Suprapubic catheter insertion in people with multiple sclerosis: long-term complications and survival in a retrospective cohort study.

Small and single-centre: 55 people, 15 deaths, records reviewed after the fact rather than data collected as events happened. The authors call the analyses exploratory. No comparison group. The study collected no data on people who were offered a suprapubic catheter and declined, or on people managed with intermittent catheterisation or an indwelling urethral catheter over the same period, so the authors say the relative benefits of one approach over another cannot be judged from it. Complications dealt with in general practice or by community nurses, such as urinary infections or catheters falling out, may never have reached the hospital records, so the complication rates may be underestimates. Quality of life and other medical conditions were not recorded, so their effect on survival could not be examined. The disability groupings used in the survival analysis (5.0–6.5, 7.0–8.0, 8.5–9.5) were chosen after the researchers had looked at the data, not decided in advance. The cause of death could not be established for 4 of the 15 people who died (27%). Wide confidence intervals around some predictors, and models using at most two variables at a time, so associations may be missed or unstable. The centre has a dedicated neuro-urology team of a urology consultant and MS nurse specialists, so results may not carry over to centres without that service. Follow-up overlapped with the COVID-19 pandemic, which likely affected mortality in this period. 3 of 55 patients had unclear MS subtype and mobility status was missing for 2, so some baseline description is incomplete.

Funded by the National Institute for Health and Care Research (NIHR) Sheffield Biomedical Research Centre and the NIHR Sheffield Clinical Research Facility. No individual author disclosures or competing interests appear in the text provided.

Do not read the favourable complication and survival figures as evidence that a suprapubic catheter is the better option than staying on an indwelling urethral catheter or continuing to self-catheterise. The study had no comparison group and collected no data on people who were offered one and declined, so the authors themselves say the relative benefits cannot be judged from it.