{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T15:14:10Z","timestamp":1788016450117,"version":"build-2784847793"},"reference-count":26,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004699","name":"Chung Shan Medical University Hospital","doi-asserted-by":"publisher","award":["CSH-2026-A-002"],"award-info":[{"award-number":["CSH-2026-A-002"]}],"id":[{"id":"10.13039\/501100004699","id-type":"DOI","asserted-by":"publisher"}]},{"award":["CSH-2026-A-002"],"award-info":[{"award-number":["CSH-2026-A-002"]}],"id":[{"id":"https:\/\/ror.org\/01abtsn51","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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 (&lt;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\u2013Meier methods and multivariable Cox regression. Results: After IPTW, baseline characteristics were well balanced. Median follow-up was 26 months (IQR 18\u201334). 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\u20130.96, p = 0.037; treatment \u00d7 SCI interaction p = 0.042). All adverse events were Clavien\u2013Dindo 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.<\/jats:p>","DOI":"10.3390\/jcm15135217","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T14:33:06Z","timestamp":1783089186000},"page":"5217","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Proactive Cystoscopic Debris Removal for Reducing Catheter Blockage in Patients with Long-Term Indwelling Catheters: A Prospective Self-Selected Cohort Study with Exploratory Subgroup Analysis on Urinary Tract Infections"],"prefix":"10.3390","volume":"15","author":[{"given":"Meng-Hsuan","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Urology, Chung Shan Medical University Hospital, Taichung 402, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Hui","family":"Huang","sequence":"additional","affiliation":[{"name":"School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan"},{"name":"Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung 402, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun-Sheng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua 500, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai-Siang","family":"Chen","sequence":"additional","affiliation":[{"name":"The Center of Humanities and Society, Chia Nan University of Pharmacy &Science, Tainan 717, Taiwan"},{"name":"Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chieh-Jui","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2648-4691","authenticated-orcid":false,"given":"Sung-Lang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Urology, Chung Shan Medical University Hospital, Taichung 402, Taiwan"},{"name":"School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1017\/ice.2024.26","article-title":"Catheter-associated urinary tract infections (CAUTIs) and non-CAUTI hospital-onset urinary tract infections: Relative burden, cost, outcomes and related hospital-onset bacteremia and fungemia infections","volume":"45","author":"Kelly","year":"2024","journal-title":"Infect. 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