Adams D, Bucior H, Day G, Rimmer JA. HOUDINI: make that urinary catheter disappear – nurse-led protocol. J Infect Prev. 2012; 13:(2)44-46

Åling M, Lindgren A, Löfall H, Okenwa-Emegwa L. A scoping review to identify barriers and enabling factors for nurse–patient discussions on sexuality and sexual health. Nurs Rep. 2021; 11:(2)253-266

Andreou C. Profiling for the good: patient profile tests and informed, autonomous decision making. Bioethics. 2021; 35:(5)429-437

Baker-Green R. Nurses experiences discussing sexuality with urinary catheter patients. Int J Urol Nurs. 2017; 11:(1)6-12

Balhi S, Arfaoui RB. Barriers affecting patient adherence to intermittent self-catheterisation. Br J Community Nurs. 2021; 26:(9)444-451

Ballard JP, Parsons S, Rodgers J, Mosack V, Starks B. HOUDINI impacts on utilization and infection rates - a retrospective quality improvement initiative. Urol Nurs. 2018; 38:(4)184-191

Bansal A, Arora A. Predictors of successful trial without catheter following acute urinary retention in benign prostatic enlargement: a single centre, multivariate analysis. Neurourol Urodyn. 2017; 36:(7)1757-1762

Carr S. Catheter valves: retraining the bladder to avoid prolonged catheter use. J Community Nurs. 2019; 33:(3)46-51

Chadwick A, Murphy N. An exploration of providing mental health skills in a generic advanced clinical practice programme. Br J Nurs. 2019; 28:(13)842-847

Cheekooree B, Casey S, Clayton H, Hambling E, Tomlinson C. Examining the challenges of hospital discharge for patients with a urinary catheter. Br J Nurs. 2021; 30:(18)S8-S16

Dawson CH, Gallo M, Prevc K. TWOC around the clock: a multimodal approach to improving catheter care. J Infect Prev. 2017; 18:(2)57-64

Dean J, Ostaszkiewicz J. Current evidence about catheter maintenance solutions for management of catheter blockage in long-term urinary catheterisation. Australian & New Zealand Continence Journal. 2019; 25:(3)74-80

Fisher E, Subramonian K, Omar MI. The role of alpha blockers prior to removal of urethral catheter for acute urinary retention in men. Cochrane Database Syst Rev. 2014; (6)

Gibney L. Offering patients a choice of urinary catheter drainage system. Br J Nurs. 2010; 19:(15)954-958

Gyesi-Appiah E, Brown J, Clifton A. Short-term urinary catheters and their risks: an integrated systematic review. Br J Community Nurs. 2020; 25:(11)538-544

Holroyd S. Blocked urinary catheters: what can nurses do to improve management?. Br J Community Nurs. 2019; 24:(9)444-447

Holroyd S. Trial without catheter: what is best practice?. J Community Nurs. 2020; 34:(2)60-67

Holroyd S. Catheter valves: appropriate use and reduction of risk to bladder. J Community Nurs. 2021; 35:(5)52-56

Fitzpatrick JM, Desgrandchamps F, Adjali K, Guerra LG, Hong SJ, Khalid SE, Ratana-Olarn K Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia. BJU Int. 2012; 109:(1)88-95

Joint Formulary Committee. British National Formulary (online). (accessed 10 March 2022)

Kristiansen P, Pompeius R, Wadström LB. Long-term urethral catheter drainage and bladder capacity. Neurourol Urodyn. 1983; 2:(2)135-143

Leontie SL, Delawder JM. Utilizing a ‘fight the foley’ bundle to reduce device utilization rates and catheter-associated urinary tract infections. Urol Nurs. 2021; 41:(4)208-213

Lower urinary tract symptoms in men: management CG97.London: National Institute for Health and Care Excellence; 2015

Nazarko L. Trial without catheters in community settings. Independent Nurse. 2020; (11)18-22

NHS Business Services Authority. Drug tariff part IX. 2019. (accessed 10 March 2022)

Nursing and Midwifery Council. The code: professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018. (accessed 10 March 2022)

Pajerski DM, Harlan MD, Ren D, Tuite PK. A clinical nurse specialist–led initiative to reduce catheter-associated urinary tract infection rates using a best practice guideline. Clin Nurse Spec. 2022; 36:(1)20-28

Payne D. Why not choose intermittent self-catheterisation?. Br J Nurs. 2021; 30:(12)696-698

Public Health England. Preventing healthcare associated Gram-negative bloodstream infections: an improvement resource. 2017. (accessed 10 March 2022)

