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Types of indwelling urinary catheters for long‐term bladder drainage in adults

Prolonged urinary catheterization is common amongst people in long‐term care settings, for example in nursing homes or home care. In addition, many people living in the community need to have a permanent catheter. Long‐term catheterization was defined as for more than 30 days. We identified only three trials involving 102 adults in various settings. All three trials were too small to provide reliable evidence to indicate which types of catheters are best to use in which patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Policies on flushing urinary catheters which are used on a long‐term basis

Many people have incontinence (leak urine) or are unable to empty their bladder properly. Some can be helped by having a catheter inserted into their bladder, through which urine is passed out of the body. When the catheter is kept in place on a long‐term basis blockages may occur. Liquid solutions may be injected into the catheter to prevent or relieve a blockage. This is sometimes known as a washout. In this review we wished to assess how effective washouts were. We looked for studies which included people with long‐term catheters, where they were allocated at random to have catheter washouts or not, and the effects compared. Studies which compared different types of washout solution were also searched for. Only five relevant studies were found. All five concluded that there was no evidence that washouts were helpful. However most studies were small and of poor quality, and their results could not be combined. We concluded that, at present, there is not enough good research evidence to say whether or not consumers and providers of health care should use catheter washouts.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Policies for replacing long‐term indwelling urinary catheters in adults

A urinary catheter is a tube that is inserted into the bladder from the end of the urethra to drain urine from the bladder. Usually, urinary catheters are only required for a few days, such as after an operation. However, there are some medical conditions that may require bladder drainage on a long‐term basis. There are many different ways to care for and maintain a long‐term urinary catheter. In this review we refer to these different care methods as health‐care 'policies'. Examples of policies that relate to the replacement of a long‐term catheter include: time between catheter replacements; use of antibiotics during replacement; use of cleaning solutions or lubricants during replacement; and personnel, environment and techniques used at replacement. This review aimed to identify which policies at the time of long‐term catheter replacement were most effective in improving patient care.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Types of urethral catheters for management of short‐term voiding problems in hospitalised adults

Urethral catheters are small tubes passed into the bladder via the urethra (outlet for urine). They are often used for a short time after major surgery. Urethral catheters are also used if a person is unable to empty the bladder when they need to (urinary retention). They are also used for monitoring urine output in hospitalised patients. About half of all hospitalised adults who have urethral catheters for longer than a week will get a urinary tract infection (UTI).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Urinary catheter policies for long‐term bladder drainage

Some people use catheters to help them manage their bladder problems (such as leaking urine or not being able to pass urine). Catheters may be permanent urethral catheters (in the tube draining the bladder), suprapubic catheters (via the abdomen) or intermittent catheters (when a catheter is inserted via the urethra several times a day). No trials were found comparing these different methods with each other. Sometimes people using the catheters develop urinary tract infections. There was some weak evidence that using antibiotics all the time reduced the chance of having a urinary tract infection while using intermittent catheters, but there was not enough information about side effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Short term urinary catheter policies following urogenital surgery in adults

Urinary catheters are often used after urological or gynaecological surgery to check on urine output, to allow patients to pass urine, to allow washing out of the bladder and to help tissues heal. They can be inserted via the urethra (tube between the bladder and the outside) or suprapubically (through the abdomen). Different designs or materials may be used for the catheters, and different ways of managing the catheters and their removal are available. This review assesses the evidence for these options.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Alpha blocker treatment for men to increase chances to have urinary catheter successfully removed

Acute urinary retention in men is a medical emergency characterised by the sudden and often painful inability to pass urine. There are many known causes including prostate obstruction (because of enlargement of the prostate or cancer), urethral strictures (a narrowing of the urethra due to scar tissue), urine infection, constipation and neurological conditions. A narrow drainage tube (urinary catheter) is temporarily inserted into the bladder through the penis to allow drainage of urine. Once the catheter is removed, some men fail to pass urine again and need to be re‐catheterised. In these men, continued use of catheters or prostate surgery are the standard treatment options. Catheters are associated with risks such as infection and can harm quality of life. Measures for increasing the rate of successful catheter removal, that is, enabling patients to urinate spontaneously again, are therefore potentially beneficial. Alpha blockers (for example tamsulosin, alfuzosin) are a group of drugs known to have positive effects on urinary symptoms such as poor urinary flow. It is believed that their relaxing effect on the prostate may also increase the chance to void again after catheter removal. This review evaluated the evidence available to support this practice.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Which route of short‐term bladder drainage is best for adults in hospital?

