Background: Catheter-associated urinary tract infections (CAUTIs) are a major concern in patients with long-term indwelling urinary catheters, especially those with neurogenic bladder. This study assessed whether proactive cystoscopic removal of bladder debris reduces symptomatic UTI incidence and catheter blockage. Methods: This prospective, self-selected cohort study was conducted between January 2022 and December 2025 at a tertiary center in Taiwan. Enrollment occurred from January 2022 to June 2024, with follow-up completed by December 2025. Patients chose standard CDC-guided care (control, n = 63) or standard care plus flexible cystoscopy every 3 months for gentle low-volume evacuation (<100 mL normal saline) of dependent bladder debris (intervention, n = 141). Inverse probability of treatment weighting (IPTW) was used to address selection bias. Symptomatic UTIs were prospectively recorded using strict criteria. Cumulative incidence was analyzed with Kaplan-Meier methods and multivariable Cox regression. Results: After IPTW, baseline characteristics were well balanced. Median follow-up was 26 months (IQR 18-34). The incidence of catheter blockage was significantly lower in the intervention group (7.8% vs. 22.2%, p = 0.004). In the overall cohort, the reduction in symptomatic UTI incidence did not reach statistical significance (49.2% vs. 36.9%, p = 0.092). In the pre-specified spinal cord injury (SCI) subgroup (n = 71), the intervention was associated with improved UTI-free survival (log-rank p = 0.03; adjusted HR 0.52, 95% CI 0.28-0.96, p = 0.037; treatment × SCI interaction p = 0.042). All adverse events were Clavien-Dindo Grade I. No major complications occurred. Conclusions: Proactive gentle cystoscopic debris removal was associated with reduced catheter blockage. A signal toward lower symptomatic UTI risk was observed in the SCI subgroup, but not in the overall cohort. Due to the self-selected design and residual confounding, these findings are hypothesis-generating.
Journal of clinical medicine. 2026 Jul 03*** epublish ***
Meng-Hsuan Lu, Yu-Hui Huang, Yun-Sheng Chen, Kai-Siang Chen, Chieh-Jui Chen, Sung-Lang Chen
Department of Urology, Chung Shan Medical University Hospital, Taichung 402, Taiwan., School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan., Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua 500, Taiwan., The Center of Humanities and Society, Chia Nan University of Pharmacy &Science, Tainan 717, Taiwan., School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.