Reid S, Brocksom J, Hamid R British Association of Urological Surgeons (BAUS) and Nurses (BAUN) consensus document: management of the complications of long-term indwelling catheters. BJU Int. 2021; 128:(6)667-677

Royal College of Nursing. Catheter care: RCN guidance for health care professionals. 2021. (accessed 10 March 2022)

Schweiger A, Kuster SP, Maag J Impact of an evidence-based intervention on urinary catheter utilization, associated process indicators, and infectious and non-infectious outcomes. J Hosp Infect. 2020; 106:(2)364-371

Shackley DC, Whytock C, Parry G Variation in the prevalence of urinary catheters: a profile of National Health Service patients in England. BMJ Open. 2017; 7:(6)e013842-e013842

Simpson P. Long-term urethral catheterisation: guidelines for community nurses. Br J Nurs. 2017; 26:(9)S22-S26

Son H, Cho SY, Park S, Kang JY, Kim CS, Kim HG. A retrospective study of clinical outcomes of α-blocker or finasteride monotherapy followed by combination therapy: determination of the period of combination therapy of α-blocker and finasteride. Int J Clin Pract. 2013; 67:(4)351-355

Tremayne P. Managing complications associated with the use of indwelling urinary catheters. Nurs Stand. 2020; 35:(11)37-42

van den Eijkel E, Griffiths P. Catheter valves for indwelling urinary catheters: a systematic review. British Journal of Community Nursing. 2006; 11:(3)111-114

Virdi G, Hendry D. Urinary retention: catheter drainage bag or catheter valve?. Current Urology. 2016; 9:(1)28-30

Vlotman-Novinuk D. Treatment options for benign prostate enlargement. Journal of Prescribing Practice. 2019; 1:(3)130-138

Waskiewicz A, Alexis O, Cross D. Supporting patients with long-term catheterisation to reduce risk of catheter-associated urinary tract infection. British Journal of Nursing. 2019; 28:(9)S4-S17

Wilson C, Sandhu SS, Kaisary AV. A prospective randomized study comparing a catheter-valve with a standard drainage system. British Journal of Urology. 1997; 80:(6)915-917

Wilson M. Urine-drainage leg bags: an overview. British Journal of Nursing. 2015; 24:S30-S35

Woodward S. Catheter valves: a welcome alternative to leg bags. British Journal of Nursing. 2013; 22:(11)650-654

Yates A. Urinary catheters 5: teaching patients how to use a catheter valve. Nursing Times. 2017; 113:(5)25-27

Catheter valves: are they useful in supporting patients in a trial without catheter?

02 June 2022
Volume 27 · Issue 6


A trial without catheter (TWOC) is a common urological procedure undertaken to remove an indwelling urinary catheter when no longer clinically indicated. An appropriately trained practitioner should undertake a TWOC in a controlled environment to ensure that a further urinary retention does not occur. Indwelling urinary catheters are commonly used with a free drainage system such as a leg bag, which continually empties the bladder. This article examines the potential benefits of using a catheter valve as an alternative to free drainage, prior to undertaking a TWOC, to optimise clinical outcomes and patient experience. This article will guide nurses to increase their knowledge of catheter valves to promote person-centred informed decision-making.

Aurinary catheter is a common urological intervention for the management of bladder drainage (Woodward, 2013). These must be changed frequently and are prone to issues such as blockages, bypassing and infections, which require further intervention by healthcare professionals (Dean and Ostaszkiewicz, 2019). It is estimated that around 90 000 adults in England are living at home with an in situ urinary catheter. However, for most people, this is an acute, short-term intervention, with evidence suggesting that 72.9% of catheterised patients are likely to have their catheter in situ for less than 28 days, compared to 22.2% needing a longer-term catheter (Shackley et al, 2017).

Urinary catheters are a prevalent burden to the healthcare setting, as they use many hospital and community resources (Nazarko, 2020). Alongside the impact on valuable resources, urinary catheters also pose risks to patients, namely an increased risk of infection, trauma to the urethra and external genitals, skin breakdown and damage and a loss of bladder tone and muscle (Gyesi-Appiah et al, 2020). It is well documented that there is a direct correlation between the length of time a catheter is in situ and the rates of catheter-acquired urinary tract infections (CAUTI), with around 75% of urinary tract infections thought to be secondary to an indwelling catheter (Public Health England, 2017; Leontie, 2021; Royal College of Nursing (RCN), 2021). The estimated annual cost to the NHS to treat a CAUTI is estimated to be around £99 million per annum (Waskiewicz et al, 2019).

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