Clean intermittent catheterization (CIC) is the gold standard treatment for chronic urinary retention due to neurogenic and non-neurogenic causes. 

Compared to a long-term indwelling catheter, the CIC aims to provide patients with more independence, fewer complications and a better quality of life. The intention of this study is to analyze the level of satisfaction, quality of life and complications associated with CIC in an adult population.

Single center observational trial in which we included patients with chronic urinary retention of any etiology (neurogenic bladder dysfunction, neobladder, Mitrofanoff, etc.) and under CIC treatment. 

The questionnaires ISC-Q ("Intermittent Self-Catheterization Questionnaire") by Pinder et al. (2012) focused in quality of life, along with the questionnaire developed by Håkansson et al. (2015) about complications and satisfaction associated with CIC, were both translated into Spanish and applied via telephone.

Among the topics included in these questionnaires are: 
ease of use, convenience, discreetness, psychological well-being, catheter characteristics, infectious complications, non-infectious complications (bladder stones, false passage, hematuria, urethral strictures, etc), emergency department visits and hospital admissions.

34 patients completed both questionnaires.

Of all the patients surveyed:
- 44% were men and 66% women, with a mean age of 39 years (18-83).
- 37% perform three or less CIC per day.
- The mean number of CIC per day is 4.6.

Main results from ISC-Q:
- 97.1% consider it is easy to prepare the catheter for use each time.
- 23.5% consider the lubrication on the catheter makes it more difficult to use.
- 23.5% consider it is uncomfortable to insert the catheter.
- 5.9% consider that the storage of catheters for daily use is inconvenient.
- 35.3% consider taking enough catheters for a 2-week holiday is very inconvenient.
- 88.2% feel confident in their ability to self-catheterize.
- 100% of patients are aware of their need for self-catheterization.
- 11.7% consider that self-catheterization limits them to visit friends or relatives.

Complications during the last year:
- 35.3% have not had any urinary tract infection, 35.3% have had 1-2 infections and 29.4% have had 3 or more.
- 32.3% have required to go to the emergency department for urinary tract infections and 23.5% have required hospital admission for this reason.
- Only 1 (2.9%) pyelonephritis have been reported and no case of prostatitis, epididymitis or urethral stenosis.
- Two (5.8%) patients reported bladder stones, both with appendicovesicostomy (Mitrofanoff).
- 88.2% of patients are satisfied with their current catheter while 11.8% would be open to trying another catheter.

Both questionnaires uniformly showed that most patients find it easy to use the catheters, they mostly feel comfortable and confident with CIC and only 11.7% of them feel that CIC limits their possibility of spending time with friends and family. 

Most patients feel their catheter is discreet and storage of catheters for daily use is convenient, yet one-third of patients find inconvenient to take enough catheters for a 2-week holiday.

Complication rate with this intervention is low for most outcomes measured (bladder stones, urethral strictures, hematuria, etc) except for urinary tract infections with one-third of patients experiencing at least one urinary tract infection in the past year and almost one third having three or more. 

Most patients are satisfied with their current catheter yet 11.8% would consider trying another one.

The majority of the patients in treatment with clean intermittent catheterization are satisfied, report a good quality of life and a low rate of complications with the exception of catheter-associated urinary tract infection.

Healthcare providers should consider offering a trial with another catheter every once in a while as more than 10% of patients that consider themselves as "satisfied" would be willing to try another in search for improving comfort.

Håkansson, M.Å., et al. Health care utilization and complications rates among users of hydrophilic coated catheters. Urologic Nursing, 35(5), 239-247. doi:10.7257/1053-816X.2015.35.5.239
Pinder B, et al. Development and psychometric validation of the intermittent self-catheterization questionnaire. Clin Ther. 2012 Dec;34(12):2302-13. doi: 10.1016/j.clinthera.2012.10.006. Epub 2012 Nov 22.
Lamin E, Newman DK. Clean intermittent catheterization revisited. Int Urol Nephrol. 2016 Jun;48(6):931-9. doi: 10.1007/s11255-016-1236-9. Epub 2016 Mar 8.