Tab. V.

Characteristics and main findings of the review included in our study.

1st Author, year [Ref.]	Study type	Objective	N. of studies included	Pathology treated with IC	Type/Features of IC	Main findings
Ercole FF, 2013 [34]	Systematic review	To seek the best evidence available in the literature concerning the knowledge produced and related to the techniques of intermittent and indwelling urinary catheterization	34 studies	-	IC	CIC is the safest procedure and has the lowest rate of complications and of UTIs, when compared with indwelling catheterization. A lower incidence of UTI was found when sterile IC was carried out as against the clean technique. The clean technique may be used as an alternative to the sterile technique in self-IC in the home. Single use of the sterile catheter self-IC does not reduce the incidence of bacteriuria and UTI when compared to the use of a clean catheter for repeated catheterizations. Self CIC was associated with lower rates of UTI and complications of the lower urinary tract when compared to sterile indwelling catheterization. A lower incidence of UTI was found when sterile IC was carried out as against the clean technique. The hydrophilic coated catheter, when compared to the one made of plastic, reduced UTI in self-catheterization. The use of lubricating gel with PVP-I reduced the contamination of the bladder with micro-organisms during self-catheterization and in intermittent catheterization carried out by family members and caregivers in the home
Li L, 2013 [35]	Systematic review and meta-analysis	To identify randomized controlled trials comparing the use of hydrophilic and nonhydrophilic catheters for IC in patients with SCI, and to perform a meta-analysis evaluating the occurrence of hematuria and UTI	5 studies	SCI	HC vs NHC	The use of hydrophilic catheters, in comparison with the standard catheter, reduced the odds of UTI by about 64% and reduced the odds of hematuria by about 43%. Episodes of hematuria were significantly fewer in the hydrophilic- treated group (p < .05) than in the noncoated catheter group. There was no significant difference in the number of patients experiencing bleeding episodes (38/55 hydrophilic; 32/59 non- hydrophilic), and no difference in the occurrence of hematuria, leukocyturia, or bacteriuria
Kidd EA, 2015 [36]	Review	To determine the advantages and disadvantages of alternative routes of short-term bladder catheterization in adults in terms of infection, adverse events, replacement, duration of use, participant satisfaction and cost effectiveness	42 trials	-	IC	For indwelling versus intermittent urethral catheterization, the evidence was inconclusive for symptomatic UTIs and asymptomatic bacteriuria. No trials reported pain. The evidence was inconclusive for suprapubic versus intermittent urethral catheterization. Trials should use a standardized definition for symptomatic urinary tract infection. Further adequately powered trials comparing all catheters are required, particularly suprapubic and intermittent urethral catheterization
Rognoni C., 2017 [37]	Systematic review and meta-analysis	Evaluation of complication rates (UTI and urethral trauma/haematuria) related to hydrophilic-coated catheters as compared to non-hydrophilic catheters for users who practice IC	7 studies	Neurogenic and no neurogenic bladder (i.e. prostatic enlargement)	• IC Hydrophilic coated • PVC standard catheters in	The estimate from these trials highlights a statistically significant decreased risk ratio of UTIs associated with hydrophilic catheters in comparison with non-hydrophilic ones and a risk reduction associated to hydrophilic-coated catheters was verified
Shamout S, 2017 [38]	Systematic review	Systematically review of the literature on the most appropriate material and technique to perform self-IC in the adult neurogenic population	31 studies	SCI and women with MS	IC	Hydrophilic vs non-hydrophilic catheters: decrease in the number of UTI episodes with hydrophilic catheter, compared with non-hydrophilic catheters. Different types of hydrophilic catheters: no significant difference. Prelubricated vs non-prelubricated catheters: significant decrease in the incidence of UTI (7.4 vs 22.2%) and bacteriuria (14.8 vs 33.3%) with pre-lubricated catheters when compared with standard PVC catheters. Catheter with introducer tip vs without introducer tip: a statistically significant decrease in UTI rate with the use of introducer tip catheter. Sterile vs clean technique: a significant difference in the number of UTI episodes using a sterile catheterization technique, no difference in terms of bacteriuria
Meixuan Li, 2019 [39]	Systematic review and meta-analysis	To compare the effect of IC with that of CC on the incidence of postpartum UTI, urinary retention and hemorrhage in laboring women with epidural analgesia	6 studies	Laboring women	IC	There was no significant difference between the IC and CC group, the symptomatic UTI group and the asymptomatic bacteriuria group
