news &views Journal Club
Condom versus Indwelling Catheter: A Randomized Trial Chiemerie E. Uche, BSN, RN, Medical IMC
Chiemerie E. Uche, BSN, RN, hosted the March Journal Club meeting to review the article “Condom versus Indwelling Catheters: A Randomized Trial” (Saint, Kaufman, Rogers, Baker, Ossenkop, Lipsky, 2006) The purpose of this study was to compare the incidence of bacteriuria, symptomatic UTI, and patient satisfaction in hospitalized men requiring a urinary collection device, with either condom catheters or indwelling urethral catheters. Twenty percent of hospitalizedacquired bacteriuria is catheter related, and of these, the mortality rate is 10 percent (Feketa, Calderwood, Bloom, 2013). Research has shown that urinary catheters lead to more UTIs and are more painful and uncomfortable than condom catheters. Jamison et al. (2004) conducted a systematic review of randomized and quasi-randomized controlled trials and found conflicting and inconclusive results about the risks and benefits of the different types of catheters (Johnson, et al., 2001; Saint Lipsky, Baker, et al., 1999; Saint, Lipsky, Goold, 2002). Further, no studies were found that directly compared condom to indwelling urinary catheters. This study examined whether use of condom catheters would decrease the incidence of bacteriuria and symptomatic UTI compared to indwelling catheters. Researchers also hypothesized that use of condom catheters in cognitively impaired patients might be less beneficial than indwelling catheters for urinary monitoring. Using a randomized controlled trial design, condom catheters were compared to indwelling catheters for managing male patients with urinary problems not caused by obstructive uropathy or neurogenic bladder. Saint et al. (2006) screened 4,241 male patients 40 years of age and older at a veterans hospital in Seattle, Washington. Seventy-five participants were enrolled: 34 were randomized to the condom catheter group and 41 were randomized to the indwelling catheter group. The incidence of bacteriuria was the primary
outcome measured. The development of symptomatic UTI, patient mortality, and patient satisfaction with the urinary collection device were also examined. To assess for bacteriuria, a urine sample was collected at the start of the study and then daily for the duration of the study. The maximum duration of followup for each participant was 30 days. Urine samples were withdrawn from the sample port with a sterile syringe for patients with an indwelling catheter. For patients wearing a condom catheter, the catheter was changed daily, and the first voided sample within an hour after catheter change was used. Patients’ mental status was assessed using the first eight items of the Mini-Mental State Exam (MMSE). Knowing whether or not a patient was cognitively impaired was important in evaluating the benefits of using condom catheters in patients with dementia. Patient satisfaction with a type of urine collection device was assessed using a previously developed standardized questionnaire (Saint, Linsky, Baker et al., 1999). The researchers used an intention to treat analysis and showed a lower incidence of bacteriuria and symptomatic UTI with use of condom catheters. Additionally, patients wearing a condom catheter were more likely to report their device was more comfortable and less painful. Finally, time of onset of bacteriuria was noted to be shorter in the indwelling catheter group compared to condom catheter group. There were several study limitations. First, a small number of participants (n=75) were enrolled in the study despite four years of intensive screening. Study eligibility requirements and patients’ refusal to be randomized to a catheter type limited enrollment. Patients were particularly resistant to being randomized to indwelling catheterization. The pool of potential participants included a large number of cognitively impaired individuals, with no surrogate decision maker, who were unable to provide informed consent, thus further limiting study enrollment Second, the study was conducted at a single site, which may limit generalizability. Third, only one specific type of condom catheter, available in various sizes and specifically designed to reliably stay in place, was used; this may limit generalizability to patient populations which use other types of condom catheters. Finally, randomization resulted in an unequal distribution of patients with
dementia being allocated to the two groups (more were randomized to the condom catheter group). Findings suggest that a condom catheter may be a safer and more comfortable alternative than an indwelling catheter when there is no need to overcome obstructive uropathy or neurogenic bladder. Discussion: • The group thought the article was very relevant and timely considering CAUTI rates at UMMC. • Several staff members mentioned ongoing unit discussions regarding comparison of infection rates between indwelling urinary catheters and male external catheters. • Urinary infections are particularly challenging to manage in certain neurology patients. • The group agreed that it is very important that nurses actively advocate for discontinuing catheter use as early as clinically possible to avoid UTIs and other adverse events. • The group noted that staff must continue to be diligent in providing proper care for their patients requiring Foley catheters when condom catheters are not appropriate. • The upcoming trial use of the Reliafit male external catheter on several UMMC units was discussed as a possible solution to the problem of poorly-fitting condom catheters, which frequently leak and fall off. References Fekete, T., Calderwood, S., Bloom, A. (2014). Catheterassociated urinary tract infections in adults. UpToDate, http://www.uptodate.com/contents/ catheter-associated-urinary-tract-infection-in-adults. Jamison, J., Maguire, S., McCann, J. (2004). Catheter policies for management of long-term voiding problems in adults with neurogenic bladder disorders. Cochrane Database Systematic Review. doi: 10.1002/14651858.CD004375.pub2 Johnson, T., Ouslander, J., Uman, G., Schnelle, J. (2001). Urinary incontinence treatment preferences in longterm care. Journal of the American Geriatrics Society, 49(6), 710-718. Saint, S., Kaufman, S., Rogers, M., Baker, P., Ossenkop, K., Lipsky, B., (2006). Condom versus indwelling catheters: A randomized trial. Journal of American Geriatric Society, 54,1055-1061. Saint, S., Lipsky, B., Baker, P., McDonald, L., Ossenkop, K. (1999). Urinary Catheters: What type do men and their nurses prefer? Journal of American Geriatric Society, 47(2), 1453-1457. Saint, S., Lipsky, B., Goold, S. (2002). Indwelling catheters: A one-point restraint? Annals of Internal Medicine, 137(2), 125-127.
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