Clean intermittent catheterization (CIC) is considered as gold standard for treating bladder emptying disorders in adult neurogenic lower urinary tract dysfunction (ANLUTD). The literature is rich about CIC and patients with spinal cord injury, but very poor concerning CIC and Multi Sclerosis (MS) patients. 
The aim of this study is to make an analysis of our experience with the use of CIC among an exclusive population of MS patient, with a long follow-up.

Retrospective Study: from 01/01/2000 to 28/03/2024
Inclusion criteria: 
MS patients, at least 18 years old, who were proposed to learn CIC, associated or not to a treatment of detrusor overactivity (DO)
Exclusion criteria: 
non MS patients
Assessed characterictics: 
- at the time when CIC was proposed : gender, patient's age, type of MS, EDSS-score, evolution of MS since more or less than five years, presence of urinary urge incontinence (UUI), use of Botox.
- CIC method adopted by the patient: 
      -clean intermittent self catheterization (CISC) alone or CISC associated with spontaneous voiding,
      -clean intermittent catheterization (CIC) alone or CIC associated with spontaneous voiding
- at last follow-up visit : EDSS-score, patient's age, presence of UUI , use of Botox.
Our data base was updated after each visit throughout the follow-up period.

Results:
CIC proposed to 217 patients:
-9 patients refused
-13 stopped immediately (psychological reason, pain, ...)
-195 patients went further with CIC:

Among 195 MS patients: 
-1. 72.3% female patients, 
-2. median age (years) 49.5   (min 24, max 75)
-3. median EDSS-score: 5.5 (4-6.5)
-4. EDSS range	     Mean age                                                    
      <6     	                     46.8 years.                           
      >6                          51.9 years
     In our result, we observed that the higher the EDSS score, the older the population, reflecting the negative evolution of the disease with advancing age. This correlation is significant (p=0.048) 
                               
-5. Patients's evolution of MS < 5 years :
   -Relapsing-remitting MS (RR-MS) patients: 27% .
   -Secondary progressive (SP-MS) patients: 1.2%.
   -Primary progressive (PP-MS) patients: 14%
 MS patients with relapsing-remitting MS (RR-MS) started earlier with CIC (p-value< 000005)

Patients's evolution of MS > 5 years :
   -Relapsing-remitting MS (RR-MS) patients: 73% .
   -Secondary progressive (SP-MS) patients: 98.8%.
   -Primary progressive (PP-MS) patients: 86%
 MS patients with relapsing-remitting MS (RR-MS) started earlier with CIC (p-value< 000005)

But in most cases, whatever the form of the disease, CIC starts more than 5 years after diagnosis.

In contrast, delay to start CIC after diagnosis does not differ according to gender (there is not significant difference in both sex). 

-6. Presence of UUI: 74.2% (female patients :55.8% and male patients 18.4% not significantly different between genders, p = 0.17)
-7.With or without associated treatment of detrusor overactivity: botox 
     In our cohort, when starting with CIC, 42.5% of patients received Botox injection. 
            -8.4% of MS patients received low dose of Botox (≤100U)
            -34,2% received higher dose of botox    (≥150U).
     

Type of voiding (%) :
    -CISC alone (49%) or CSIC associated with spontaneous voiding (24.5%)
    -CIC alone (12.5%) or CIC associated with spontaneous voiding (13.5%)

At last follow-up visit:  (mean duration 8.8 years)
-1. median EDSS-score = 6.5 (min 5 - max 8)
-2. mean age = 59.1 (+/- 10.6)
-3. Presence of UUI: 68.4% (female patients : 46.3% and male patients 22.1% significantly different between genders, p = 0.02)
-4. At the end of follow-up, 38.7% of them still have this treatment.
        In contrast, we observed that using of CIC is associated to higher proportion of high dose
                  -35% with dose ≥150U 
                  -3,6% with low doses.

127 MS patients still performed CIC
68 MS patients had stopped

We were able to convince 208 out of 217 MS patients (95.8%) to learn CIC
195 MS patients adopted CIC.
Only 127 of the 195 MS patients (65.1%) were still performing CIC at last follow-up visit: this show that CIC is a real challenge in this population.
EDSS-score slightly worsened between the first and last visits from 5.5 to 6.5, but this can explain the persistance of a high incontinence rate because of lack of patient's mobility.

CIC is considered as the gold standard for treating bladder emptying disorders in adult neurogenic lower urinary tract dysfunction (ANLUTD). There is less literature concerning the use of CIC in MS population. Our current study showed an encouraging compliance at CIC in MS population.