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Reused silicone catheter for clean intermittent catheterization (CIC): is it safe for spinal cord-injured (SCI) men?
A Kovindha1, W Na Chiang Mai, H Madersbacher
1Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Insights
Reusable silicone catheters are safe for spinal cord injured men using clean intermittent catheterization (CIC) long-term. Proper cleaning is crucial to minimize infection risks when reusing catheters in developing countries.
Area of Science:
- Urology
- Biomaterials Science
Background:
- Spinal cord injury (SCI) often necessitates long-term bladder management.
- Clean intermittent catheterization (CIC) is a common method for bladder emptying in SCI individuals.
- The cost and availability of disposable catheters can be a barrier, particularly in developing countries, prompting interest in reusable options.
Purpose of the Study:
- To evaluate the safety and clinical outcomes of reusable silicone catheters used for CIC in men with SCI.
- To assess the impact of long-term reuse on catheter morphology and urethral health.
Main Methods:
- A cross-sectional study involving SCI men using reusable silicone catheters for over a year.
- Review of demographic data, urological management, and urinary tract complications.
- Radiological assessment of urethral status.
- Electron microscopy analysis of reused catheters for surface morphology, lumen patency, and stiffness.
Main Results:
- Twenty-eight SCI men with an average of 4.8 years of CIC use and 3 years of individual catheter reuse were studied.
- While urinary complications were noted, they did not significantly correlate with urethral abnormalities or infections.
- Electron microscopy showed catheter encrustation and increased stiffness with reuse, but no lumen obstruction.
- Higher CIC frequency was associated with lower urethral abnormality rates.
Conclusions:
- Reusable silicone catheters demonstrate comparable clinical outcomes regarding urethral health to disposable ones for SCI patients.
- Proper cleaning and application are essential to mitigate the increased risk of infection associated with catheter reuse.
- For SCI patients in resource-limited settings, reusable silicone catheters may offer a safe and viable alternative to disposable ones if managed correctly.
- Further research is needed to establish optimal reuse durations for silicone catheters in developing countries.
Study Design:
Study of reusable catheter.
Objective:
To investigate whether a silicone cathether reused over years for clean intermittent catheterization (CIC) was safe for spinal cord injured (SCI) men.
Setting:
Maharaj Hospital, Chiang Mai, Thailand.
Method:
A cross-sectional study was obtained from SCI men who had used CIC with a reusable silicone catheter for more than a year. Demographic data, urological management and urinary tract complications focusing on the radiologic status of the urethra were reviewed and analyzed. In addition, two reused and one new catheters were studied under electron microscope for catheter morphology (surface and lumen) and stiffness.
Results:
There were 28 SCI men included in this study. The average duration of CIC use was 4.8 years and the average time of usage for each catheter was 3 years (range 1-7 years). In all, 26 men previously used indwelling catheterization (ID) during the acute phase. In all, 23 men performed self-catheterization. Regarding urinary complications, three reported urethral bleeding, five had episodes of pus per urethra, five had epididymitis, four had passing stones, 18 had occasional foul smelly urine, 10 developed fever and cloudy urine during the past year. Of 17 patients who had ultrasonography done, four had pathologic findings in kidney and one had bladder calculi. Demographic data, urinary management and complications did not have significant relation to the abnormality of the urethrogram or urinary tract infection. However, where the frequency of CIC was higher, the abnormality of the urethra was lower (P<0.05). All had serum Cr level < or =1.3 mg/dl. Electron microscopic findings of reused catheters for 2 years revealed encrustation but no obstruction in the lumens and 20% increase in stiffness.
Conclusion:
The clinical outcome, especially with regard to urethral abnormalities with this reusable silicone catheter is as good as with a disposable one. However, to reuse urinary catheters, one should consider the increasing risk of infection. For SCI patients in developing countries, CIC with a reusable silicone catheter may be a suitable and safe choice if one cleans and applies it properly to reduce infection. In order to answer the question how long a person in a developing country should use the same silicone catheter, further research should be conducted.