Reusable COMPaREs well with single-use catheters for intermittent catheterization

Results from the COMPaRE trial presented at EAU26 show that reusable catheters are on par with single-use catheters for clean intermittent catheterization (CIC).

“[Our findings show] that reusable catheters are noninferior to single-use catheters in the incidence of urinary tract infections (UTIs) per month,” said Prof Bertil Blok from Erasmus MC, Rotterdam, the Netherlands, during his presentation at EAU26.

The noninferiority of reusable to single-use catheters was evident across the modified intention-to-treat (ITT; incidence rate [IR], 0.050 vs 0.054), ITT (IR, 0.052 vs 0.054), and per-protocol populations (IR, 0.040 vs 0.050) at 12 months. [EAU 2026, abstract A0495]

Both reusable and single-use groups also had similar incidences of catheter-related complications, such as macroscopic haematuria (23 vs 24), hospital admission UTI (3 in each arm), epididymo-orchitis (2 vs 4), urosepsis (1 vs 0), prostatitis (0 vs 1), pyelonephritis (1 in each arm), and urethral stricture (1 in each arm).

Approximately a quarter of the complications in the reusable catheter group were grade 1 per the CTCAE*, whereas in the single-use group, most complications were grade 3 (8.9 percent).

Of note, a fifth of reusable catheter users reported grade 1–2 urethral irritation, compared with only about 5 percent in the single-use group (p=0.035). Nonetheless, the rate of grade ≥3 serious adverse events was lower in the former vs the latter group (4 percent vs 7 percent).

PROs, cost-effectiveness

According to Blok, patients preferred reusable to single-use catheters in terms of convenience (eg, no need to carry them in bulk when traveling), but the latter had the edge over the former in terms of satisfaction, as it was easier to use. “The reduced ease of use highlights the need for improvements in reusable catheter design.”

There were no differences in health-related quality of life based on the patient-reported outcome measures used, he added.

Reusable catheters are highly cost-effective, with estimated annual costs of €875 (Q2W) or €290 (Q6W). With single-use catheters, the annual cost could rise to €5,648, yielding a between-group difference of €4,773 per patient. Reusable catheters are thus nearly seven times cheaper than single-use ones, Blok noted.

Significant environmental, cost benefits

There is a growing need for an alternative to single-use catheters, given the enormous cost (€99M/year; €5,648/patient) and environmental burden (21M/year; 600,000 kg plastic waste/year) associated with its use, Blok noted. In the Netherlands, there are >50,000 CIC patients, and this has steadily increased since 1997. [Ther Adv Urol 2021;doi:10.1177/17562872211007625]

In COMPaRE, 386 patients (average age 61 years, 63 percent men) were randomized 1:1 to either a reusable or single-use catheter. The reusable catheter was used for 2 weeks. Approximately a third of patients had a neurogenic cause of CIC, and about two-thirds had CICs ≥5 times daily. Seventy-five percent of participants had an average CIC experience of >1 year, and 68 percent had no UTI in the past 6 months.

Given the noninferiority of reusable catheters relative to single-use catheters in terms of UTI incidence, plus the clear cost and QoL benefits, the results support the integration of reusable catheters into routine urological care, Blok and colleagues noted.

They added that future design refinements to improve handling and usability can further enhance patient satisfaction and accelerate widespread adoption.

“Broad implementation can lead to significant environmental benefits and cost savings … The question is no longer whether reusable catheters are acceptable, but whether continued reliance on single-use catheters still is,” Blok concluded.