Is It Really the Foley? A Systematic Review of Bladder Management and Infection Risk

Top Spinal Cord Inj Rehabil, 2023 · DOI: 10.46292/sci22-00009 · Published: January 1, 2023

Simple Explanation

This study reviews existing research on bladder management methods (BMM) for individuals with spinal cord injury (SCI) and the risk of urinary tract infections (UTIs). The focus is on comparing indwelling catheters (IND) and intermittent catheterization (IC). Many guidelines suggest IC is better due to lower infection risk. However, this review questions that, suggesting the evidence isn't strong, and other factors might be involved, like the Spinal Cord Injury Immune Deficiency Syndrome (SCI-IDS). The review looks at the quality of studies, focusing on whether they properly accounted for factors like injury severity and immune status, which can affect UTI risk regardless of the catheter type used.

Study Duration

January 1, 1980, to September 15, 2020

Participants

24 studies involving adults with SCI

Evidence Level

Systematic Review

Key Findings

1
Most studies do not show a significant difference in UTI risk between indwelling and intermittent catheterization.
2
Studies suggesting higher UTI rates with indwelling catheters often have methodological flaws, such as not accounting for the Spinal Cord Injury Immune Deficiency Syndrome (SCI-IDS).
3
Other factors, such as bladder behavior during urodynamic testing and severity of injury, may be more strongly associated with UTI risk than the type of catheter used.

Research Summary

This systematic review challenges the common belief that indwelling catheters lead to more UTIs than intermittent catheterization in individuals with spinal cord injuries. The review found that most studies do not demonstrate a significant difference in UTI risk between the two bladder management methods, and studies favoring intermittent catheterization often have a higher risk of bias. The authors conclude that perceptions about infection risk should not be the primary factor in choosing between indwelling and intermittent catheterization, and other factors should be considered.

Practical Implications

Clinical Practice

Clinicians should not automatically favor intermittent catheterization over indwelling catheters based solely on perceived infection risk. A more individualized approach is necessary.

Research

Future research should focus on better controlling for confounding factors such as the Spinal Cord Injury Immune Deficiency Syndrome (SCI-IDS) and bladder behavior during urodynamic testing.

Patient Education

Patients should be educated that the type of catheter may not be the most important factor in UTI prevention and that other factors may play a larger role.

Is It Really the Foley? A Systematic Review of Bladder Management and Infection Risk

Simple Explanation

Key Findings

Research Summary

Practical Implications

Clinical Practice

Research

Patient Education

Study Limitations

Your Feedback

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Is It Really the Foley? A Systematic Review of Bladder Management and Infection Risk

Simple Explanation

Key Findings

Research Summary

Practical Implications

Clinical Practice

Research

Patient Education

Study Limitations

Your Feedback

Was this summary helpful?