What is the best choice for chronic urinary retention: indwelling catheter or clean intermittent catheterization?

Objective: The aim of this study was to analyze the advantages and disadvantages of clean intermittent catheterization, comparing to indwelling urinary catheter, in the treatment of chronic urinary retention. Methods: This literature review was carried out in order to highlight the best evidences for the choice between treatments. The extensive literature review was made through PubMed and Cochrane National Library. We selected the main articles published between 1950 and 2007, using urinary retention, indwelling urinary catheter, and clean intermittent catheterization as keywords. Results: Twenty five papers were selected, including three meta-analyses evaluating the long-term complications of clean intermittent catheterization, prophylactic intervention, and catheter types. Most articles discussed complications in patients with neurologic dysfunctions. Conclusion: Clean intermittent catheterization is better than indwelling catheter, as it is related to lower complication rates, both short and long-term. Indwelling catheterization was associated with decreased vesical compliance and bladder calculi, among others. Objetivo: O objetivo do estudo foi analisar quais as vantagens e desvantagens do uso do cateterismo intermitente limpo, se comparado a sonda vesical de demora, no tratamento dos pacientes com retencao urinaria cronica. Metodos: O estudo foi feito por meio da revisao da literatura, com o objetivo de destacar as melhores evidencias para a realizacao de um ou de outro tratamento. A pesquisa bibliografica foi realizada no PubMed e na Cochrane Library. As palavras-chave utilizadas foram retencao urinaria, cateteres de demora e cateterismo intermitente limpo, e os artigos foram selecionados no periodo compreendido entre 1950 e 2007. Resultados: Dos 25 artigos selecionados, foram incluidas tres metanalises, que avaliaram as complicacoes em longo prazo do uso do cateterismo intermitente limpo, medidas profilaticas para manuseio do cateter e tipos de cateter utilizados. A grande maioria dos artigos selecionados se referiu ao tratamento e manuseio das complicacoes em pacientes com disfuncoes neurologicas. Conclusoes: O cateterismo intermitente demonstrou ser superior a sondagem de demora, pois esta associado a uma menor taxa de complicacoes a curto e a longo prazo, como, por exemplo, calculos vesicais, reducao da complacencia vesical, dentre outras.