Review article (meta-analysis)| Volume 94, ISSUE 4, P782-787, April 2013

Impact of Hydrophilic Catheters on Urinary Tract Infections in People With Spinal Cord Injury: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Published:November 19, 2012DOI:



      To identify randomized controlled trials comparing the use of hydrophilic and nonhydrophilic catheters for intermittent catheterization (IC) in patients with spinal cord injury (SCI), and to perform a meta-analysis evaluating the occurrence of hematuria and urinary tract infection (UTI).

      Data Sources

      We searched the following electronic databases to identify studies: EMBASE (1991 to August 2011), PubMed (1991 to August 2011), Cochrane Library (no date restriction), China National Knowledge Infrastructure (no date restriction), and the Chinese Biomedical Literature Database (no date restriction).

      Study Selection

      Randomized controlled trials, parallel-control, crossover-control, and prospective cohort studies that assessed morbidity associated with the use of hydrophilic catheters and nonhydrophilic catheters in patients after SCI were included.

      Data Extraction

      Data extraction was performed using standardized forms of the Cochrane Collaboration. Methodologic quality was independently assessed by 2 reviewers using the Downs and Black instrument. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for dichotomous data.

      Data Synthesis

      Five studies involving 508 subjects; 462 subjects completed the study and were included in this meta-analysis. There was a significantly lower incidence (OR=.36; 95% CI, 24%–54%; P<.0001) of reported UTIs in the hydrophilic-treated group compared with the nonhydrophilic-treated group. Hematuria was also reported significantly less in the hydrophilic catheter group than in the nonhydrophilic catheter group (OR=.57; 95% CI, 35%–92%; P=.001).


      This meta-analysis found UTIs and hematuria less frequently associated with the use of hydrophilic-coated catheters for IC in patients with SCI. These findings support the use of hydrophilic catheters in this patient population.


      List of abbreviations:

      CI (confidence interval), CIC (clean intermittent catheterization), CNKI (China National Knowledge Infrastructure), EMBASE (Excerpta Medica Database), IC (intermittent catheterization), MeSH (Medical Subject Heading), OR (odds ratio), SCI (spinal cord injury), UTI (urinary tract infection)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Garcia Leoni M.E.
        • Esclarin De Ruz A.
        Management of urinary tract infection in patients with spinal cord injuries.
        Clin Microbiol Infect. 2003; 9: 780-785
        • Siroky M.B.
        Pathogenesis of bacteriuria and infection in the spinal cord injured patient.
        Am J Med. 2002; 113: S67-S79
        • Giannantoni A.
        • Scivoletto G.
        • Di Stasi S.M.
        • et al.
        Clean intermittent catheterization and prevention of renal disease in spinal cord injury patients.
        Spinal Cord. 1998; 36: 29-32
        • Morris N.S.
        • Stickler D.J.
        • Mclean R.J.
        The development of bacterial biofilms on indwelling catheters.
        World J Urol. 1999; 17: 345-350
        • Waller L.
        • Jonsson O.
        • Norlén L.
        • Sullivan L.
        Clean intermittent catheterization in spinal cord injury patients: long-term follow up of a hydrophilic low friction technique.
        J Urol. 1995; 153: 345-348
        • Vaidyanathan S.
        • Soni B.M.
        • Dundas S.
        • Krishnan K.R.
        Urethral cytology in spinal cord injury patients performing intermittent catheterization.
        Paraplegia. 1994; 32: 493-500
        • Diokno A.C.
        • Mitchell B.A.
        • Nash A.J.
        • Kimbrough J.A.
        Patient satisfaction and the LoFric catheter for clean intermittent catheterization.
        J Urol. 1995; 153: 349-351
        • Chartier-Kastler E.
        • Denys P.
        Intermittent catheterization with hydrophilic catheters as a treatment of chronic neurogenic urinary retention.
        Neurourol Urodyn. 2011; 30: 21-31
        • Stensballe J.
        • Looms D.
        • Nielsen P.N.
        • Tvede M.
        Hydrophilic-coated catheters for intermittent catheterisation reduce urethral micro trauma: a prospective, randomized, participant-blinded, crossover study of three different types of catheters.
        Eur Urol. 2005; 48: 978-983
        • Sutherland R.S.
        • Kogan B.A.
        • Baskin L.S.
        • Mevorach R.A.
        Clean intermittent catheterization in boys using the LoFric catheter.
        J Urol. 1996; 156: 2041-2043
      1. Van Kuppevelt HJM, Angenot E, van Asbeck FWA. Comparative randomized cross-over evaluation of a modern catheter SpeediCath with conventional catheters LoFric and EasiCath. Proceedings of the 43rd Annual Meeting of the International Spinal Cord Society (ISCoS); 2004 Sep 26-29; Athens (Greece). [Poster 77].

