Urinary catheters: state of the art and future perspectives - a narrative review

Catheter associated urinary tract infection (CAUTI) is the most frequent healthcare associated infection, arising from microbial adhesion to catheter surfaces, biofilm development, and the growing problem of antimicrobial resistance. Many publications have addressed CAUTI epidemiology, biofilm biology, or biomaterials for catheters in isolation, yet there is little literature that connects these areas into a coherent translational perspective. This review seeks to fill that gap by combining an overview of biofilm pathophysiology with recent advances in material based innovations for catheter design, including nanostructured and responsive coatings, sensor enabled systems, additive manufacturing, and three dimensional printing. Established approaches such as hydrophilic or antimicrobial impregnated catheters are considered alongside bio inspired surface textures, zwitterionic polymers, and multifunctional hydrogels. Each strategy is evaluated in terms of maturity, clinical applicability, and barriers to translation, with a focus on shifting from antibiotic dependent treatment toward prevention of biofilm formation. By bringing together knowledge from microbiology, engineering, and clinical urology, the review outlines pathways for developing the next generation of catheters that improve outcomes and reduce infection rates.