Every person deserves access to high quality care in all healthcare settings delivered by trained healthcare professionals that promote quality of life, foster shared decisions making and informed consent. Intermittent catheterization (IC) is the gold standard treatment for individuals with urinary retention and/or neurogenic lower urinary tract dysfunction. [¹] Unfortunately many individuals who perform IC can feel left out of their healthcare discussions, neglected and overlooked yet are subsequently responsible for their own care.[2]  The clinical reality of IC is that many patients receive inadequate education at the initiation of IC. If patients are not informed, motivated, and engaged with their own care, they risk lapsing in their routine, resorting to behaviors detrimental to their wellbeing, such as avoiding social contact or restricting fluid intake, or even abandoning IC altogether. The gap in current clinical practice indicates a need for guidance principles to ensure appropriate engagement of individuals performing IC. Guidance can increase adherence to IC and may decrease catheter-associated complications. The goal of these principles is to outline best practices pre-treatment, during the initial catheter selection and education process and for the lifespan of the IC user based on the evidence available for ensuring safe and quality IC care.

The Intermittent Catheterization Clinical Practice Principles were developed by a working group of international experts in urology, rehabilitation, and continence care. This working group is multidisciplinary and multinational in nature, bringing to these discussions various clinical expertise and points of view. Over the course of four workshops between April and August 2023, the group assessed key clinical guidelines across global geographies and clinical specialties, including a mix of professional associations and governmental institutions. The group identified a need for clinical practice principles that partners healthcare professionals and IC users to establish a baseline of expectations when IC is initiated. Once the categories were agreed upon, the group collated a list of principles through discussions and debate until a group consensus was reached for each of the principles using a modified Delphi method. The global principles were subsequently reviewed by a focus group of IC users and an associated qualitative survey completed till saturation (n=7).

The purpose of these principles is both to educate IC users and their caregivers, but also to create an open dialogue and collaboration between IC users and healthcare professionals thus empowering IC users to self-advocate. The IC user should be involved in all phases of their IC experience and receive the following (see Table 1).

Expert consensus on the practice principles was validated through qualitative surveys to the IC user focus groups. IC users were asked to evaluate expected impact of the principles on their engagement with their healthcare and providers. All respondents indicated the practice principles were informative and would improve IC preparation, self-advocation, and foster open dialogue and collaboration with their providers.

Intermittent catheter user compliance rates range between 34%-81% with several reasons cited for non-compliance including internal and external factors, yet there are few studies that explore specific factors of non-compliance.[2]  Of those that address IC noncompliance, very few evaluate IC user education, especially at initiation of catheterization. Currently, education programs available do not involve shared decision making or adequately promote partnership with providers.  These practice principles are intended to serve as a foundation to ensure collaborative engagement and empowers IC users and their healthcare team.  Furthermore, it is hoped that these practice principles will be a significant and critical first step towards improved compliance with catheterization.  The next steps include educating charities and professional organizations about the principles and further validation on a larger scale.

Neumeier V, et al. Indwelling catheter vs intermittent catheterization: is there a difference in UTI susceptibility? BMC Infectious Diseases.2023;23(507):1-10.
Seth JH, Haslam C, Panicker J. Ensuring patient adherence to clean intermittent self-catheterization. Patient Prefer Adherence.2014 February;8:191-8.
Burgess J, Gleba J, Lawrence K, Mueller S. Ostomy and Continent Diversion Patient Bill of Rights. Journal of Wound Ostomy Continence Nursing.2022;49(3):251-260.

Continence 12S (2024) 101659
DOI: 10.1016/j.cont.2024.101659