Management with catheter valves

National Clinical Guideline Centre (UK)

11.1. Catheter valves

11.1.1. What is the safety and efficacy of the catheter valve compared with urinary drainage bags in neurological disease?

Clinical Methodological Introduction
Population:	Incontinence due to neurogenic lower urinary tract dysfunction (NLUTD)
Intervention:	Catheter valve
Comparison:	Urinary drainage bags
Outcomes:	No. of incontinence episodes per week Patient and carer perception of symptoms Quality of life Kidney function (hydronephrosis) Treatment adherence Adverse events (UTI, catheter blockage) Successful trial without a catheter

We searched for RCTs and observational studies comparing the effectiveness of catheter valves as interventions for improving outcomes for patients with neurological disease or injury. We looked for any RCTs or observational studies that compared the effectiveness of one or more of catheter valves with urinary drainage bags.

11.1.1.1. Clinical Evidence Review

No RCTs or observational studies were identified comparing catheter valves with urinary drainage bags for improving outcomes in patients with incontinence due to NLUTD.

11.1.1.2. Economic evidence

No relevant economic evaluations comparing catheter valves with urinary drainage bags were identified.

Unit costs

In the absence of recent UK cost-effectiveness analysis, relevant unit costs are provided below to aid consideration of cost-effectiveness.

Economic considerations

Catheter valves and day use urinary drainage bags (Table 105) are similar in cost and both are used in current practice. However, when considered at the cost per annum, urinary drainage bags, used on their own, are the marginally cheaper intervention; this is due to the slight increase in cost associated with catheter valves. Extra costs for fitting the valves will have to be considered also, however this is not considered to be high and can be done by the patient or carer readily with minimal training.

Table 105

Unit Cost of catheter valves and urinary drainage bags.

11.1.1.3. Evidence statements

Clinical Evidence statement

No clinical evidence

Economic evidence statements

The costs of the interventions are similar. However there is no evidence of benefit of one intervention over the other in terms of reducing incontinence. However, taken as a whole it is very likely that the costs associated with the interventions will easily be offset by the benefits of incontinence reduction and the reduction in cost of incontinence aids.

If one intervention is shown to be associated with fewer infections, then it is likely that this intervention will be cost effective compared with the other.

11.1.2. Recommendations and links to evidence

Recommendations:	MANAGEMENT WITH CATHETER VALVES 47. In people for whom it is appropriate a catheter valve may be used as an alternative to a drainage bag. [This recommendation is from ‘Infection: prevention and control of healthcare-associated infections in primary and community care’ (NICE clinical guideline 139).] 48. To ensure that a catheter valve is appropriate, take into consideration the person’s preference, family member and carer support, manual dexterity, cognitive ability, and lower urinary tract function when offering a catheter valve as an alternative to continuous drainage into a bag. 49. Consider the need for continuing upper urinary tract surveillance in people who have impaired bladder storage (for example, due to reduced bladder compliance).
Relative value placed on the outcomes considered	The GDG recognised the high value placed on quality of life.
Economic considerations	The clinical review will inform which one should be used in which group of patients, and this is likely to lead to cost savings as clinicians will avoid recommending the wrong equipment for use and later switching to the other option. Using both options at the same time will also be avoided. Based on a simple cost analysis based on unit costs and GDG assumptions on the quantity of resources needed, catheter valves and urinary drainage bags have similar costs. As the clinical review has revealed that there is no difference in incontinence, the main issue to consider in terms of cost effectiveness is the risk of urinary tract infections and adherence (patient comfort). If one intervention is shown to be associated with fewer infections, then this will probably be cost effective, due to a reduction in longer term costs. The greater the comfort of the patient also will lead to better adherence and greater effectiveness of the treatment A fairly simple analysis of cost allows us to see that while there is very little difference between catheter valve and bag usage, using drainage bags rather than non drainable bags is cheaper. Whether they are more cost effective is dependent on the prevalence of infection and patient comfort.
Quality of evidence	There was no evidence of harm or benefit available to the GDG as no relevant studies were identified in the literature review. Recommendations on the use of catheter valves were made on the basis of the clinical experience of the GDG members.
Trade-off between clinical benefits and harms	In selected patients there may be significant quality of life benefits from the use of intermittent bladder drainage using a catheter valve rather than continuous drainage of urine into a bag but there is a risk of harm (in the form of incontinence, infection and renal damage) if catheter valves are used in patients whose bladders are not capable of storing urine at safe pressures. The GDG agreed that the recommendation from the Infection control guideline be incorporated.
Other considerations	The GDG noted that the use of catheter valves was dependent on the patient’s cognitive ability, dexterity, or the availability of a carer to assist and these factors need to be considered when drawing up an individuals support plan. A valve may not be suitable for all patients, however the group agreed that a valve was often the option preferred by patients, because of convenience, the feeling of increased control over their bladder management and the relatively discreet nature of a valve as opposed to a leg bag.

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Bookshelf ID: NBK132818

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Urinary Incontinence in Neurological Disease: Management of Lower Urinary Tract Dysfunction in Neurological Disease.

11Management with catheter valves