With more than 90,000 people with long-term indwelling catheters residing in the UK, and a worldwide reliance on urinary catheters to manage bladder dysfunction, the potential or actual harm caused by these devices is well-documented (Gage et al, 2017). Current catheter designs can lead to urinary tract infection (UTI) or urosepsis, bladder or urethral trauma and frequent blockage in approximately 50% of users (Gibney, 2016). Furthermore, these devices can severely disrupt users' lives, limiting their daily activities and can be challenging to manage for community healthcare providers as frequent and unplanned catheter changes and complications involve cost, time and resources (Murphy, 2019; Paterson et al, 2019). 

A recent study suggests that long-term catheter users experience 1.7 blockages, 0.35 leaks or dislodgements and 0.1 infections per annum (Gage et al, 2024). Catheter blockage is frequently managed with acidic maintenance solution instillations (Holroyd, 2017). In the authors' clinical experience, maintenance solutions are frequently used to lengthen the life of catheters rather than changing them.

An additional study undertaken in a community setting (n=193), demonstrated that 67% of the indwelling catheter users reported urine leakage (bypassing) at least once in the last 12 months (Wilde et al, 2017). The study also suggests that 34% of catheter users had experienced catheter blockage at least once in the previous 12 months.
 

Improving outcomes for people with indwelling catheters

While there is no recent evidence, overarching data suggest that UK hospitals are seeing an increase in admissions due to catheter-related complications (NHS England, 2018). However, in the authors' clinical experience, implementing a service development initiative (as described in this article) – such as introducing an alternative catheter and maintaining fundamental catheter care – can help to reduce:
  • The risk of catheter blockages
  • The need for frequent
catheter changes
  • Catheter-associated urinary tract infection (CAUTI), 
pain and bladder spasms (involuntary contractions of 
the detrusor muscle).
This, in turn, can result in fewer hospital visits and improve catheter users' quality of life. 

Catheter fundamentals

Upskilling nurses and increasing their confidence to deliver patient-centred catheter care is vital to improve outcomes for patients with long-term indwelling urinary catheters.
 
For long-term catheter users, maintaining a healthy diet, adequate hydration and an effective bowel emptying regimen can help to prevent constipation (see below) (Gibney, 2016). These fundamental measures may also improve urine flow and catheter efficacy by reducing the risk of blockage and leakage (Australia and New Zealand Urological Nurses Society [ANZUNS], 2014; Gibney, 2016; Paterson et al, 2019). Safely increasing fluid intake can also help to dilute urine and flush out bacteria (Geng et al, 2024).
 
Constipation (classed as passing hard stools, incomplete defaecation or an irregular bowel regimen) can negatively affect indwelling catheters and lead to: 
  • Obstruction: a full rectum 
and sigmoid colon can compress the bladder and the catheter tubing, obstruct urine flow and prevent drainage 
  • Leakage: increased pressure due to constipation can result in urine bypassing the catheter causing discomfort and/or skin irritation. Bypassing can also occur due to increased straining on defaecation
  • Bladder spasms: constipation can exacerbate bladder spasms and lead to pain or urine leakage. Mechanical pressure on the bladder causes spasms (ANZUNS, 2014). 
Practice point: Complications linked to indwelling catheterisation
Infection and risk of urosepsis (resulting in a rise in hospital admissions)
Blockage leading to frequent catheter changes or catheter maintenance solution usage
Bypassing
Bladder spasm leading to pain
Catheter tip can cause irritation or tissue damage in the bladder
From Reid et al (2021).

Catheter maintenance solutions

Anecdotal evidence suggests that catheter maintenance solutions are frequently used but do not promote effective catheter outcomes. These solutions can cause chemical irritation to the bladder mucosa (Holroyd, 2017). Furthermore, frequent breaking of a closed catheter drainage system to instil a solution can introduce infection risk.

A Cochrane review showed insufficient evidence to determine whether prophylactic catheter maintenance solution policies were beneficial or harmful for patients with long-term catheters (Shepherd et al, 2017). Holroyd (2017) documented that administration of the solutions can cause mucosal trauma within the bladder, especially if the solution is acidic or force is used, resulting in haematuria, pain and discomfort. 

