In the past, urinary tract infections were the primary cause of death for people with spinal cord injury. Today, those with SCI continue to have urinary tract complications, with UTI remaining the number one cause of hospital readmission. However, advances in intermittent catheterization — namely the use of hydrophilic-coated catheters — have reduced the risk of UTI for some with SCI, spina bifida and multiple sclerosis.
Hydrophilic-coated catheters have a specialized smooth, slippery coating that reduces friction and trauma and therefore lowers the risk of urethral damage and infection during catheter insertion and removal. These catheters, designed to minimize risk of contamination and UTI, are viewed as a beneficial innovation. However, access to hydrophilic catheters has been ignored under the current reimbursement coding system.
There are currently only three reimbursement codes that apply to catheters, and none differentiate between uncoated and hydrophilic. The result? IC users often find that they don’t have true access to their prescribed hydrophilic-coated catheters, primarily because there is no separate reimbursement code.
An IC user’s prescription for a hydrophilic-coated catheter could be deemed “filled” at the pharmacy or provider whether the user receives a hydrophilic-coated catheter or an uncoated catheter and separate packet of gel lubricant. Each is reimbursed under the same code even though they are substantially different.
In the European Union, hydrophilic catheters are the standard of care since physicians and users have long recognized the added benefits of such catheters. However, it is estimated that far fewer IC users have true access to their physician prescribed hydrophilic catheters in the U.S.
Benefits of Hydrophilic Catheters
To understand the benefits of hydrophilic-coated catheters, consider first that all IC catheters require lubrication. Hydrophilic catheters accomplish this by bonding a slippery coating to the catheter surface, which is then activated by water or saline solution. The hydrophilic coating has been shown to reduce friction, trauma and potential bleeding during catheter insertion and withdrawal. Moreover, studies have found that certain people who use hydrophilic catheters are at less risk for getting a UTI (Cardenas, et. al., 2011; Cindolo, et. al., 2004).
On the other hand, uncoated catheters require users to have separate gel lubricant on hand, which must be applied to the catheter. This can be difficult for those with limited dexterity, and more importantly, using gel can introduce the opportunity for contamination. Gel lubricants may also come off during insertion, which can cause friction during withdrawal. Poor lubrication has in fact been associated with increasing risk for UTI (Newman, et. al., 2011).
Hydrophilic-coated catheters can also promote compliance with doctors’ orders. For IC users, it’s critical to comply with their physician’s prescribed catheter regimen (e.g., number of catheterizations per day) to reduce UTIs and hospital readmission (Cardenas, et. al., 2009). Hydrophilic-coated catheters can aid in compliance since they are less painful and easier for people to use, versus uncoated. As researchers pointed out, “With a long-term management strategy like IC, user satisfaction is crucial” (Chartier-Kastler, et. al., 2010).
Catheter materials are an important consideration since the longer the use, the higher the risk for developing allergies (to the catheter materials) and long-term complications. For instance, people with spina bifida who employ catheterization often choose to use hydrophilic catheters instead of uncoated ones because of their inherent high risk of developing allergies and the diminished risk of urethral trauma with insertion that hydrophilic coating provides. (Chrisman, et. al., 2013).
[EDITOR: Studies have also shown that not all IC users require a hydrophilic-coated catheter. Many IC users minimize UTIs when using regular catheters along with clean technique (washing hands before and after cathing; rinsing and drying catheters and storing in a clean plastic bag). But those who have more frequent UTIs or have diminished manual dexterity may find that hydrophilic catheters reduce frequency of UTIs.]
Restricting access to technologically advanced hydrophilic-coated catheters puts many long-term IC users at greater risk of UTI and other complications. The clinical benefits of hydrophilic-coated catheters are clear indicators that they should be viewed distinctly from uncoated, especially for those who rely on lifelong IC. Expanding the categories to include a separate reimbursement code for hydrophilic-coated catheters will grant IC users better access to their physician prescribed, medically necessary supplies.