The use of a catheter to empty the bladder intermittently has been around for a long time.
Ancient texts from China report the use of onion stalks, while Hindus, Egyptians, Romans and Greeks described the use of tubes made from wood and precious metals.1 American Founding Father Benjamin Franklin created a flexible silver coil catheter in 1752 when his brother suffered from bladder stones.2 Mass-produced catheters became available in the mid nineteenth century thanks to Charles Goodyear, who was looking for applications for his newly developed vulcanized rubber.3
For much of the twentieth century, although intermittent catheterisation was known, it was not recognised as a method that patients could perform themselves in community settings. Urologists advocated only laborious sterile catheterisation because of the perceived risk of bacterial infection. But this changed in the early 1970's when it was demonstrated that catheters could safely be used to drain the bladder intermittently in conditions that were simply clean rather than totally sterile, without causing infections.1, 4 Since then, millions of people all over the world have been able to independently manage bladder dysfunctions associated with many conditions using “clean intermittent catheterisation”.
When clean intermittent catheterisation was introduced it was performed using a water-based lubricant and plain, plastic or rubber catheters that were washed and used many times. 2 Later, catheters intended for single use were developed and these are now the norm in the UK. These single-use catheters are usually either packaged pre-coated in a lubricating gel, or have a hydrophilic coating that becomes slippery when soaked in water for a short period. Some hydrophilic catheters are packaged with their own reservoir of water. With some patients catheterising up to five times per day, the cost implications are significant. Costs to the NHS in England for intermittent catheters rose from around £13.5 million per annum in 1999 to £88 million in 2013 and >£120 million in 2017, the bulk of this cost being for single-use catheters. 5,6
There is little research evidence to suggest that single-use is superior to multi-use of catheters, or indeed to recommend any particular approach to intermittent catheterisation or catheter design over any other. The evidence that does exist suggests that no method is more likely than any other to cause urinary tract infections or any other problems. Some evidence suggests that some users find it difficult to carry a lot of single-use catheters with them and that disposing of them and their packaging can be difficult, especially in public places, and that some prefer multi-use catheters. 7,8 In many countries around the world, the re-use of catheters is commonplace. 8, 9 10, 11, 12 Furthermore, the environmental challenge to reduce the amount of plastic and other non-biodegradable materials being thrown away makes this research to provide robust evidence for single or multi-use of catheters very timely.
1. Relief in a tube: Catheters remain a steadfast treatment for urinary disorders. Milestones in Urology: William P Didiusch Centre for Urologic History / American Urological Association; 2005 (Accessed 7/1/2015); Available from: http://www.urologichistory.museum/content/milestones/catheterization/p1.cfm
2. Hirschmann JV. Benjamin franklin and medicine. Annals of Internal Medicine. 2005;143(11):830-4.
3. Biomaterials and tissue engineering in urology. Denstedt J, Atala A, editors. Cambridge: Woodhead Publishing; 2009.
4. Lapides J, Ananias CD, Silber SJ, Lowe BS. Clean intermittent self catheterisation in the treatment of urinary tract disease. J Urol. 1972;107:458-61.
5. Health and Social Care Information Centre. Prescription cost analysis data - england 2013. . [cited 2014 22 August ]; Available from: www.hscic.gov.uk
6. Prescription Cost Analysis – England, 2017 [Internet]. NHS Digital. Accessed October 2018 via: https://digital.nhs.uk/data-and-information/publications/statistical/prescription-cost-analysis/prescription-cost-analysis-england-2017
7. Avery M, Prieto Jacqui, Okamoto I, Cullen S, Clancy B, Moore K, Macaulay M, Fader M. (2018). Reuse of intermittent catheters: A qualitative study of IC users’ perspectives. BMJ Open. 8. e021554. 10.1136/bmjopen-2018-021554. Avery
8. Wilde MH, Brasch J, Zhang Y. A qualitative descriptive study of self-management issues in people with long-term intermittent urinary catheters. J Adv Nurs. 2011;67(6):1254-63.
9. Bolinger R, Engberg S. Barriers, complications, adherence, and self-reported quality of life for people using clean intermittent catheterization. J Wound Ostomy Continence Nurs. 2013;40(1):83-9.
10. Leek H, Stephenson Z, Reus A, Karantanis E, Moore KH. Clean intermittent self-catheterisation: A randomised controlled crossover trial of single-use versus multiple re-use of non-coated catheters: Is cystitis rate altered? Neurourol Urodyn. 2013;32:759-60.
11. Sherbondy AL, Cooper CS, Kalinowski SE, Boyt MA, Hawtrey CE. Variability in catheter microwave sterilization techniques in a single clinic population. J Urol. 2002;168(2):562-4.
12. Woodbury MG, Hayes KC, Askes HK. Intermittent catheterisation practices following spinal cord injury: A national survey. Can J Urol. 2008;15(3):4065-71.
This website refers to independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research (PGfAR) Programme (Grant Reference Number RP-PG-0610-10078). The views expressed are those of the research team and not necessarily those of the NHS, the NIHR or the Department of Health.