Authors' objectives:

At the request of the Ontario Health Technology Assessment Committee, the Medical Advisory Secretariat systematically reviewed the evidence of the effectiveness of hydrophilic catheters for patients requiring intermittent catheterization.

Authors' results and conclusions: Five randomized controll trials (RCTs) were identified that compared hydrophilic catheters to standard catheters. There was substantial variation across the studies in terms of the reason for catheterization, inclusion criteria and type of catheter used. Two RCTs used reusable catheters in the control arm, while the other 3 RCTs used single-use catheters in the control arm. All 5 RCTs predominantly focused on males requiring intermittent catheterization. Age varied considerably across studies, from a mean of 12 to 71 years. The RCTs reported conflicting results regarding the effectiveness of the hydrophilic catheters compared to standard catheters in terms of rates of urinary tract infections (UTIs). All 5 RCTs had serious limitations. Two of the studies were small, and likely underpowered to detect significant differences between groups. One RCT reported 12-month follow-up data for all 123 patients even though more than half of the patients had dropped out of the study by 12 months. Another RCT had unequal groups at baseline: the patients in the hydrophilic group had twice the mean number of urinary tract infections at baseline as the standard catheter group. The fifth RCT used catheters to treat patients with bladder cancer, thus the results of their study are not generalizable to the population requiring intermittent catheterization. Two studies did not find significant differences between the hydrophilic and standard catheter groups for patient satisfaction. Another RCT reported conflicting results, but overall, patient opinion of the catheters was not significantly different between the treatment groups. A fourth RCT found that the hydrophilic catheters were significantly more comfortable than the standard catheters. The fifth RCT did not report results for quality of life or patient satisfaction. Similar to the results for effectiveness, it is not possible to clearly establish if there is a significant difference in patient satisfaction between the patients using hydrophilic catheters and those using standard catheters. Patients requiring intermittent catheterization use, on average, 4 to 5 intermittent catheters per day. Patients admitted to hospitals using intermittent catheters typically do not reuse catheters, due to the potential increased risk of infection in hospital. Patients self-catheterizing at home are more likely to re-use catheters. Standard catheters cost approximately $1.00 to $1.50 Cdn per catheter. Hydrophilic catheters cost approximately $2.00 to $5.00 Cdn per catheter, depending on the type and whether they have antibiotics impregnated inside the catheter. All hydrophilic catheters are single-use catheters.

Authors' recommendations: At this time there is insufficient evidence to indicate whether hydrophilic catheters are associated with a lower rate of UTIs and improved patient satisfaction among individuals requiring intermittent catheterization.

Authors' methods: Systematic review

Project Status: Completed

Year Published: 2006

URL for published report: http://www.health.gov.on.ca/english/providers/program/mas/tech/reviews/pdf/rev_hydrocat_030106.pdf

URL for additional information: http://www.hqontario.ca/en/mas/mas_ohtas_tech_hydrocat_030106.html

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Medical Advisory Secretariat

Contact Address: Medical Advisory Secretariat, 20 Dundas Street West, 10th Floor, Toronto, ON M5G 2N6 CANADA. Tel: 416-314-1092l; Fax: 416-325-2364;

Contact Name: MASinfo.moh@ontario.ca

Contact Email: MASinfo.moh@ontario.ca

Copyright: Medical Advisory Secretariat, Ontario Ministry of Health and Long-Term Care