Difficulties of patients and caregivers in performing clean intermittent catheterization: scoping review



Cateterismo Uretral Intermitente, Bexiga Urinária Neurogênica, Reabilitação.


Objective: To identify the main difficulties reported by patients and caregivers in the use of clean intermittent catheterization described in the scientific literature. Methods: Scoping review with studies published in Portuguese, English or Spanish, without date limit, in electronic databases and digital libraries, using descriptors and keywords. Results: 790 studies were identified, including 34 studies published between 1984 and 2019. The main difficulties reported in performing clean intermittent catheterization were related to catheter insertion, pain, discomfort, urethral trauma, public bathrooms with inadequate facilities, physical difficulties and lack of access to necessary inputs. Conclusion: The studies analyzed show the difficulties that patients who use clean intermittent catheterization and their caregivers face on a daily basis, which are related to intrinsic and extrinsic, institutional and governmental factors and can decrease satisfaction and adherence to rehabilitation programs bladder, with an impact on the quality of life of patients and their caregivers. Therefore, it highlights the need for health education for the proper teaching of performing clean intermittent catheterization, emphasizing the importance of the nurse’s role in this process.


Download data is not yet available.


Metrics Loading ...


Di Benedetto P. Clean intermittent self-catheterization in neuro-urology. Eur J Phys Rehabil Med. 2004 Dez;47(4):651-59.

Vahr S, Cobussen-Boekhorst H, Eikenboom J, Geng V, Holroyd S, Lester M et al. Catheterisation Urethral intermittent in adults. Evidence-based Guidelines for Best Practice in Urological. The Netherlands: European Association of Urology Nurses; 2013.

Lopes MAL, Lima EDRP. Continuidade do cateterismo vesical intermitente: pode o supor social contribuir? Rev Latino-Am. Enfermagem. 2014 Mai/Jun;22(3):461-66. https://doi.org/10.1590/0104-1169.3268.2438

Bickhaus JA, Drobnis EZ, Critchlow WA, Occhino JA, Foster RT. The feasibility of clean intermittent self-catheterization teaching in an outpatient setting. Female Pelvic Medicine & Reconstructive Surgery. 2015 Jul/Ago;21(4):220-24. https://doi.org/10.1097/SPV.0000000000000155.

Faleiros F, Pelosi G, Warschausky S, Tate D, Käppler C, Thomas E. Factors influencing the use of intermittent bladder catheterization by individuals with spina bifida in Brazil and Germany. Rehabilitation Nursing. 2016 Jan/Fev;43(1):46-51. https://doi.org/10.1002/rnj.302.

Newman DK, Willson MM. Review of intermittent catheterization and current best practices. Urologic Nursing. 2011 Jan/Fev;31(1):12-28.

Mazzo A, Bardivia CB, Jorge BM, Souza VD, Fumincelli L, Mendes IAC. Urinary catheterization delay: clinical practice. Enfermería Global. 2015 Abr;14(38):60-68.

Martins MS, Santos VLCG, Secoli SR, Mata SM, Nogueira DS, Souza DM. Estudo comparativo sobre dois tipos de cateteres para cateterismo intermitente limpo em crianças estomizadas. Rev. esc enferm. USP. 2009 Dez;43(4):865-71. https://doi.org/10.1590/S0080-62342009000400018

Sarica S, Akkoc Y, Karapolat H, Aktug H. Comparison of the use of conventional, hydrophilic and gel-lubricated catheters with regard to urethral micro trauma, urinary system infection, and patient satisfaction in patients with spinal cord injury: a randomized controlled study. European Journal of Physical and Rehabilitation Medicine. 2010 Dez;46(4):473-79.

Chartier-Kastler E, Denys P. Intermittent catheterization with hydrophilic catheters as a treatment of chronic neurogenic urinary retention. Neurourology and Urodynamics. 2011 Jan;30(1):21-31. https://doi.org/10.1002/nau.20929.

Lamin E, Newman DK. Clean intermittent catheterization revisited. International Urology and Nephrology. 2016 Jun;48(6):931-39. https://doi.org/10.1007/s11255-016-1236-9.

Mazzo A, Pecci GL, Fumincelli L, Neves RC, Santos RCR, Cassini MF, et al. Intermittent urethral catheterisation: the reality of the lubricants and catheters in the clinical practice of a Brazilian service. Journal of Clinical Nursing. 2016 Nov;25(21-22):3382-90. https://doi.org/10.1111/jocn.13466.

Chan MF, Tan HY, Lian X, Ng LYG, Ang LLE, Lim LHL, et al. A randomized controlled study to compare the 2% lignocaine and aqueous lubricating gels for female urethral catheterizantion. Pain Pract. 2014 Fev;14(2):140-45. https://doi.org/10.1111/papr.12056.

Ercole FF, Macieira TGR, Wenceslau LCC, Martins AR, Campos CC, Chianca TCM. Revisão integrativa: evidências na prática do cateterismo urinário intermitente/demora. Rev. Latino-Am. Enfermagem. 2013 Jan/Fev;21(1):459-68. https://doi.org/10.1590/S0104-11692013000100023.

Lima MB, Rebouças CBA, Castro RCMB, Cipriano MAB, Cardoso MVLML, Almeida PC. Construção e validação de vídeo educativo para orientação de pais de crianças em cateterismo intermitente limpo. Rev. esc enferm. USP [on line]. 2017 Dez; [citado 2019 mar 7];51:e03273. Disponível em http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0080-62342017000100462&lng=en. https://doi.org/10.1590/s1980-220x2016005603273.

Roecker S, Budó MLD, Marcon SS. Trabalho educativo do enfermeiro na Estratégia Saúde da Família: dificuldades e perspectivas de mudanças. Rev. esc. enferm. USP. 2012 Jun;46(3):641-49. https://doi.org/10.1590/S0080-62342012000300016.

Orlandin L, Mazzo A, Meska MHG, Jorge BM, Cotta Filho, CK, Fumincelli L. Low‐fidelity simulation for patients and caregivers in the use of lubricants in clean intermittent catheterization. Int J of Urol Nurs. 2018 Mar;12(1):9-15. https://doi.org/10.1111/ijun.12155.

Peters MDJ, Godfrey C, Mcinerney P, Baldini SC, Khalil H, Parker D. Chapter 11: Scoping Reviews. In: Aromataris E, