Reused silicone catheter for clean intermittent catheterization (CIC): is it safe for spinal cord-injured (SCI) men?

Abstract

Study Design: Study of reusable catheter. Objective: To investigate whether a silicone cathether reused over years for clean intermittent catheterization (CIC) was safe for spinal cord injured (SCI) men. Setting: Maharaj Hospital, Chiang Mai, Thailand. Method: A cross-sectional study was obtained from SCI men who had used CIC with a reusable silicone catheter for more than a year. Demographic data, urological management and urinary tract complications focusing on the radiologic status of the urethra were reviewed and analyzed. In addition, two reused and one new catheters were studied under electron microscope for catheter morphology (surface and lumen) and stiffness. Results: There were 28 SCI men included in this study. The average duration of CIC use was 4.8 years and the average time of usage for each catheter was 3 years (range 1-7 years). In all, 26 men previously used indwelling catheterization (ID) during the acute phase. In all, 23 men performed self-catheterization. Regarding urinary complications, three reported urethral bleeding, five had episodes of pus per urethra, five had epididymitis, four had passing stones, 18 had occasional foul smelly urine, 10 developed fever and cloudy urine during the past year. Of 17 patients who had ultrasonography done, four had pathologic findings in kidney and one had bladder calculi. Demographic data, urinary management and complications did not have significant relation to the abnormality of the urethrogram or urinary tract infection. However, where the frequency of CIC was higher, the abnormality of the urethra was lower (Po0.05). All had serum Cr level p1.3 mg/dl. Electron microscopic findings of reused catheters for 2 years revealed encrustation but no obstruction in the lumens and 20% increase in stiffness. Conclusion: The clinical outcome, especially with regard to urethral abnormalities with this reusable silicone catheter is as good as with a disposable one. However, to reuse urinary catheters, one should consider the increasing risk of infection. For SCI patients in developing countries, CIC with a reusable silicone catheter may be a suitable and safe choice if one cleans and applies it properly to reduce infection. In order to answer the question how long a person in a developing country should use the same silicone catheter, further research should be conducted.

Retrospective study for risk factors for febrile UTI in spinal cord injury patients with routine concomitant intermittent catheterization in outpatient settings

“…Therefore, educating CIC patients on how best to decrease their risk of UTI is important and should be an ongoing mission, 24 in that, for instance, many times of CIC with keeping clean technique leading to low rate of frequency of UTI occurrence. 4,25,26 We did not show significant relationship between anticholinergics or other bladder pressure-decreasing-treatments and UTI occurrence, and it is considered the double treatments for low-compliance bladder by CIC and those drugs mutually operated and make analysis more complicated.…”

The good, the bad and the ugly of catheterization practices among elite athletes with spinal cord injury: a global perspective

“…Forty-nine patients completed a 12-month study, and the authors supported the use of hydrophilic-coated catheters, as they were associated with less hematuria and a decrease in the rate of UTIs. Interestingly, Kovindha et al 15 described the safety of long-term catheter reuse practices among individuals with SCI in Thailand. They reported an average usage time for each silicone catheter as~3 years (ranging from 1 to 7 years).…”

“…Some studies have suggested that single-use catheters may be reused if cleaned appropriately; however, these authors also cautioned that the reuse of catheters may be associated with increased risk of UTI. 15 Interestingly, others studies demonstrated that even microwaving of catheters up to 12 min was not sufficient to eradicate Pseudomonas aeruginosa or Staphylococcus aureus, although there was minimal change to the physical qualities of the catheter. 16 No studies, however, have attempted to directly examine the relationship between catheter reuse and UTIs, or what factors may influence this relationship.…”

Urethral Complications in Spinal Cord Injury

“…A study showed that re-usable silicone catheters did not lead to increased urethral complications in 23 men but did lead to increased UT. 19 The average catheter use of a single catheter was three years. Therefore, this could be a method of bladder management in developing countries.…”