The Impact of Catheter Selection on UTIs

Using a hydrophilic rather than an uncoated catheter may dramatically decrease the risk of urinary tract infections in children on clean intermittent catheterization for neurogenic bladder, according to the results of a research study at Cincinnati Children’s.

Clean intermittent catheterization (CIC) is the initial treatment of choice for these patients, but it can lead to complications. The most common is urinary tract infections (UTIs). While not life threatening, UTIs can cause some morbidity, discomfort and a need for antibiotics. Other CIC-related complications include urethral false passage, urethral strictures and gross hematuria.

Physicians in the United States tend to prescribe conventional uncoated catheters, likely because of the perceived lower cost. However, some research indicates that hydrophilic catheters cause less trauma to the urethra due to their slippery coating. “We decided to compare these two types of catheters in patients with neurogenic bladder, looking at the incidence of UTI, difficulty passing the catheter, urethral injury and patient satisfaction,” says W. Robert DeFoor, Jr., MD, MPHa pediatric urologist and lead author of the study. “We theorized that patients using the hydrophilic catheter would experience fewer urethral complications and urinary tract infections.”

Seventy-eight patients ages 2 to 17 were enrolled, with 37 randomized to the hydrophilic group and 41 to the uncoated control group. The groups were about equally split male and female, and approximately two-thirds of participants had myelomeningocele. Participants who perform self-catheterization were tested for hand dexterity to make sure the groups were evenly matched. There were no significant differences between the groups at baseline as far as age, gender, bladder anatomy or dominant-hand dexterity scores. Patients were followed for about one year.

Significant UTI impact

The study did not show a difference between the two groups for pain, hematuria or urethral injuries, but did indicate a significant difference in UTI occurrence. For example:

  • Two UTIs occurred in two patients in the hydrophilic group, and 17 UTIs occurred in seven patients in the uncoated catheter group.
  • Patients with UTIs in the hydrophilic group went from 16 percent in the previous year to 5 percent during the study.
  • Three children in the hydrophilic group had three or more UTIs in the year before enrollment and none during the study.

 “Most patients who used hydrophilic catheters were pleased overall and asked to continue using them after the study, although some found the catheters difficult to handle due to their slippery coating,” DeFoor says. “Based on the study results, we are offering hydrophilic catheters as an option for patients on CIC, and strongly considering them for patients on CIC who experience a UTI while using uncoated catheters.”


The study, “Results of a Prospective Randomized Control Trial Comparing Hydrophilic to Uncoated Catheters in Children with Neurogenic Bladder,” appeared online in the Journal of Pediatric Urology in July 2017.

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