Clean intermittent self-catheterisation: a randomised controlled crossover trial of single-use versus multiple reuse of catheters

Urinary tract infection is often reported by people who perform clean intermittent selfcatheterisation (CISC). This project aimed to assess the incidence of urinary tract infection, in those undertaking multiple catheter reuse versus single-use catheter, using a prospective randomised controlled trial, with crossover design. The burden of costs for the patient employing single-use catheters, compared to multiple reuse catheters was also examined. Eligible participants performing CISC were randomised to single-use or multiple reuse of catheters for eight weeks, then crossed over to the alternative for eight weeks. The primary outcome measure was the incidence of symptomatic urinary tract infection, determined by bacteria load in catheter specimens of urine collected at baseline and then every four weeks. Proven bacterial cystitis and asymptomatic bacteriuria was also determined. Measures of the financial impact of self-catheterisation were also collected. The 23 participants (average age 60 years) were 73% female. Self-catheterisation for post-operative retention was required for 10/23 (43%) of participants. At week eight, symptomatic urinary tract infection occurred in 20% of singleuse, versus 17% in the multiple reuse group. The infection rate did not increase after crossover from single-use to multiple catheter reuse (p=0.26). Similarly, the incidence of pyuria in participants did not differ in the single or multiple reuse arm of the trial (p=0.75). The estimated annual cost of single use CISC was more than 20 times higher than for multiple reuse. These data show no clinically apparent trend towards increased rates of UTI in participants who reused their CISC catheters.