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Determining the Noninfectious Complications of Indwelling Urethral Catheters: A Systematic Review and Meta-analysis

John M. Hollingsworth, MD, MS; Mary A.M. Rogers, PhD; Sarah L. Krein, PhD, RN; Andrew Hickner, MSI; Latoya Kuhn, MPH; Alex Cheng, MD; Robert Chang, MD; and Sanjay Saint, MD, MPH
[+] Article, Author, and Disclosure Information

From the University of Michigan, Center for Healthcare Outcomes & Policy, Veterans Affairs Ann Arbor Medical Center/University of Michigan Patient Safety Enhancement Program, and Veterans Affairs Ann Arbor Health Services Research & Development Center of Excellence, Ann Arbor, Michigan; and University of California, Los Angeles, Los Angeles, California.

Grant Support: In part by the Agency for Healthcare Research and Quality (grant 1K08HS020927-01A1; Dr. Hollingsworth).

Potential Conflicts of Interest: Dr. Hollingsworth: Grant: Agency for Healthcare Research and Quality. Dr. Saint: Employment: Veterans Affairs Ann Arbor Medical Center and University of Michigan; Expert testimony: Legal cases focusing on medical malpractice; Grants/grants pending (money to institution): National Institutes of Health, U.S. Department of Veteran Affairs, Agency for Healthcare Research and Quality, and Blue Cross Blue Shield of Michigan Foundation; Payment for lectures (including speakers bureaus): Honoraria from academic meetings, group-purchasing organizations (Veterans Health Administration and Premier), state hospital associations (Michigan Health & Hospital Association), visiting professorships, and nonprofit foundations (Institute for Healthcare Improvement); Royalties: Lippincott Williams and Wilkins, McGraw-Hill, and Wiley-Blackwell; Stock/stock options: Doximity, Jvion. All other authors have no disclosures. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-0374.

Requests for Single Reprints: John M. Hollingsworth, MD, MS, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 16, 1st Floor, #113W, Ann Arbor, MI 48109; e-mail, kinks@med.umich.edu.

Current Author Addresses: Drs. Hollingsworth, Rogers, Krein, and Saint; Mr. Hickner; and Ms. Kuhn: University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109.

Dr. Cheng: 11811 Venice Boulevard #238, Los Angeles, CA 90066.

Dr. Chang: 3119 Taubman Center, Box 0376, 1500 East Medical Center Drive, Ann Arbor, MI 48109.

Author Contributions: Conception and design: J.M. Hollingsworth, S.L. Krein, A. Hickner, A. Cheng, S. Saint.

Analysis and interpretation of the data: J.M. Hollingsworth, M.A.M. Rogers, R. Chang, S. Saint.

Drafting of the article: J.M. Hollingsworth, A. Hickner, L. Kuhn, R. Chang.

Critical revision of the article for important intellectual content: J.M. Hollingsworth, M.A.M. Rogers, S.L. Krein, R. Chang, S. Saint.

Final approval of the article: J.M. Hollingsworth, M.A.M. Rogers, S.L. Krein, A. Hickner, L. Kuhn, R. Chang, S. Saint.

Statistical expertise: M.A.M. Rogers.

Obtaining of funding: S. Saint.

Administrative, technical, or logistic support: J.M. Hollingsworth, A. Hickner.

Collection and assembly of data: J.M. Hollingsworth, M.A.M. Rogers, A. Hickner, L. Kuhn, A. Cheng, R. Chang.

Ann Intern Med. 2013;159(6):401-410. doi:10.7326/0003-4819-159-6-201309170-00006
Text Size: A A A

Background: Although the epidemiology of catheter-associated urinary tract infection is well-described, little is known about noninfectious complications resulting from urethral catheter use.

Purpose: To determine the frequency of noninfectious complications after catheterization.

Data Sources: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Conference Papers Index, BIOSIS Previews, Scopus, and ClinicalTrials.gov were searched for human studies without any language limits and through 30 July 2012.

Study Selection: Clinical trials and observational studies assessing noninfectious complications of indwelling urethral catheters in adults.

Data Extraction: Relevant studies were sorted into 3 categories: short-term catheterization in patients without spinal cord injury (SCI), long-term catheterization in patients without SCI, and catheterization in patients with SCI. The proportion of patients who had bladder cancer, bladder stones, blockage, false passage, gross hematuria, accidental removal, urine leakage, or urethral stricture was then pooled using random-effects models.

Data Synthesis: Thirty-seven studies (2868 patients) were pooled. Minor complications were common. For example, the pooled frequency of urine leakage ranged from 10.6% (95% CI, 2.4% to 17.7%) in short-term catheterization cohorts to 52.1% (CI, 28.6% to 69.5%) among outpatients with long-term indwelling catheters. Serious complications were also noted, including urethral strictures, which occurred in 3.4% (CI, 1.0% to 7.0%) of patients with short-term catheterization. For patients with SCI, 13.5% (CI, 3.4% to 21.9%) had gross hematuria and 1.0% (CI, 0.0% to 5.0%) developed bladder cancer.

Limitations: Although heterogeneity existed across studies for several outcomes, most could be accounted for by differences between studies with respect to quality and sex composition. Evidence published after 30 July 2012 is not included.

Conclusion: Many noninfectious catheter-associated complications are at least as common as clinically significant urinary tract infections.

Primary Funding Source: Agency for Healthcare Research and Quality.


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Figure 1.

Summary of evidence search and selection.

* Excluded because studies involved certain urologic and urogynecologic procedures in which attribution of noninfectious complications to urethral catheter use could not be reliably determined, they reported results from duplicate populations, or they included other types of urine drainage and only reported complications across the combined group of participants.

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Figure 2.

Pooled complication frequencies for short-term catheterization.

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Figure 3.

Pooled complication frequencies for long-term catheterization.

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Figure 4.

Pooled complication frequencies for catheterized patients with spinal cord injury.

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Submit a Comment/Letter
non infectious urethral catheter complications
Posted on October 20, 2013
Brian C. Weiner, MD
Rutgers Robert Wood Johnson School of Medicine
Conflict of Interest: None Declared
Dear Sirs:

Hollingsworth et al provided an important service in highlighting the non-infectious complications of urethral catheters. Sexual function is a critical function, particularly of the male genetalia. Was there any data collected on impairments of sexual function after urethral catheterization?

Brian Weiner, MD.
RE: sexual dysfunction following indwelling urethral catheterization.
Posted on November 8, 2013
John M. Hollingsworth
Department of Urology, Universtiy of Michigan Medical School
Conflict of Interest: None Declared
On behalf of my coauthors, I would like to thank Dr. Weiner for his interest in our work. His question, regarding sexual dysfunction following indwelling urethral catheterization, is an important one. Unfortunately, none of the articles included in our systematic review and meta-analysis collected data on this complication. Thus, further work is needed to derive pooled estimates of the frequency of this complication.
Submit a Comment/Letter

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