Shamout S, Biardeau X, Corcos J, Campeau L
Division of Urology, Department of Surgery, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada.
Spinal Cord. 2017 Jul;55(7):629-643. doi: 10.1038/sc.2016.192. Epub 2017 Jan 24.
Systematic review (Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA); http://www.prisma-statement.org).
Different types of catheters and techniques have been described in the past three decades to identify the best self-intermittent catheterization method. Our aim is to review systematically the literature on the most appropriate material and technique to perform self-intermittent catheterization in the adult neurogenic population.
A systematic review search was performed through PubMed/Medline, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) databases to study all types of self-intermittent catheters, and analyzing their impact on urinary tract infections (UTIs), urethral trauma, cost-effectiveness, quality of life and patient's satisfaction. We used the following keywords: 'intermittent catheterization/catheterisation', 'neurogenic', 'urinary catheters for intermittent use' and 'urethral catheterization/catheterisation' published by November 2015.
After screening 3768 articles, 31 were included in the final synthesis (level of evidence 1b to 2b). The 2188 trial participants were mainly spinal cord injury adults and women with multiple sclerosis. Hydrophilic-coated catheters tended to decrease the incidence of UTI as well as urethral trauma and improve patient's satisfaction when compared with non-hydrophilic-coated catheters. Similarly, prelubricated catheters were associated with better results in terms of patient satisfaction. Sterile technique seemed to decrease the incidence of recurrent UTI; however, these results are counter-balanced by significantly increasing cost compared with clean catheterization.
The present review demonstrated advantages of hydrophilic-coated catheters in decreasing risk of UTI and urethral trauma as well as improving patient's satisfaction. Prelubricated catheters has been shown to be superior to conventional polyvinyl chloride catheters. Randomized controlled trials comparing hydrophilic and prelubricated catheters must be conducted to assess possible superiority and cost-effectiveness.
系统评价（系统评价与Meta分析的首选报告项目（PRISMA）；http://www.prisma-statement.org）。
在过去三十年中，已经描述了不同类型的导管和技术，以确定最佳的自我间歇性导尿方法。我们的目的是系统回顾关于在成年神经源性人群中进行自我间歇性导尿的最合适材料和技术的文献。
通过PubMed/Medline、Embase和Cochrane对照试验中央注册库（CENTRAL）数据库进行系统评价检索，以研究所有类型的自我间歇性导尿管，并分析它们对尿路感染（UTI）、尿道创伤、成本效益、生活质量和患者满意度的影响。我们使用了以下关键词：2015年11月之前发表的“间歇性导尿”、“神经源性”、“间歇性使用的导尿管”和“尿道导尿”。
在筛选了3768篇文章后，最终纳入综合分析的有31篇（证据级别为1b至2b）。2188名试验参与者主要是脊髓损伤的成年人和患有多发性硬化症的女性。与非亲水涂层导尿管相比，亲水涂层导尿管倾向于降低UTI的发生率以及尿道创伤，并提高患者满意度。同样，预润滑导尿管在患者满意度方面也有更好的结果。无菌技术似乎可以降低复发性UTI的发生率；然而，与清洁导尿相比，这些结果被成本显著增加所抵消。
本综述表明亲水涂层导尿管在降低UTI风险和尿道创伤以及提高患者满意度方面具有优势。预润滑导尿管已被证明优于传统的聚氯乙烯导尿管。必须进行比较亲水和预润滑导尿管的随机对照试验，以评估可能的优势和成本效益。
