A randomized trial provides qualified support for the idea that condom catheters are safer than indwelling catheters.
For men who need urinary catheters, clinicians have the option of using indwelling or condom catheters. To compare them, this randomized trial was performed in a U.S. Veterans Affairs Health Care System; according to the authors, it is the first randomized study of these alternatives.
Participants were 75 men (mean age, 74) who were hospitalized in medicine, neurology, rehabilitation, or nursing home units and who needed a urinary catheter for reasons other than urinary retention or severe bladder outlet obstruction. Each received an indwelling Foley catheter or a self-adhering external condom catheter. By chance, significantly more patients with dementia were assigned to the condom catheter group than to the indwelling catheter group.
Bacteriuria developed in 38% of condom catheter patients and 42% of indwelling catheter patients, a nonsignificant difference. However, a difference in time to development of bacteriuria (median days, 13 vs. 7) approached significance. Only a few cases of symptomatic urinary infection or death occurred in each group. Among patients without dementia, the composite outcome of bacteriuria, symptomatic urinary infection, or death occurred significantly more frequently in the indwelling catheter group (hazard ratio, 4.8); among patients with dementia, there were no differences between groups.
Comment: Common sense suggests that condom catheters should be safer than indwelling catheters; this study supports that idea. However, it was a small, single-center trial, and randomization did not result in balanced assignment of patients with dementia. A larger, multicenter trial should be done to create a conclusive evidence-based standard for this common intervention.
— Allan S. Brett, MD
Citation(s):
Saint S et al. Condom versus indwelling urinary catheters: A randomized trial. J Am Geriatr Soc 2006 Jul; 54:1055-61.