Evaluating the Efficacy of the Centers for Medicare and Medicaid Services Intermittent Catheter Policy Requires a Multifaceted Approach. Reply.

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You have accessJournal of UrologyLetters to the Editor1 Mar 2023Evaluating the Efficacy of the Centers for Medicare and Medicaid Services Intermittent Catheter Policy Requires a Multifaceted Approach. Reply.is a reply to letterEvaluating the Efficacy of the Centers for Medicare and Medicaid Services Intermittent Catheter Policy Requires a Multifaceted Approach. Letter. Christopher S. Elliott, Kai Dallas, Kazuko Shem, and James Crew Christopher S. ElliottChristopher S. Elliott Division of Urology, Santa Clara Valley Medical Center, San Jose, California More articles by this author , Kai DallasKai Dallas Division of Urology, City of Hope, Duarte, California More articles by this author , Kazuko ShemKazuko Shem Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California More articles by this author , and James CrewJames Crew Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003152AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail To the Editor: We appreciate the concerns expressed by the Board of Directors of the Wound, Ostomy and Continence Nursing Certification Board as they recapitulate the limitations we express in the Discussion section of our manuscript.1 Our need to use of a large retrospective data set, rather than a prospective randomized trial, will always leave our findings open to potential questions of error related to confounding even though all efforts were made to minimize the chances of this occurring. In addition, our use of the outcome variable “hospitalizations for genitourinary reason” as a proxy for hospitalizations for urinary tract infection (UTI) is also imperfect, although in other well-performed studies UTI predominates in this category (∼90%).2-4 When considering other potential advantages of single-use catheters, such as improvement in user quality of life, we can only agree that our research was not designed to investigate this matter. Along these lines, we would like to reiterate that we feel that our study in no way can be seen as “definitive” when discussing the lack of improvement in hospitalizations for genitourinary reasons—hence the use of the word “appears” in our title. Rather, we hope that instead of being seen as an attempt to change policy, our work is used as a talking point to spur further investigation into UTI prevention in the neurogenic population, as our data suggest that over the past 2 decades we have failed to develop interventions that provide a meaningful impact.