Intermittent urethral catheters for chronic incomplete bladder emptying in adults

The evaluation states that there is not enough evidence to determine whether price variation is justified between different intermittent urethral catheters for chronic incomplete bladder emptying in adults. It recommends that the healthcare professional and the person with chronic incomplete bladder emptying should decide together which intermittent urethral catheters to use, taking into account ease and comfort of use and risk of infection. 

If more than one catheter meets the person's needs and preferences and is clinically appropriate, the least expensive catheter should be chosen. 
 

Recommendations for healthcare professionals 

The document lists the following considerations for healthcare professionals: 

• Many factors can influence which type of intermittent catheter is most appropriate and how effective it might be. 
• Decide together with the person with chronic incomplete bladder emptying which catheter to use, following the principles of NICE's guidance on shared decision making. 
• More than 1 type of catheter may need to be prescribed to suit different settings and situations. Recommendation 1.4 should be considered for each type of catheter that a person needs. 
• Inform people with chronic incomplete bladder emptying that there is a range of catheters available and offer them: 
  • a choice of catheters 
  • training on how to use each type of catheter 
  • regular review of the chosen catheter's suitability, which may change over time. 

These recommendations are not intended to affect existing catheter use if the person's catheter is clinically appropriate and meets their needs. The recommendations should be considered when people are changing catheter or reviewing their catheter use. 

The document also provides the following information for people with chronic incomplete bladder emptying:

• You should be told about the range of catheters available and given a choice of catheters that are suitable for you. 
• You should be given training on how to do intermittent catheterisation. 
• If catheters that you are using cause complications, such as pain or discomfort, urinary tract infection or bleeding, you should be supported to see if changing the catheter type helps. 

In outlining why they have made these recommendations, the committee stated that: 
 

‘there is no robust clinical evidence of the effectiveness of individual features of catheters. The available evidence also does not consistently report on the most important outcomes. Where there is limited evidence for a particular feature, there is a lack of information about how the reported outcome can be attributed to that feature. Evidence from people who use intermittent catheters for bladder drainage shows that the most important factors for them are ease and comfort of insertion and risk of infection. It also shows that their needs, preferences and experiences of using intermittent catheters vary. 

There is not enough evidence to determine whether price variation between catheters with different features is justified, and more information is needed.'