Presentation Authors: Pedro A. Madero-Morales*, J. Iván Robles-Torres, Guillermo Vizcarra-Mata, Andrés H. Guillén-Lozoya, Soraya Mendoza-Olazán, Elvira Garza-González, Adrián Gutiérrez-González, Monterrey, Mexico
Introduction: Urinary tract infections (UTI) are common and severe complications in patients with spina bifida (SB). Urological management includes intermittent bladder catheterization (IC), which can utilize single use or reused sterile catheters. There is insufficient evidence to set a standard among the different techniques. We determined whether single-use polyvinylchloride (PVC) catheters reduce UTIs compared to reused PVC catheters for patients with neurogenic bladder (NB) due to SB.
Methods: We conducted a 2-arm randomized parallel clinical trial from 2015 to 2016 with an 8-week follow-up at our center in patients with NB caused by SB consisting of single use and reused PVC catheters groups. Evaluations were established at days 0, 7, 14, 28, 42 and 56. Participants reported symptoms and urine culture results were obtained. Primary outcome was frequency of UTIs, defined as positive urine culture plus fever, flank pain, malaise, cloudy or odorous urine. Eligibility criteria were age â‰¥ 2 years, diagnosis of SB with regular clean IC, and no UTI at the initial evaluation.
Results: Calculated sample size was 75; 135 patients were screened, 83 were randomized and 75 completed follow-up. There were 29 men and 46 women, mean age of 12.7 years. No statistical difference was found between the single use vs reused catheter groups in frequency of asymptomatic bacteriuria (32.4% and 23.7%; p=0.398) and UTIs (35.2% and 36.8%; p=0.877) during followup. Evaluation of demographic, pharmacologic therapy, urological comorbidities, and urodynamic characteristics demonstrated a higher frequency of UTI in both trial arms in patients unable to walk (p < 0.01), absence of antimuscarinic therapy (p < 0.05), and a history of VUR â‰¥grade 2 (p < 0.01).
Conclusions: Single-use PVC catheters did not decrease the incidence of UTI in IC for our patients with NB compared to reused PVC catheters. These results are consistent with the 2014 Cochrane Review.