People with nerve damage affecting the bladder may have incontinence (leakage of urine) or an inability to empty the bladder (voiding problem). This may cause infections or damage to the kidneys. Treatments include a permanent urinary catheter; using a catheter intermittently whenever the bladder needs to be emptied; an external sheath catheter fitted to the penis; or timed voiding, which involves regular emptying of the bladder at timed intervals. Although all these methods are used in practice, the review found that no randomised trials have been conducted to provide good evidence to suggest which is best and in which circumstances.
Despite a comprehensive search no evidence from randomised or quasi-randomised controlled trials was found. It was not possible to draw any conclusions regarding the use of different types of catheter in managing the neurogenic bladder.
Management of the neurogenic bladder has the primary objectives of maintaining continence, ensuring low bladder pressure (to avoid renal damage) and avoiding or minimising infection. Options include intermittent urethral catheterisation, indwelling urethral or suprapubic catheterisation, timed voiding, use of external catheter (for men), drug treatment, augmentation cystoplasty and urinary diversion.
The primary objective was to determine the effects of different methods of managing long-term voiding problems (persisting after three months) with catheters in patients with neurogenic bladder.
Specific hypotheses to be addressed included:
1. that intermittent catheterisation is better than indwelling catheterisation;
2. that indwelling urethral catheterisation is better than suprapubic catheterisation;
3. that external (sheath) catheters are better than indwelling or intermittent urethral catheters;
4. that external (sheath) catheters are better than suprapubic catheters;
5. that intermittent catheterisation is better than timed voiding.
We searched the Cochrane Incontinence Group Specialised Register (searched 3 July 2013), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in process, and handsearched journals and conference proceedings. We sought additional trials from other sources such as the reference lists of relevant articles and by contacting consultants in Spinal Cord Injury Centres throughout the United Kingdom.
All randomised and quasi-randomised controlled trials comparing methods of using catheters to manage urinary voiding in people with neurogenic bladder.
Abstracts were independently inspected by the reviewers and full papers were obtained where necessary.
Approximately 400 studies were scrutinised. No trials were found that met the inclusion criteria, and five studies were excluded from the review.