This Cochrane review found that there was not enough evidence to determine whether one route of bladder drainage was more likely to reduce urinary tract infection than another. The evidence suggests that participants with suprapubic catheters were less likely to have catheter‐associated pain compared with those with indwelling urethral catheters. The quality of evidence in this review was low, and many of the trials did not report important outcomes such as catheter‐associated quality of life and ease of use. The included trials reported few adverse effects, but it is not clear if this is because the adverse effects did not occur or were simply not reported. Because of the limited evidence, we need more high‐quality trials. It is important that these trials report symptomatic urinary tract infection, pain from using catheters, quality of life, adverse effects and ease of use.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Strategies for removing catheters used in the short term to drain urine from the bladder in hospitalised patients

Patients in hospital with a brief severe illness or following surgery may have a tube placed into the passage from the bladder (an in‐dwelling urethral catheter). Potential complications are infection, tissue damage and patient discomfort. This review identified 26 controlled trials looking at the best strategies for removal of catheters. In 11 studies comparing late night versus early morning removal, removal at midnight resulted in a longer time to first void and patients passing significantly larger volumes, although these findings varied widely. There was no apparent effect on the number of patients who required recatheterisation because of subsequent urinary retention, but patients with catheters removed at midnight were discharged from hospital significantly earlier than those with morning removal. Based on findings from 13 trials, limiting how long a catheter was left in place was linked to a shorter stay in hospital and less risk of infection. The information available from three trials was too limited to assess whether clamping prior to removal, to simulate normal filling of the bladder, improved outcomes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Methenamine hippurate for preventing urinary tract infections

Bladder and kidney infections (urinary tract infections ‐ UTI) can cause vomiting, pain, dysuria, septicaemia, fever and tiredness, and occasionally kidney damage. Some people are at high risk of repeated UTIs, and they are also more likely to have serious complications (including people with kidney problems, or people who have catheters to release urine). Long‐term use of antibiotics can lead to resistance, so methenamine salts (methenamine or hexamine hippurate) are often used. This review identified 13 studies (2032 participants). Methenamine hippurate may be effective in preventing UTI in patients without renal tract abnormalities particularly when used for short term prophylaxis. It does not appear to be effective for long term prophylaxis in patients who have neuropathic bladder. There were few adverse effects.Additional well controlled randomised controlled trials are necessary in particular to clarify effectiveness for longer term prophylaxis in those without neuropathic bladder.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

The effects of using of urinary catheter in women during and after a caesarean section

Caesaren section (CS) has become the most common obstetric surgery, with one in three of pregnant women having a caesarean delivery. The use of urinary catheters (flexible elastic tube used to drain urine from the bladder) during and after CS is routinely used with caesarean delivery. Alleged benefits of using catheters include; maintains bladder drainage that may improve visualisation during surgery and minimise bladder injury, and less retention of urine after operation (inability to pass urine), but it could be associated with an increased incidence of urinary tract infection, urethral pain, voiding difficulties after removal of the catheter, delayed ambulation, and increased hospital stay.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Benign enlarged prostate: Surgery: Advantages and disadvantages

Surgery can very effectively reduce the problems associated with a benign enlarged prostate. But side effects are common. Surgery is considered if, for instance, other treatments do not provide enough relief, or if the enlarged prostate keeps causing medical problems such as urinary tract infections.There is usually no urgent need for men who have a benign enlarged prostate to have surgery. So they can generally take their time to consider whether they think a surgical procedure will have more pros or more cons for them. Men might decide to have surgery for various reasons:The prostate-related problems are very distressing, and other treatments have not lead to a big enough improvement.The enlarged prostate frequently causes other medical problems, such as recurring urinary tract infections or bladder stones.Treatment with medication is not possible for medical reasons.An enlarged prostate can occasionally lead to a fairly rare complication called acute urinary retention. This happens when the prostate pushes against the urethra so much that the man can hardly urinate any more, or can no longer urinate at all. Then the bladder has to be emptied using a catheter. Surgery is usually needed afterwards too. Sometimes surgical treatment is not an option, or not advisable, because of other medical conditions or particular risks. For example, general anesthetics may be too risky in some people.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 15, 2014

Antibiotic prophylaxis for short‐term catheter bladder drainage in adults

Catheters may be used to drain urine from the bladder in hospital for short periods of time (less than two weeks). This may cause a urinary infection, or an increase in the number of bacteria in the urine. The review found that people who had antibiotics before or during catheter use were less likely to have an infection, and less likely to have a large number of bacteria or pus cells in the urine. However, there was no evidence concerning the chance of allergic reactions or other side effects from the antibiotics. Antibiotic‐resistant bacteria were identified in most studies but there was no definite link made to the use of antibiotics.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

There is no evidence of difference in clinical and microbiological efficacy of quinolones for uncomplicated acute cystitis in women, but there is some evidence of differences in occurrence and range of adverse reactions.

