Top-Vented Urinary Drainage Catheters Cause Fewer Epithelial and Vascular Changes in the Bladder Mucosa Compared to Conventional Catheters and May Reduce Susceptibility to Urinary Tract Infections

Abstract

Introduction: We performed a prospective, randomized, double-blinded controlled trial to investigate whether use of DOVERTM Urine Collection Systems with top vent (Tyco Healthcare Group L.P. d/b/a Couidien, Marshfield, MA, USA) top-vented urinary catheters cause fewer epithelial and vascular changes in the bladder mucosa than conventional non-vented catheters. Materials and Methods: Women undergoing a mid-urethral sling were randomized to either placement of a non-vented or top-vented catheter. Primary outcome was change in appearance of the bladder mucosa as graded on a 4-point scale (0–3) after a single drainage event. Secondary outcome was change in red and white blood cell counts per high power field between urinalyses collected intraoperatively and after overnight bladder drainage. A paired T-test with Wilcoxon rank sum was used to compare the grade of mucosal change and the change in cell count. Results: Forty-one women were randomized. The mean change in appearance of the bladder mucosa was significantly greater in the conventional drainage catheter group (2.0 ± 0.23 vs. 0.4 ± 0.11, p < 0.0001). There was no significant difference in the mean cell count intervals on urinalyses between the two groups (1.2 ± 0.34 vs. 0.8 ± 0.34, p = 0.08). Conclusions: By avoiding suction on the bladder mucosa, top-vented urinary catheters cause fewer epithelial and vascular changes in the bladder mucosa compared to conventional catheters.

Development of an ex-vivo porcine lower urinary tract model to evaluate the performance of urinary catheters

“…The extent to which the bladder mucosa was sucked into the catheter´s lumen raises the concern for potential microtrauma during IC, even more so considering that 4–6 catheterizations are performed by an IC user daily. Eyelet-related microtrauma due to mucosal suction has been previously reported for indwelling catheters 25 and it may be argued that similar events could occur with intermittent catheters. At present, there is limited knowledge about the extent of the microtrauma produced by mucosal suction with intermittent catheters.…”

“…Flowrate corresponds to the speed of the flow during emptying, the remaining volume in the bladder at first flow-stop represents the residual volume, mucosal suction occurs when the bladder mucosa is suddenly sucked inside the catheter lumen stopping the flow, which raises the concern for microtrauma. This event has been previously associated with indwelling catheters 25 , but according to the authors, never in IC. In the ex-vivo porcine LUT model, mucosal suction can be perceived by the operator holding the catheter while performing the catheterization.…”

“…As mucosal suction can occur several times during bladder emptying, concerns for potential mucosal suction-induced microtrauma to the bladder mucosa are very relevant. Especially considering that mucosal suction has been previously described for indwelling catheters 25 , linking the event to the formation of suction marks/oedemas. Microtraumas to the bladder moreover represent an additional factor that was linked to an increased risk of developing UTIs 9 and should therefore be minimized.…”

“…The catheter was held throughout the test by the operator to register tactile sensations. Two tactile feedbacks were recorded by the operator; the sudden pulse of the catheter during flow-stops described in the literature as mucosal suction 21 , 25 but also during catheter repositioning, and the rapid pulsation/vibration of the catheter (hammering). Repositioning of the catheter was performed when flow stopped, and until no more liquid was being emptied.…”

“…As residual urine has been previously listed as one of the risk factors for developing UTIs, this parameter requires special attention 9 . Mucosal suction: event previously reported in the literature 21 , 25 , originating from sudden flow-stop. When mucosal suction happens, because of the negative pressure originating from the water column in the catheter, tissue of the bladder mucosa is pulled inside of the catheter lumen in an abrupt and vigorous manner.…”