Why use open-ended catheters?

An open-ended urinary catheter is designed with an open tip, allowing for more efficient drainage of urine and potentially reducing the risk of blockage compared to traditional nelaton tip catheters (Zhao et al, 2024). 

Open-ended Foley catheters are made from silicone, have larger internal diameters and are associated with reduced rates of intraluminal biofilm adherence (Newman, 2022). Long-term silicone catheter usage is also associated with a lower risk of urethritis, bladder mucosal irritation and urethral strictures, making them a preferred material (ANZUNS, 2014; Greenberg et al, 2017).

Vaidyanathan et al (2009) reported extremely positive results with the use of an open-ended catheter in a case of severe encrustation. They can also be effective for users who experience frequent blockage due to sediment or debris or have a history of bladder spasms or bypassing (Simpson, 2017).
Practice point: Positive aspects of open-ended catheters
Encourage higher urine flow
Potential to drain larger amounts of debris
Designed to reduce risk of blockage
Less bladder mucosa irritation
From Greenberg et al (2017).

Service development project 

In August 2022, the rapid response team in Tower Hamlets (part of East London NHS Foundation Trust) identified that a high number of emergency callouts were due to catheter blockages – averaging 132 incidents per month (January–July). Having identified the issue for patients and the inevitable burden on community nurse teams, the trust sought to:
  • Reduce emergency callouts
  • Improve patient outcomes
  • Decrease costs associated with nurse time to undertake frequent catheter changes or repeated catheter maintenance instillations.
A decision was made by the first author, based on review of emergency callouts in 2022, to evaluate the implementation of open-ended catheters for long-term catheter users. Thus, the Tower Hamlets continence service transitioned 100% of their patient caseload from standard tip Foley catheters to ProsysÆ open-ended Foley catheters (Clinisupplies) following promising initial reviews by the authors, which suggested decreased catheter blockage rates. The Prosys catheter's open-ended design and wide lumen tube allows continuous flow, reducing the risk of blockages (Ejiogu and Powell, 2025). 
 
Other factors impacting on catheter management were also reviewed, including:
  • Constipation: a three-monthly clinic review which included medication review with continence nurses and a letter to the GP. Treatment advice included lifestyle adjustments, dietary changes including increase in fibre and fluid intake and consistent toilet routine. Advice given on gentle physical activity (based on clinical assessment) such as a daily walk can help stimulate bowel movements
  • Medication: medication review by GP as well as a prescription laxative unless contraindicated
  • Fluid intake: advice was given on being well hydrated by drinking plenty of water, aiming for 2 litres per day unless contraindicated
  • Use of catheter maintenance solutions: recommended following full clinical assessment and should only be used to prevent catheter blockages and not as part of routine care
  • Fundamental aspects of 
catheter management. 
A high expenditure on supplies was also recorded for a small number of participants who required frequent catheter maintenance instillations, replacement catheter valves, replacement of 2-litre drainage bags and leg bags. 
 

Project findings and outcomes

Monthly emergency callout reduction

As said, before implementation of the open-ended catheter, the average number of monthly emergency callouts due to catheter blockages was 132.

Following the introduction of Prosys open-ended Foley catheters, call-outs were reduced to 70 per month, marking a nearly 47% decrease in monthly blockage-related emergencies.
 

Yearly emergency callout reduction

In 2022, the East London Trust recorded 1,459 emergency callouts for catheter blockages.

With the adoption of Prosys catheters in 2023, the trust saw a 40% reduction in emergency callouts for catheter complications.

This positive trend continued into 2024, with callouts dropping by 63%, reflecting the sustained effectiveness of Prosys catheters in reducing blockages and the need for emergency interventions.
 

Operational and financial impact

The decrease in emergency callouts led to improved resource allocation within the trust, freeing the community nurses to focus on increasing caseload demands.

Cost of nurse time

In 2023/2024, average cost of a district nurse (DN) visit was £57, but dependent on several factors; length of call, travel time, resources used and experience (NHS banding), out of hours costs, number of nurses required for the visit (King's Fund, 2025). 

