2026-06-02
The incidence of urinary tract infections and the common bacterial flora vary depending on the bladder management method. Clean intermittent catheterization is recognized as the most safe and effective bladder management method. A large number of clinical studies have shown that hydrophilic-coated intermittent catheters can reduce the damage to the urethral mucosa during insertion and are beneficial in reducing the occurrence of urinary tract infections.
1.Urinary tract infection
Urinary tract infection is the most common complication of intermittent catheterization. Despite the continuous improvement of treatment and care techniques, urinary tract infection remains the primary cause of patients' readmission and death.
Due to the different criteria for diagnosing urinary tract infections, the incidence rates of urinary tract infections reported in various studies vary significantly. Singh et al.'s investigation of 386 male and 159 female patients with traumatic spinal cord injuries showed that the overall incidence of urinary tract infections per 100 people per day was 0.64 times. The rate for patients with indwelling catheters was 2.68 times, for those using clean intermittent catheterization it was 0.34 times, for those using condom urination it was 0.34 times, for those with suprapubic bladder fistula it was 0.56 times, and for those with spontaneous urination it was 0.34 times.
Urinary tract infections not only cause endless troubles and pose a threat to patients' lives, but also result in huge medical expenses. According to statistics in the United States in 2009, the treatment cost for each catheter-related urinary tract infection is at least $600, and the treatment cost for catheter-related bacteremia is as high as $2,800. What is even more worrying is that repeated urinary tract infections may develop into antibiotic resistance. Therefore, prevention and treatment of urinary tract infections are of utmost importance.
2.Common bacterial flora in urinary tract infections
Ryu et al. divided 112 patients with spinal cord injury based on different urination methods, including 41 cases of clean intermittent catheterization, 34 cases of suprapubic bladder fistula, 9 cases of indwelling urinary catheter, and 28 cases of spontaneous urination. They conducted urine culture and antibiotic sensitivity tests on 1,236 urine specimens from these patients. The results showed that the positive rate of urine culture was 74.8%, and 30.2% had more than one type of bacterial infection. The pathogenic microorganisms were mainly Gram-negative bacteria (84%): Pseudomonas aeruginosa (22.9%), Escherichia coli (2.1%), Klebsiella species (6.7%), etc. The common Gram-positive bacteria (13.6%) were Streptococcus (8.6%) and Staphylococcus (2.6%). The most common pathogenic bacteria in the clean intermittent catheterization group was Escherichia coli, while in the suprapubic bladder fistula group and the spontaneous urination group, the most common infection was Pseudomonas aeruginosa. It is recommended that before waiting for the results of urine culture and bacterial sensitivity tests, if patients urgently need to use antibiotics to control the infection, they can experimentally select antibiotics based on their urine voiding method.
3.Strategies for Treating Urinary Tract Infections
The causes of urinary tract infections include insufficient frequency of catheterization, inadequate urine drainage during catheterization, problems with catheter insertion and care, excessive intake of liquid food, and frequent nocturnal urination. Nurses should provide targeted training and guidance based on the specific conditions of each patient.
In recent years, numerous clinical studies, including randomized controlled trials, have proved that the use of hydrophilic-coated urinary catheters can reduce the occurrence of urinary tract infections. Cardenas et al.'s clinical experiment on 224 patients with acute traumatic spinal cord injury at 15 spinal cord injury centers in North America showed that patients who used hydrophilic-coated urinary catheters for intermittent catheterization had a significantly later onset of symptomatic urinary tract infections requiring antibiotic treatment compared to those using uncoated ordinary PVC catheters (with lubrication). At the same time, it reduced the incidence of urinary tract infections during hospitalization by 21%.
Compared with ordinary PVC catheters, hydrophilic-coated nelaton catheters can reduce the friction between the catheter and the urethra, thereby minimizing the minor trauma caused by catheter insertion to the urethra and reducing the occurrence of urinary tract infections. Moreover, the overall satisfaction rate of hydrophilic-coated urinary catheters in terms of convenience and comfort is also higher, and patients are more willing to accept and use them for a long time. A randomized trial study on healthy male volunteers also obtained the same results.
Patients with neurogenic bladder suffer from neurological dysfunction, resulting in decreased sensitivity of the urethra or even complete loss of sensation. They are unable to accurately perceive the comfort level and pain during catheter insertion. Therefore, experimental results from healthy individuals are more reliable.
4.Other Complications
Other complications caused by intermittent catheterization include prostatitis, urethral bleeding, urethral stenosis, and formation of urethral pseudo-channel. The incidence of male prostatitis ranges from 5% to 33%. Urethral bleeding is common at the beginning stage of intermittent catheterization, and persistent bleeding may be a sign of urinary tract infection. Urethral stenosis often occurs in the anterior part (urethral opening and urethral bulb) and posterior part (urethral membranous part and prostate part) of the urethra, and is caused by repeated minor trauma to the urethra leading to inflammatory response. Patients with urethral stenosis, detrusor-sphincter coordination disorder, and enlarged prostate should be alert to the formation of urethral pseudo-channel.
Most of the current clinical data come from male patients with spinal cord injury. Female patients and other patients with NLUTD such as spina bifida and multiple sclerosis are relatively rare. We look forward to further studies on this group of people.
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