Catheter-associated urinary tract infections (CAUTIs) represent a significant burden in healthcare settings, with indwelling urinary catheters being a primary risk factor. The accumulation of bladder debris, including clots and biofilm, is hypothesized to elevate CAUTI risk by fostering bacterial colonization. This prospective trial aimed to evaluate the efficacy of regular cystoscopic removal of bladder debris in reducing the incidence of CAUTIs and catheter blockage in adult patients with long-term indwelling urinary catheters, addressing a critical gap in current catheter care strategies.

A prospective, self-selected cohort study was conducted involving 204 adult patients (age ≥18 years) with long-term indwelling urinary catheters recruited from a tertiary hospital. Participants were categorized into two groups: a control group (n=63) receiving standard catheter care according to CDC guidelines, and an intervention group (n=141) receiving standard care plus scheduled cystoscopy every three months for the removal of bladder debris. Cystoscopy involved gentle evacuation of dependent debris using <100 mL of normal saline. The primary outcome was the incidence of UTIs, categorized as major (requiring hospitalization or fever >38°C) and minor (defined by turbid/deep-colored urine, new voiding issues, kidney/bladder discomfort, or autonomic dysreflexia in spinal cord injury patients, without other identified causes), identified through medical record review and patient interviews. Cumulative incidence rates of UTIs were compared between groups using Kaplan-Meier survival curves. Catheter blockage rates and adverse events were also assessed.

The study cohort comprised 130 males and 74 females with a mean age of 61.8 ± 13.6 years and a mean indwelling catheter duration of 36.3 ± 9.5 months. The overall annual UTI rates were 2.32 ± 1.38 (major), 3.45 ± 1.46 (minor), and 5.77 ± 3.65 (total). While the intervention group exhibited a lower overall total UTI rate compared to the control group, this difference did not reach statistical significance (p > 0.05). However, subgroup analysis of SCI patients revealed a statistically significant reduction in total UTIs in the 3-month cystoscopy group (n=48) compared to the standard care group (n=23; p = 0.03). Furthermore, the incidence of catheter blockage was significantly lower in the intervention group (9%) compared to the control group (18%; p = 0.04). No major adverse events, such as hematuria, were reported. Minor discomfort during cystoscopy was reported by 5% of patients in the intervention group.

Regular proactive cystoscopic removal of bladder debris appears to be a safe and potentially effective strategy for reducing the incidence of CAUTIs and catheter blockage, particularly in SCI patients with long-term indwelling urinary catheters. The observed benefit in the SCI subgroup suggests that targeted bladder debris management could enhance catheter care protocols in this high-risk population. While the overall reduction in UTI rates did not reach statistical significance in the entire cohort, the findings warrant further investigation in larger, randomized controlled trials to confirm efficacy and refine this low-risk approach for broader clinical application in the management of long-term indwelling catheters