Determining the noninfectious complications of indwelling urethral catheters: a systematic review and meta-analysis

Ann Intern Med. 2013 Sep 17;159(6):401-10. doi: 10.7326/0003-4819-159-6-201309170-00006.


Background: Although the epidemiology of catheter-associated urinary tract infection is well-described, little is known about noninfectious complications resulting from urethral catheter use.

Purpose: To determine the frequency of noninfectious complications after catheterization.

Data sources: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Conference Papers Index, BIOSIS Previews, Scopus, and were searched for human studies without any language limits and through 30 July 2012.

Study selection: Clinical trials and observational studies assessing noninfectious complications of indwelling urethral catheters in adults.

Data extraction: Relevant studies were sorted into 3 categories: short-term catheterization in patients without spinal cord injury (SCI), long-term catheterization in patients without SCI, and catheterization in patients with SCI. The proportion of patients who had bladder cancer, bladder stones, blockage, false passage, gross hematuria, accidental removal, urine leakage, or urethral stricture was then pooled using random-effects models.

Data synthesis: Thirty-seven studies (2868 patients) were pooled. Minor complications were common. For example, the pooled frequency of urine leakage ranged from 10.6% (95% CI, 2.4% to 17.7%) in short-term catheterization cohorts to 52.1% (CI, 28.6% to 69.5%) among outpatients with long-term indwelling catheters. Serious complications were also noted, including urethral strictures, which occurred in 3.4% (CI, 1.0% to 7.0%) of patients with short-term catheterization. For patients with SCI, 13.5% (CI, 3.4% to 21.9%) had gross hematuria and 1.0% (CI, 0.0% to 5.0%) developed bladder cancer.

Limitations: Although heterogeneity existed across studies for several outcomes, most could be accounted for by differences between studies with respect to quality and sex composition. Evidence published after 30 July 2012 is not included.

Conclusion: Many noninfectious catheter-associated complications are at least as common as clinically significant urinary tract infections.

Primary funding source: Agency for Healthcare Research and Quality.

Publication types

  • Meta-Analysis
  • Research Support, N.I.H., Extramural
  • Review
  • Systematic Review

MeSH terms

  • Catheters, Indwelling / adverse effects*
  • Female
  • Hematuria / etiology
  • Humans
  • Male
  • Sex Factors
  • Spinal Cord Injuries / complications
  • Time Factors
  • Urethral Stricture / etiology
  • Urinary Bladder Neoplasms / etiology
  • Urinary Catheterization / adverse effects*
  • Urination Disorders / etiology