Moore et al. 2006
Canada
PEDro=4
RCT
N=36

Population: SCI inpatients undergoing rehabilitation and requiring intermittent catheterization due to neurogenic bladder; Mean age = 40 yrs; Gender: males = 28, females = 8; Level of injury: cervical.
Treatment: Comparison of clean vs sterile IC. Laboratory personnel were blinded to subject allocation.
Outcome Measures: Prevalence of UTI, time to onset of UTI, costs of intermittent catheterization, types of bacteria, adverse effects. Urine analysis was conducted weekly.

• No significant difference (p>0.05) between the groups was seen in:
• Prevalence of UTI.
• Time to onset of UTI.
• Cost for clean intermittent catheterization per day was half that of sterile ($7.56 CDN vs $16.62 CDN).
• The most common type of bacteria included Enterococcus and Klebsiella.
• No adverse effects were reported.

Prieto-Fingerhut et al. 1997
USA
PEDro=2
RCT
N=29

Population: SCI during inpatient rehabilitation: Gender: males = 16, females = 13; Severity of injury: AIS: A-D.
Treatment: Comparison of sterile vs non-sterile (clean) intermittent catheterization technique every 4 to 6 hours.
Outcome Measures: Number of UTI over a 3 month period.

• There were less UTIs with the sterile vs the non-sterile catheterization program (28.6% vs 42.4%) but this difference was not significant.
• Sterile catheterization program was 277% more costly.

Charbonneau-Smith 1993
Canada
Downs & Black score=18
Prospective Controlled Trial (retrospective control group)
N=110

Population: Traumatic SCI on inpatient rehabilitation; 2 groups were similar with respect to median age (30.5 vs 30 years), gender, paraplegics vs quadriplegics, level of lesion and extent of lesion; LOS: 4.8 vs 11 weeks.
Treatment: Assessment of no-touch vs traditional straight IC method.
Outcome Measures: UTIs, infection free days, duration of infection, cost of antibiotics, nurse satisfaction with method collected during rehabilitation hospital stay.

• “No-touch” experimental group had fewer UTIs (p=0.0001), and reduced duration of infections (p=0.0004).
• No difference on total cost (including antibiotics) and # of infection-free days (trends were in favour of “No-touch”, p=0.072, p=0.125).
• Similar number of catheters used despite > 2x longer LOS for traditional method.
• Majority of nurses reported they preferred “No touch” catheter.

Jensen et al. 1995
Norway
Downs & Black score=14
Pre-Post
N=12

Population: SCI rehabilitation inpatients: Age = 17-72 yrs; Gender: males = 11, females = 1; Level of injury: complete, incomplete; Time since injury = 3-7mths.
Treatment: Effect of residual urine volume following IC on UTIs.
Outcome Measures: Residual urine volume as measured by utrasonography and occurrence of UTIs collected during hospital stay.

• Residual urine volumes were not associated with UTIs - Mean & Max residual volumes/UTI correlations: r=.19 & .16 (p=.52 & .63) respectively.
• Trend for greater maximal residual urine in hyperactive vs hypoactive bladder following IC (p=0.06).
• No differences in hyperactive vs hypoactive bladder for mean residual volumes  (p=0.21) or UTIs (p=0.49).

Wyndaele & De Taeye 1990
USA
Downs & Black score=8
Case Control
N=73

Population: SCI inpatients; Age = 6-59 yrs; Gender: males = 22, females = 3; Level of injury: paraplegia, tetraplegia.
Treatment: Comparison of patient self-catheterization vs in-hospital catheter team for IC.
Outcome Measures: Success in balancing bladder, UTI rate, urethral trauma collected over inpatient stay.

• No difference in UTI between groups.
• No difference in achieving a state of balanced bladder between groups (i.e., able to empty bladder by tapping or straining after a mean of 5 weeks.)
• No difference in urethral trauma between groups.

Yadav et al. 1993
India
Downs & Black score=7
Case control
Group A: n=27
Group B: n=21

Population: Group A: males = 26, females = 1; Time since injury = 12-96 hrs; Group B: Level of injury: paraplegia = 19, tetraplegia = 2; Chronicity = chronic.
Treatment: Group A (short-term clean intermittent catheterization (CIC)) - CIC started on day 1 of hospitalization.  Group B (Long term CIC) – CIC over 1-12 years.
Outcome Measures: Number of UTIs collected over 10 days to 3 months (A) or over 6 months (B).

• Both short-term and long-term groups had relatively low rates of UTI.
• Group A: 5 subjects had symptomatic UTI between 10 days-3mos (18.5%).
• Group B:  0.07 episodes per patient per month symptomatic UTI (33%).