Mixed Catheter Use Shows Comparable Safety

Intermittent catheterisation supports long-term bladder emptying for people who cannot fully empty the bladder without assistance. In many countries, single-use catheters remain standard practice, although rising costs and waste have maintained interest in reusable alternatives. A randomised controlled trial published in the International Journal of Nursing Studies compared a mixed approach, using reusable catheters alongside usual single-use products, with single-use catheterisation alone. The UK-based MultICath trial followed 578 community-dwelling adults for 12 months and focused on microbiologically confirmed symptomatic urinary tract infection (UTI). Mixed use met the safety threshold set for comparison with single use and was associated with lower antibiotic use. Quality of life and adverse events were broadly similar, although some practical difficulties were more common with reusable catheters. The comparison reflects longstanding concerns about infection risk, user burden and service waste.

Community Care and Patient Choice

Intermittent catheter users were recruited through general practices, community nursing teams and hospital clinics in England, Scotland and Wales. Eligible participants were adults using catheterisation through the urethra, either independently or with help from a personal carer. They had already used intermittent catheterisation for several weeks and expected to continue for at least 12 months. Most participants carried out catheterisation themselves, and baseline characteristics were broadly similar between the two groups. Nurses remain central to catheter practice in several specialisms, including urology, women’s health, neurology and community nursing, where they teach, support, select and prescribe intermittent catheters.

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MultICath reflected a self-directed approach rather than complete replacement of single-use catheters. Participants allocated to mixed use received reusable catheters and continued to access their usual single-use catheters. A cleaning process involved soap and water, followed by a short soak in a chlorine-based solution. A two-week learning period allowed gradual adoption of the reusable catheter, with participants adjusting frequency according to preference and tolerance. The single-use group continued usual care. This design matched the preference expressed by some catheter users for choice across settings, including the option to use reusable catheters at home and single-use products away from home.

Comparable Infection Outcomes

The main safety measure combined a positive urine culture, symptoms recognised by the participant and help-seeking or self-help behaviour. Over 12 months, fewer than one third of mixed-use participants in the primary analysis had at least one confirmed symptomatic UTI, compared with about one third of those using single-use catheters only. The comparison met the pre-set non-inferiority margin, meaning mixed use was not worse than single use for the principal infection outcome.

The same pattern appeared across additional infection measures. Results over six months, sensitivity checks and analyses using a narrower UTI definition were consistent with the main comparison. Antibiotic use also favoured mixed use. Courses for suspected UTI were 35% lower in the mixed-use group in the primary analysis, while other UTI outcomes also moved in the same direction. These infection and antibiotic results matter for healthcare professionals because concern about UTI risk has been a central barrier to wider use of reusable catheters. Earlier evidence had left uncertainty around differences in UTI rates, and MultICath adds a larger community-based comparison of mixed use against single-use catheterisation only. The findings support mixed use as a safe option for community management when users can retain access to single-use catheters.

Practical Barriers and Care Delivery

Mixed use did not create evidence of poorer quality of life, higher adverse event rates or greater visible blood, pain, discomfort, microhaematuria or inability to pass the catheter. Related adverse events were low and comparable across groups. Serious adverse events requiring hospitalisation for reasons possibly related to the intervention occurred in both groups, including genito-urinary tract infections. The overall safety profile therefore aligned with the main UTI result. Among participants who continued with reusable catheters, reuse accounted for more than 60% of catheterisations and did not decline over time.

Practical tolerability remained important. Sticking during catheter removal occurred more often with mixed use than with single-use catheters only. The reusable silicone catheter required external lubrication and differed from the smooth, plastic-based single-use products commonly used by participants. Mixed-use participants were also more likely to withdraw or discontinue the reusable catheter while remaining in follow-up. Reported reasons included catheter-related difficulties, reuse processes and the burden of cleaning. Some users found the reusable catheter harder to insert, and some found cleaning difficult to sustain. These barriers indicate that reusable catheters are unlikely to suit every user. Nursing, continence and community services therefore need to treat reusable products as an option within supported choice rather than a universal replacement.

MultICath supports the safe use of reusable catheters alongside single-use products for adults managing long-term bladder emptying problems in the community. Mixed use met the safety threshold for UTI and was associated with lower antibiotic use, while quality of life and adverse events were broadly similar. Practical problems, especially sticking and the burden of cleaning, remain important considerations. Reusable catheters can therefore form part of patient-centred catheter management when users have appropriate support and retain access to single-use catheters within routine community care. The model depends on flexibility, practical training and continued access to both catheter types.

Source: International Journal of Nursing Studies

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