Li M, 2019 [40]	Systematic review	To assess the incidence of urinary tract infection (UTI) and complications of different urinary drainage methods (indwelling urinary catheterization, suprapubic catheterization, and intermittent catheterization)	15 studies	Gynecologic surgery	IC	Indwelling catheterization may increase symptomatic UTI compared with intermittent catheterization. Intermittent catheterization reduced the rate of symptomatic UTI compared with indwelling catheterization. There was no difference in other aspects among the three drainage routes
Chang, Shih-Chung, 2020 [41]	Systematic review	Systematically review of the literature on the outcome of different intervention methods to reduce urinary tract infection incidence.	42 articles	Adults with SCI and MS-spinal cord lesions (SCLs)	IC and CIC	Clean IC vs Sterile IC: no difference in UTI incidence of both groups Self-IC had a higher reduction of UTI when compared with those used assisted IC CIC vs other urination methods: UTI incidences were the same in patients with CIC and normal voiding and were lower than other urination methods UTI incidences were lower in IC groups than other urination method except in spontaneous voiding Hydrophilic catheters are more suitable for adults than children because of complex handling
Engberg S., 2020 [42]	Scoping review	To summarize evidence related to adherence to intermittent catheterization (IC), complication rates, satisfaction with IC, and its effect on health-related quality of life	70 articles	Neurogenic and non neurogenic LUT disorders	IC vs different catheters HC vs NC Self vs Non self IC	UTIs are the most common complication of IC and prophylactic antibiotic therapy may reduce the risk of recurrent UTIs Evidence also suggests that UTIs are common in adult patients using IC and there are limited and mixed research about sex-related differences in UTI rates
Kinnear N, 2020 [43]	Systematic review	To systematically compare the impact of catheter-based bladder drainage methods on the rate of urinary tract infections (UTIs) amongst patients with neurogenic bladder	8 studies	NGB	ISC	IC vs Indwelling: ISC use was associated with a lower odds ratio of UTI in five studies, although in only two were these results significant SPC vs IC: The odds ratio of UTI was lower amongst patients using SPC in one study, 12 and not significantly different in the remainder
Ye D, 2021 [44]	Systematic review	Systematic evaluation of all available types of IC and determine which one is best suited for clinical use	25 articles	SCI	IC	The pooled odds ratios of symptomatic UTI were lower for two ready-to-use single-use catheters (gel-lubricated non-coated catheter, OR: 0.30, 95% CI 0.095-0.86; preactivated hydrophilic-coated catheter, OR: 0.41, 95% CI 0.19-0.83) as compared to single-use non-coated catheter GSNC were the preferred option to decrease the risk of symptomatic UTI, followed PSHC, SHC and CNC
Prieto AJ, 2021 [45]	Systematic review	Evaluation of different catheterization techniques, strategies and catheter designs which may affect symptomatic UTIs, other complications and user preference	23 trials (12 RCT; 11 cross-over trials)	-	IC CIC	Aseptic vs clean techniques: uncertain if there is any difference between techniques in the risk of symptomatic UTI Single-use (sterile) catheter vs multiple-use (clean): uncertain if there is any difference between single-use and multiple-use catheters in the risk of symptomatic UTI Hydrophilic-coated catheters vs uncoated catheters: uncertain if there is any difference between hydrophilic and uncoated catheters in the number of people with symptomatic UTI One catheter length vs another catheter length: uncertain
Mitchell G, 2021 [46]	Systematic review	To identify the incidence of UTI and bacteriuria in people undertaking IC and second to determine the effectiveness of antiseptic cleaning of the meatal area prior to IC in reducing the incidence of UTI and bacteriuria	25 studies	-	IC polyvinylchloride, Hydrophilic-coated, latex, and silicone	The proportion of participants experiencing ≥ 1 UTIs per year ranged from 15.4% to 86.6%. Synthesis of these studies suggest a combined incidence of 44.2% (95% CI 40.2-48.5%) of participants having ≥ 1 UTIs per year
CIC: Clean intermittent Catheterization; CIF: indwelling Foley Catheterization; CNC: Clean reused Non-coated Catheter; GSNC: Gel-lubricated Single-use Non-coated Catheter; HC: Hydrophilic Catheters; IC: Intermittent Catheterization; ISC: Intermittent Self-Catheterization; LUTS: Lower Urinary Tract infections; NHC: Non-coated Catheters; NLUTD: Neurogenic Lower Urinary Tract Dysfunction; PSHC: Pre-activated Single-use Hydrophilic-coated Catheter; SCI: Spinal Cord Injuries; SHC: Single-use Hydrophilic-coated Catheter; UTIs: Urinary Tract Infections.