Clean intermittent catheterization in the treatment of neurogenic dysfunctions of the lower urinary tract after spinal cord injury – comparison of the results of hydrophilic
Coated and standard PVC catheters

Česká verzia

Authors: Vladimír Šámal ¹; Alena Kyrianová ²; Jaroslav Šrám ²; Jan Mečl ¹; Jan Fogl ¹
Authors place of work: Urologické oddělení, Krajská nemocnice Liberec a. s. ¹; Spinální jednotka Traumatologicko-ortopedické centrum Krajská nemocnice Liberec a. s. ²
Published in the journal: Ces Urol 2011; 15(4): 229-236
Category: Original article

Summary

Aim:
Clean intermittent catheterization (CIC) of the urinary bladder is one of the standard procedures for emptying of the urinary bladder after spinal cord injury. Complications of intermittent catheterization are infection, injury of the urethra or urethral stricture. In addition to standard PVC catheters are also today available catheters, whose surface is coated with hydrophilic, wettable layer. Hydrophilic catheters should minimize the complications.

Material and methods:
This is a randomized, open label, prospective study monitoring the incidence of symptomatic infections and injuries of the urethra using different material of catheters for CIC. Patients who were admitted to the Spinal Cord Unit of Regional Hospital Liberec were randomized into two groups. The group A using a hydrophilic coated catheters and group B using standard PVC catheters. Patients urine culture examination was performed at weekly intervals. They watched episodes of symptomatic infections and complications of catheterization. During the study patients did not use antibiotic prophylaxis. Since 2009 there were 53 patients after spinal cord injury enrolled. Endpoint was the incidence of symptomatic infection and bloody discharge from urethra or hematuria as an evidence of trauma.

Results:
After entering the study 56.6% of patients had experiences with technique of CIC, others with CIC started. The mean follow-up was 9.09 weeks. The incidence of urinary tract infection was very high in both groups. Without UTI were only 22.2% of patient in the group with hydrophilic catheters and 11.8% patients in the group with standard PVC catheters. At least one episode of symptomatic infection were observed in 74.8% of patients in the group of hydrophilic catheters and 88.2% in the PVC catheters. We demonstrated a significantly lower incidence of symptomatic urinary tract infections in the group using hydrophilic catheters (p < 0.05)

Conclusion:
Intermittent catheterization is a standard option for treatment of dysfunction of the lower urinary tract after spinal cord injury. Use of hydrophilic coated catheters does not affect the incidence of asymptomatic bacteriuria, but decreases the numbers of episodes of symptomatic urinary tract infection. We did not observe a difference in urethral trauma between the two groups of catheters, but the lesions resulting after using PVC catheter was of greater extent.

Key words:
neurogenic detrusor overactivity, intermittent catheterization, urinary tract infection, urethral trauma, hydrophilic coated catheter.

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