Male External Catheters and Urinary Tract Infections: A Systematic Review and Meta-Analysis of Current Evidence and the Need for Standardized Reporting.

Catheter-associated urinary tract infections (CAUTIs) are a significant cause of morbidity and mortality among hospitalized patients, prompting the implementation of various strategies to reduce their incidence, including the use of male external catheters (MEC). However, the effectiveness of MEC in preventing urinary tract infections (UTIs) remains uncertain. This study aimed to systematically summarize existing research and conduct a meta-analysis to evaluate the impact of MEC on UTI rates and related outcomes. We searched PubMed, Medline, Embase, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform for peer-reviewed articles and clinical trials from inception until June 30, 2024, ultimately including 42 of 1,545 publications in our systematic review, comprising 40 observational studies and two randomized controlled trials (RCTs). Our meta-analysis focused on eight articles with complete methodology and outcomes, revealing a non-significant 27% decrease in UTIs among MEC users (odds ratio 0.73, confidence interval 0.44-1.22) with moderate heterogeneity (I = 58.47%). Additionally, asymptomatic bacteriuria was associated with a non-significant 3% lower risk for MEC (odds ratio 0.97, confidence interval 0.61-1.54) and mild heterogeneity (I = 29.79%). The incidence rate ratio (IRR) for UTIs significantly decreased when comparing MEC users to indwelling urinary catheter (IUC) users (odds ratio, 0.20; 95% confidence interval, -0.03 to 0.43), demonstrating significant heterogeneity (I = 99.98%). Our findings indicated variability in the reporting of secondary outcomes, with a non-significant decrease in UTI and asymptomatic bacteriuria events among MEC users compared to IUC users. However, effect sizes were associated with significant heterogeneity. We recommend standardized reporting of secondary outcomes in future studies to enhance comparability and reliability.