Taking the average annual cost to the NHS of catheter management of £1191 (Gage et al, 2024), DN records showed that the average number of contacts with patients for catheter care was seven visits per annum, about two-thirds of which were planned, adding on average about £200 per year to the costs of catheter management (Table 1). 
Table 1: Average monthly callout rate
Month/year Callout rate
January–July 2022 132
August–December 2022 100
2023 73
January–August 2024 67

Catheter removal

The project also led to the removal of catheters in some individuals who did not have a clinical need – routine use should be clinically justified, but rarely is anecdotally.
 

Patient testimonials 

After introducing Prosys open-ended Foley catheters, patients reported the following improved outcomes:

I always get problems with suprapubic catheters. Some days, I am completely dry; but some days, there would not be any drainage in the suprapubic catheter, but I still experience leakage. For the past two years, since using the open-ended catheter, there has been no persistent leakage of urine.
Patient one

I used to get up four or five times a night due to prostate problems, but the difference between being able to sleep eight hours in a row, I would not take off my bag even if they made me.
Patient two

I had a catheter inserted in the hospital, which I had a very bad experience with. After having my catheter changed to an open-ended catheter called Prosys by the continence nurse, I can now comfortably live with my long-term catheter.
Patient three

Clinician comments

Nurses who had training from the first author's team commented:

As a district nurse, I am very aware of the importance of meeting not only clinical and diagnostic needs, but also in helping patients. In this case, to help those with indwelling catheters and suffering from very serious illnesses to attain their goals and maintain a high quality of life.

I want to highlight how effective the educational interventions offered by Chinny and her team has helped me to improve my knowledge, attitudes, and practices in catheter management, as I had very low confidence in carrying out catheter insertion.
 

Conclusions

Analysis of the data suggests that Prosys open-ended Foley catheters can be both an effective option when managing long-term catheter blockage and reduce emergency callouts. Further evaluation is recommended to assess the long-term efficacy of open-ended catheters for long-term users. It would be helpful to collect more data in relation to reasons for catheterisation, length of usage of indwelling catheters, frequency of blockage or catheter-related complications. A more detailed analysis of the data would be beneficial to calculate cost savings as well as to measure patient outcomes and feedback. 
Patient story
Mr A is an 88-year-old gentleman who had an indwelling catheter inserted in 2019. He had previously experienced lower urinary tract symptoms due to benign prostate hyperplasia (enlargement) and went into retention. He lives alone and is self-caring with regards to daily catheter management.

Mr A has a daily fluid intake of approximately 1.2 litres and usually maintains a daily bowel regimen passing a soft stool with occasional episodes of constipation.

His prescribed medication includes a laxative, finasteride and tamsulosin (both drugs are used to reduce the symptoms of benign prostate enlargement).

Before the implementation of an open-ended catheter in 2023, Mr A required three emergency callouts over a three-month period for catheter blockage/complications and a weekly catheter maintenance solution as part of his routine catheter management. 

Since having an open-ended catheter inserted his catheter is changed every 10 weeks and he has not needed a maintenance solution or emergency callout for catheter blockage.

Key points

  • Urinary catheter blockage is a common complication of long-term catheterisation that frequently affects outcomes and quality of life for catheter users. 
  • Management of catheter blockage significantly impacts care provision by community-based nursing teams.
  • Upskilling nurses and increasing their confidence to deliver patient-centred catheter care is vital to improve outcomes for patients with long-term indwelling urinary catheters.
  • An open-ended urinary catheter is designed with an open tip, allowing for more efficient drainage of urine and potentially reducing the risk of blockage compared to traditional nelaton tip catheters. 
  • In August 2022, the rapid response team in Tower Hamlets (part of East London NHS Foundation Trust) identified that a high number of emergency callouts were due to catheter blockages – averaging 132 incidents per month (January–July).  
  • The Tower Hamlets continence service transitioned 100% 
of their patient caseload from standard tip Foley catheters to Prosys® open-ended Foley catheters (Clinisupplies) following promising initial reviews.
Originally published in Journal of Community Nursing: Ejiogu C, Powell K (2026) Service development to improve outcomes for people with indwelling catheters. Journal of Community Nursing 40(1): 59-62. https://www.jcn.co.uk/journals/issue/02-2026/article/service-development-improve-outcomes-people-indwelling-catheters

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