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JU INSIGHT: Adoption of Single-use Clean Intermittent Catheterization Policies Does Not Appear to Affect Genitourinary Outcomes in a Large Spinal Cord Injury Cohort
By: Christopher S. Elliott, MD, PhD; Kai Dallas, MD; Kazuko Shem, MD; James Crew, MD | Posted on: 01 Nov 2022
Elliott CS, Dallas K, Shem K, Crew J. Adoption of single-use clean intermittent catheterization policies does not appear to affect genitourinary outcomes in a large spinal cord injury cohort. J Urol. 2022;208(5):1065-1074.
Study Need and Importance
The idea for this study was generated during a presentation given at Stanford Urology Grand Rounds in 2020 (Single-Use vs Multi-Use Catheters for Clean Intermittent Catheterization [CIC]). After highlighting the existing randomized trials and a subsequent meta-analysis (all of which fail to show differences in urinary tract infection [UTI] rates, see Table), an audience member asked why someone did not do a larger study to evaluate the 2008 Medicare Policy change. Over time, we realized that the possibility did exist in the Model Systems Spinal Cord Injury Database, if one were willing to examine hospitalizations for genitourinary reasons (of which greater than 90% are due to UTI in the spinal cord injury population).
Table. Overall UTI Rate (Single-use 27.7% vs Multiuse 29.3%, P = .218)
What We Found
When comparing hospitalizations for genitourinary reasons, both before and after the 2008 Medicare Policy change permitting coverage for single-use CIC, we found no difference. This finding persisted on multivariate logistic regression analysis. We further found that adoption of CIC was not affected.
Limitations
Beyond being retrospective and only examining hospitalizations for genitourinary reasons (which are not always due to UTIs), our study is unable to evaluate how single-use CIC might make life easier for the end user, specifically eliminating the need to carry around used catheters or the need to clean them between uses. Thus, we would be remiss to think that our study alone indicates that single-use CIC should be discouraged.
Interpretation for Patient Care
What our study highlights most is that a seemingly good plan, ie, using a clean catheter for each CIC episode to decrease bacterial introduction into the bladder, may not bring about its intended effect. In addition, the dogma that reusing a urinary catheter leads to worsened health outcomes might need to be reconsidered, though this should be carefully balanced with quality-of-life data if further policy changes are considered.
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