Darouiche et al. 2006
USA
PEDro=4
RCT
N=127/118

Population: Hospital inpatients with neurogenic bladders requiring an indwelling or suprapubic bladder; Experimental group: Age = 55 yrs; Gender: males = 88%, females = 12%; Level of injury: cervical = 48%, thoracolumbar = 40%, mutiple sclerosis = 12%; Control group: Age = 56 yrs; Gender: males = 88%, females = 12%; Level of injury: cervical = 50%, thoracolumbar = 45%, mutiple sclerosis = 5%.
Treatment: Experimental group: indwelling bladder catheters secured by the Statlock device; Control group: catheter secured by tape, velcro strap, cath-secure, or nothing.
Outcome Measures: Rate of symptomatic UTI, catheter dislodgement, Urethral meatal erosion.

• Trend for lower UTI incidence in the Statlock group versus the control group (13.3% vs 24.1%, p=0.16). 
• Trend for lower incidence of symptomatic UTI per 1000 device days in the Statlock group vs the control group (p=0.16).
• No significant difference in the rates of catheter dislodgement and urethral meatal erosion between the two methods of securing catheter.

Nwadiaro et al. 2007
Nigeria
Downs & Black=17
Case control
N=125

Population: Traumatic SCI; Mean age = 30 yrs; Gender: males = 117, females = 8; Level of injury: cervico-thoracic = 53, thoraco-lumbar = 72; Severity of injury: complete.
Treatment: Retrospective comparison of indwelling urethral catheterization (UC) vs suprapubic cystostomy (SPC).
Outcome Measures: Prevalence of UTI, patient satisfaction with management and complications collected from hospital admission to 1 year post-admission.

• Prevalence of UTI was significantly less in the SPC group versus the UC group (p<0.05).
• Patient satisfaction was significantly higher in the SPC group rather than the UC group (p<0.05).
• SPC resulted in significantly less mortality at 1 year post admission than UC (p<0.05).

Lloyd et al. 1986
USA
Downs & Black score=16
Case control
N=204/203

Population: SCI admitted to acute SCI care: Mean age = 29 yrs; Severity of injury: complete, incomplete; Time since injury = within 36hrs.
Treatment: Comparison of initial bladder management - A) IC at acute centre (n=21), B) suprapubic catheter followed by IC (n=21), C) indwelling catheter followed by IC at mean of 36 days (n=106), D) suspected long-term use of indwelling catheter (n=23), E) IC at community hospital (n=33).
Outcome Measures: UTIs, episodes of chills and fevers, excretor urogram (IVP) graded by 2 MDs for pyelocaliectasis, renal plasma flow assessed at 1 year follow-up.

• No statistically significant differences between groups at 1 year post injury for any of:
  • rate of UTIs
  • # chills and fevers
  • upper tract changes,
  • genitourinary complications
  • frequency of urological procedures.

Sugimura et al. 2008
New Zealand
D&B=16
Case series

• N=149

Population: Gender: males=124, females=25; Level of injury: quadriplegia=96, paraplegia=68
Treatment: SCI patients managed with SPC were retrospectively reviewed for complications.

• Outcome Measures: UTIs, complications.

• 49% of patients experienced no complications
• 29% experienced UTIs.
• The most common lower tract complication was bladder stones (22%).
• Renal complication was seen in 20 out of 149 patients.
• Only 6% of patients experienced renal scarring.
• 11 patients experienced urethral incontinence

Ku et al. 2005
South Korea
D&B=12
Case series
N=179

Population: Mean age=25.2yrs; Gender: males= 179; Severity of injury: complete=41, incomplete=138
Treatment: Comparison of various bladder management methods including: urethral catheter, intermittent catheterization, suprapubic cystostomy, Crede menuever or reflex voiding, condom catheter.

• Outcome Measures: Adverse events.

• No significant difference was found in incidence of pylonephritis or renal stones across bladder management methods.
• Overall, 34% of patients presented with pylonephritis, 24.6% had renal stones, upper tract deterioration was seen in 32.4%.
• Risk of pylonephritis was 2.8x higher in patients with vesicouriteral reflux.
• Upper tract deterioration (abnormal kidney appearance or function) was more common in patients using indwelling (urethral or suprapubic) catheters.

Gilmore et al. 1992
USA
Downs & Black score=10
Prospective Controlled Trial
N=119

Population: SCI admitted for SCI inpatient rehabilitation: Mean age = 28 yrs; Gender: males; Level of injury: paraplegia = 41%, tetraplegia = 59%.
Treatment: External urinary collection system (EUCS): Group 1-continuous EUCS, Group 2-EUCS during day only, Group 3-no EUCS.
Outcome Measures: # of Pseudomonas and Klebsiella in swab cultures of urethra, perineum, rectum; significant bacteriuria (10,000 bacteria/ml urine). Each collected every 2 weeks during inpatient stay.

• EUCS being on or off did not influence rate of bacteriuria.
• Reduced Pseudomonas and Klebsiella in urethra, perineum or rectum only if no EUCS (p<0.05).
• Removal of the EUCS at night reduced urethral colonization with Pseudomonas only (p=0.03).

Joshi & Daroucihe 1996 USA
Downs & Black score=10
Prospective Controlled Trial
Initial N=41/29

Population: SCI inpatients with UTI: Mean age =45 yrs; Gender: males = 29; Severity of injury: AIS: A.
Treatment: Comparison of IC (n=10), Suprapubic catheter (n=10), Indwelling foley catheter (n=9) during a 7-day course of an appropriate antibiotic.
Outcome Measures: Pyuria (WBCx107/L) sampled at initial, mid and endpoint of 7 day antibiotic treatment.

• IC group had lowest residual pyuria at mid and endpoint (p<0.05) vs other 2 bladder management methods.
• Pyuria was significantly reduced with antibiotic for all management groups (p<0.005).
• Multiple organisms isolated in 62% of urine cultures.