External catheter reduces risk of urinary tract infection

An external or “condom” catheter appears to reduce the risk of urinary tract infections or death by 80% compared with an indwelling catheter, according to a randomized, controlled trial comparing the two types of catheters.

“This is one of the bread-and-butter issues that adversely affects the safety of many hospitalized patients and that will affect more of us as the population continues to age,” said lead author Sanjay Saint, MD, MPH, of the University of Michigan Medical School, Ann Arbor. “It has implications for many hospitalized patients, 25% of whom use catheters, but also for patients in nursing homes and at home.”

The trial included 75 men, of whom 41 received an indwelling catheter and the rest received one of five sizes of silicone condom catheters. Eleven new cases of bacteriuria were reported for every 100 days of hospitalization in patients with indwelling catheters, compared with six for those with condom catheters. Indwelling catheter users developed the condition faster (within 7 days) compared with condom catheter users (13 days).

In patients without dementia, indwelling catheter users were 4.8 times more likely than were condom catheter users to experience bacteriuria, symptomatic UTI, or death. In patients with dementia, this difference was not seen. The impact of dementia, Dr. Saint says, may be linked to the tendency of cognitively impaired men to touch or to try to remove their catheters.

The study, published in the Journal of the American Geriatrics Society (2006; 54:1055-61), also showed that nearly 90% of condom catheter users said the device was comfortable, and 5% said it was painful, compared with 58% and 36%, respectively, of those with indwelling catheters.