title: Intermittent catheterisation for long-term bladder management (abridged cochrane review).
abstract: OBJECTIVE
  To review the evidence on strategies to reduce UTI, other complications or improve satisfaction in intermittent catheter (IC) users by comparing: (1) one catheter design, material or technique versus another; (2) sterile technique versus clean; or (3) single-use (sterile) or multiple-use (clean) catheters.
  
  
  METHODS
  We searched Cochrane Incontinence Group Specialised Trials Register, MEDLINE, EMBASE, CINAHL, ERIC, reference lists, and conference proceedings to November 2013. We contacted other investigators for unpublished data or clarification. Trial screening, assessment and data abstraction were all in accordance with the Cochrane handbook.
  
  
  RESULTS
  Thirty one trials (13 RCTs and 18 randomized crossover trials), addressed the inclusion criteria comparing method or design and UTI/bacteriuria, other complications or participant assessed outcomes. Studies varied widely in follow-up, UTI definition and attrition; in some, data could not be combined. Where there were data, confidence intervals were wide and hence clinically important differences could neither be reliably identified nor ruled out.
  
  
  CONCLUSIONS
  Current research evidence is weak and design issues are significant. It has not yet been established whether incidence of UTI, other complications such as haematuria, or user satisfaction are affected by sterile or clean technique, coated or uncoated catheters, single or multiple-use catheters or by any other strategy. For people using IC, choice of catheter will depend on personal preference, cost, portability, and ease of use. Individuals should discuss the catheter options with their healthcare practitioner. Cost-effectiveness analysis and use of the standard definition of UTI are essential in any proposed clinical trial.
authors.affiliation: University of Southampton-Faculty of Health Sciences, South Academic Block, Southampton General Hospital, Southampton, United Kingdom.
authors.forename: Jacqui A
authors.initials: JA
authors.lastname: Prieto
authors.affiliation: University of Southampton-Faculty of Health Sciences, South Academic Block, Southampton General Hospital, Southampton, United Kingdom.
authors.forename: Catherine
authors.initials: C
authors.lastname: Murphy
authors.affiliation: University of Alberta Faculty of Nursing Edmonton, Alberta, Canada.
authors.forename: Katherine N
authors.initials: KN
authors.lastname: Moore
authors.affiliation: University of Southampton-Faculty of Health Sciences, South Academic Block, Southampton General Hospital, Southampton, United Kingdom.
authors.forename: Mandy J
authors.initials: MJ
authors.lastname: Fader
mesh_terms: D055499:Catheter-Related Infections / Q000209:etiology / Q000517:prevention & control; D004867:Equipment Design; D006801:Humans; D017060:Patient Satisfaction; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology*; D001745:Urinary Bladder Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014546:Urinary Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D062885:Urinary Catheters; D014563:Urodynamics
keywords: intermittent catheterisation; lower urinary tract symptoms; quality of life; urinary tract infection