Silver-Coated Foley Catheters to Reduce UTIs: A Randomized Clinical Trial

Importance: This study is important as it challenges the effectiveness of silver-coated catheters in reducing urinary tract infections (UTIs) after pelvic floor surgery (PFS).

Objective: The aim of this study was to investigate the incidence of UTIs in patients using silver-coated silicone transurethral indwelling catheters (TICs) compared with standard silicone TICs among women with postoperative urinary retention following PFS.

Study design: This was a double-blind, randomized controlled trial of women undergoing PFS between June 2022 and February 2024 with postoperative urinary retention. Participants were randomized to a silver-coated silicone TIC or a standard silicone TIC. The primary outcome was the incidence of symptomatic, culture-proven UTI within 30 days of surgery. Secondary outcomes included the categorization of uropathogens as well as adverse symptoms potentially related to the catheter. A sample size of 155 participants per arm was calculated to find a relative decrease of 47%, from 30% to 16%.

Results: Of 310 participants randomized, 303 were included in the analysis: 154 controls and 149 silver catheter. Demographics were similar for both groups. For our primary outcome, 56 patients in the control group and 52 patients in the silver catheter group were diagnosed with a UTI (36.4% vs 34.9%; P = 0.81). No adverse reactions to the silver catheter were noted. Analysis of the urinary microbiomes demonstrated Escherichia coli was the most represented uropathogen, found in 43% of the urine cultures overall.

Conclusion: There was no difference in incidence of symptomatic, culture-confirmed UTIs in patients who received silver-coated silicone TICs compared with standard silicone TICs in women undergoing PFS.