

The total evidence in favor of hydrophilic catheters, as compared to non-hydrophilic, is the basis of conclusions on cost-effectiveness. So far, cost effectiveness for hydrophilic-coated catheters has been established in five different healthcare settings, proposing fewer UTIs and better quality of life during a life-time use with the catheter.14,29-32 This makes hydrophilic coated catheters a cost-effective a contributor in catheter-related UTI prevention.2