Researchers at the University of Michigan and veterans hospitals in Michigan and Seattle describe their study as the first-ever randomized, controlled comparison of the two types of catheters. Hospitals may use catheters to collect urine from patients during and after surgery, including routine surgeries such as knee replacements. Men are often given indwelling catheters inserted through the urethra rather than noninvasive condom-type external catheters that fit over the penis.

The researchers recruited hospitalized veterans age 40 and older who received a urinary collection device. They studied 41 men with an internal catheter and 34 with a silicone condom catheter for up to 30 days.

Using urine tests, medical chart reviews, pain assessments and other measures, the scientists found that the risk of urinary tract infections (UTIs) and death was 80 percent lower in men without dementia using an external catheter. This difference was not observed in the patients who had dementia, perhaps because demented patients often try to remove their catheters, which may increase risk of infection.

The findings are important because UTIs are the most common infections experienced by hospital patients and can cause fevers, extended hospital stays and other complications, the investigators reported. In addition, the men using the condom catheters were far more likely to find them painless than those using the internal catheters.

"This is one of the bread-and-butter issues that adversely affects the safety of many hospitalized patients, and that will affect more of us as the population continues to age," lead author Dr. Sanjay Saint stated in a news release issued by the university. "It has implications for many hospitalized patients, 25 percent of whom use catheters, but also for patients in nursing homes and at home.

"Sometimes we physicians just order a urinary catheter as a knee-jerk response, instead of thinking through whether the patient needs it. We should only use catheters when necessary, and even then we should have reminders to prompt discontinuation," he said. "Even if the infection rate were the same between the two, we should err on the side of giving patients the option they would probably prefer. The only drawback is that we don't yet have an external device for women that works well."

External catheters are not an option for some men, the researchers noted, such as those who have an obstructed urinary tract due to prostate enlargement, have received certain anesthetics or are in intensive care and need close monitoring of urine.

The study was published this month in the Journal of the American Geriatrics Society.

Copyright 2000-2006 HealthCentersOnline Inc.