Hypothesis / aims of study
Clean intermittent catheterization (CIC) is the “gold-standard” to manage chronic urinary retention or patients with postvoid residual urine due to neurogenic or non-neurogenic causes. However, limited data exist on the daily experiences of individuals performing intermittent self-catheterization (ISC). Successful health outcomes can be subjective and often depend on the patient’s perspective. The Continence Care Registry (ConCaReTM) serves as a multinational, longitudinal study collecting electronic patient-reported outcomes (ePRO) to explore catheter preferences and healthcare usage among ISC users, including the impact of ISC on quality of life (QoL). This study aims to explore factors that influence catheter choice and overall satisfaction among ISC users.
Study design, materials and methods
We conducted a descriptive analysis of baseline data collected from 210 participants in the Continence Care Registry (ConCaReTM), encompassing individuals from the United States (63%), Canada (14%), and the United Kingdom (23%) who perform ISC. The participant gender distribution included 130 males, 79 females and 1 non-binary individual. Recruitment efforts focus on community-dwelling individuals aged 18 and older performing ISC who self-enroll in the registry on a rolling basis. Questionnaires are electronically distributed monthly for one year, then quarterly for up to five years and include the Intermittent Self-Catheterization Questionnaire (ISC-Q), EuroQoL-5D, and RAND modified Medical Outcomes Study Social Support Survey, which explore quality of life and satisfaction, health care utilization, and factors influencing catheter choice.
Results
Analysis revealed that ease of use (49%), comfort (47%), hygiene (38%), and compactness/portability (30%) were the four most predominant catheter attributes influencing catheter selection among participants. Gender differences were evident, with males prioritizing ease of use (46%) and females prioritizing comfort (57%) (Table 1). The majority of participants reported ease in preparing their catheter for use (78%) and ease of insertion due to catheter design (85%). However, 41% of respondents occasionally found catheter insertion uncomfortable, highlighting a significant area for improvement. Hygiene was shown to also be an important catheter attribute with 78% who felt assured their catheter allowed for a hygienic catheterization, with females (82%) responding more favorable than males (76%). Concerning compactness/portability, 40% primarily used compact catheters, with a greater proportion of females (56%) than males (30%) using this type of catheter. The gender difference in use of compact catheters may also reflect perceptions of discreetness with a greater proportion of females (72%) than males (45%) who agreed their catheter is discreet (Table 2).
Interpretation of results
The baseline data revealed that most participants reported ease with the preparation and insertion of catheters, suggesting a general satisfaction with the features of their catheters that promote ease of use. Ease of handling, or lack thereof, is a crucial factor that may drive intermittent catheter users to switch catheter types.[1] Longitudinal data tracking how the ease of use evolves over time, alongside changes in health conditions, could highlight prospective unmet needs among ISC users as they age or if their health status declines.
Comfort emerges as a paramount factor influencing catheter selection. Yet, a significant portion of users, nearly half, reported occasional discomfort during catheter insertion. This observation aligns with findings from Roberson et al., where 40% of participants acknowledged occasional pain during catheterization. Given the high value placed on comfort by ISC users, the prevalence of pain upon insertion underscores a critical area for enhancement.
UTI risk reduction is crucial as UTIs are one of the top concerns among ISC users. While guidelines for intermittent catheterization recommend “no-touch” catheterization to help prevent UTIs, 34% of patients in a study by Roberson et al. reported touching the catheter during insertion.[2] Environment can also have an impact on the catheter user’s experience as access to clean public facilities may be limited. “No touch” catheter features may provide assurance that users will have a hygienic catheterization.
While compactness/portability was selected as a key catheter attribute, only 40% of participants, predominantly females, reported a compact catheter as their primary catheter. Findings from a study by Chartier-Kastler et al, showed a 28% higher ISC-Q score among compact catheter users, indicating an improved quality of life.[3] The lower perception of discreetness among male catheter users identifies a potential unmet need and underscores the importance of offering a range of catheter designs to meet diverse user requirements and preferences.
The data suggests that while current designs generally meet the needs regarding ease of use, insertion, and hygiene, discomfort during insertion and potential discretion concerns remain considerable issues for a subset of users.