Urinary tract infection (UTI) refers to the presence of a certain threshold number of bacteria in the urine. Bacterial cystitis (bacteria in the bladder, also called acute cystitis) can occur in men and women and the signs and symptoms include dysuria (pain on passing urine), frequency, cloudy urine, occasionally haematuria (blood in the urine), and is often associated with pyuria (high urine white blood cell count). There is an additional important distinction between complicated and uncomplicated UTI. Complicated UTIs are those associated with fever and/or back pain (indicating kidney infection), UTIs in men, UTIs associated with indwelling or intermittent urinary catheters, obstructive uropathy (any changes in the urinary tract due to obstruction), vesicoureteric reflux (urine travels from the bladder back up toward the kidneys) and other urological abnormalities. These types of infections require more intensive treatment. Uncomplicated acute cystitis is the most prevalent form of uncomplicated UTI in women. Quinolones are recommended as the drugs of choice for acute cystitis in regions where the level of resistance to other antimicrobials namely co‐trimoxazole is high. The aim of this systematic review was to investigate which quinolone is most effective in treating uncomplicated acute cystitis and to also investigate safety and how well they are tolerated. Eleven studies (7535 women) were identified. No two studies compared the same quinolones. We found no significant differences in clinical or microbiological efficacy between quinolones. Several adverse events were reported in the individual studies. These included photosensitivity, insomnia, skin adverse events, central nervous system adverse events and adverse events leading to withdrawal to treatment. We were unable to determine which quinolone would be the safest or the most tolerated due to the lack of head‐to‐head data.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Can interventions to improve professional adherence to guidelines prevent device‐related infections?

Healthcare‐associated infections (HAIs) are a major threat to patient safety, and are associated with mortality rates varying from 5% to 35%. Important risk factors associated with HAIs are the use of invasive medical devices (e.g. central lines, urinary catheters and mechanical ventilators) that breach the body's normal defence mechanisms, and poor staff adherence to infection prevention practices during insertion and care for the devices when in place.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Bladder and Other Urothelial Cancers Screening (PDQ®): Patient Version

Expert-reviewed information summary about tests used to detect or screen for bladder cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: August 7, 2015

Bladder Cancer Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of bladder cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: July 7, 2016

Catheter policies for management of long‐term voiding problems in adults with nerve damage affecting the bladder

People with nerve damage affecting the bladder may have incontinence (leakage of urine) or an inability to empty the bladder (voiding problem). This may cause infections or damage to the kidneys. Treatments include a permanent urinary catheter; using a catheter intermittently whenever the bladder needs to be emptied; an external sheath catheter fitted to the penis; or timed voiding, which involves regular emptying of the bladder at timed intervals. Although all these methods are used in practice, the review found that no randomised trials have been conducted to provide good evidence to suggest which is best and in which circumstances.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Intermittent catheterisation for long‐term bladder management

Intermittent catheterisation is a common treatment used by people who have bladder emptying problems. A hollow tube (catheter) is passed through the channel to the bladder (urethra) or through a surgically made channel to the skin surface to regularly empty the bladder, usually several times every day. This treatment is used by people who have difficulty emptying their bladders themselves. However, this treatment often causes urine infections resulting in school or work absences or even hospitalisations.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Combined spinal‐epidural versus epidural analgesia in labour

Regional analgesia has been shown to be effective in providing pain relief in labour. Regional analgesia can be an epidural, a spinal or a combination of the two. An epidural is when the pain‐relieving drugs are injected into the part of the body which surrounds the spinal column (epidural space). It is most common for these drugs to be infused through a very fine tube (catheter) positioned in the epidural space. Traditionally, high concentrations of local anaesthetic drugs were used. These numbed the woman from the waist downwards giving pain relief for most women. However, it also caused leg weakness, poor mobility and difficulty for the mother giving birth. This led to increased instrumental vaginal births with subsequent increased bruising, pain and incontinence later on for the mother. More recently with epidurals, low‐dose local anaesthetic drugs have been used in combination with opioid drugs. Here there is less numbing of the woman's legs but the opioid drugs cross the placenta and may make the baby sleepy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

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