        • Auger J.
        • Rihaoui R.
        • François N.
        • Eustache F.
        Effect of short-term exposure to two hydrophilic-coated and one gel pre-lubricated urinary catheters on sperm vitality, motility and kinematics in vitro.
        Minerva Urol Nefrol. 2007; 59: 115-124
        • Mauroy B.
        • Soret R.
        • Bonnal J.L.
        • Fantoni J.C.
        Comparison of 3 self-lubricated urethral catheters: prospective study on 27 patients.
        Ann Urol (Paris). 2001; 35: 223-228
        • Pascoe G.
        • Clovis S.
        Evaluation of two coated catheters in intermittent self-catheterization.
        Br J Nurs. 2001; 10: 325-329
        • Fader M.
        • Moore K.N.
        • Cottenden A.M.
        • Pettersson L.
        • Brooks R.
        • Malone-Lee J.
        Coated catheters for intermittent catheterization: smooth or sticky?.
        BJU Int. 2001; 88: 373-377
        • Darouiche R.O.
        • Goetz L.
        • Kaldis T.
        • Cerra-Stewart C.
        • AlSharif A.
        • Priebe M.
        Impact of StatLock securing device on symptomatic catheter-related urinary tract infection: a prospective, randomized, multicenter clinical trial.
        Am J Infect Control. 2006; 34: 555-560
        • Chartier-Kastler E.
        • Lauge I.
        • Ruffion A.
        • Goossens D.
        • Charvier K.
        • Biering-Sørensen F.
        Safety of a new compact catheter for men with neurogenic bladder dysfunction: a randomized, crossover and open-labeled study.
        Spinal Cord. 2011; 49: 844-850
        • Sarica S.
        • Akkoc Y.
        • Karapolar H.
        • Aktuq H.
        Comparison of the use of conventional, hydrophilic and gel-lubricated catheters with regard to urethral micro trauma, urinary system infection, and patient satisfaction in patients with spinal cord injury: a randomized controlled study.
        Eur J Phys Rehabil Med. 2010; 46: 473-479
        • Cardenas D.D.
        • Moore K.N.
        • Dannels-McClure A.
        • et al.
        Intermittent catheterization with a hydrophilic-coated catheter delays urinary tract infections in acute spinal cord injury: a prospective, randomized, multicenter trial.
        PM R. 2011; 3: 408-417
        • Cardenas D.D.
        • Hoffman J.M.
        Hydrophilic catheters versus noncoated catheters for reducing the incidence of urinary tract infections: a randomized controlled trial.
        Arch Phys Med Rehabil. 2009; 90: 1668-1671
        • De Ridder D.J.
        • Everaert K.
        • Fernández L.G.
        • et al.
        Intermittent catheterization with hydrophilic-coated catheters (SpeediCath) reduces the risk of clinical urinary tract infection in spinal cord injured patients: a prospective randomized parallel comparative trial.
        Eur Urol. 2005; 48: 991-995
        • Vapnek J.M.
        • Maynard F.M.
        • Kim J.
        A prospective randomized trial of the LoFric hydrophilic coated catheter versus conventional plastic catheter for clean intermittent catheterization.
        J Urol. 2003; 169: 994-998
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Reprint-preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Phys Ther. 2009; 89: 873-880
        • Bero L.
        • Rennie D.
        The Cochrane Collaboration. Preparing, maintaining, and disseminating systematic reviews of the effects of health care.
        JAMA. 1995; 274: 1935-1938
        • Horan T.C.
        • Andrus M.
        • Dudeck M.A.
        CDC/NHSN surveillance definition of health care associated infection and criteria for specific types of infections in the acute care setting.
        Am J Infect Control. 2008; 36: 309-332
        • Jadad A.R.
        • Moore R.A.
        • Carroll D.
        • et al.
        Assessing the quality of reports of randomized clinical trials: is blinding necessary?.
        Control Clin Trials. 1996; 17: 1-12
        • Woodward M.
        Epidemiology: design and data analysis.
        2nd ed. Chapman and Hall/CRC Pr, Boca Raton2005
        • Egger M.
        • Davey Smith G.
        • Schneider M.
        • Minder C.
        Bias in meta-analysis detected by a simple, graphical test.
        BMJ. 1997; 315: 629-634
        • Begg C.B.
        • Mazumdar M.
        Operating characteristics of a rank correlation test for publication bias.
        Biometrics. 1994; 50: 1088-1101
        • Lapides J.
        • Diokno A.C.
        • Silber S.J.
        • Lowe B.S.
        Clean intermittent self-catheterization in the treatment of urinary tract disease.
        J Urol. 1972; 107: 458-461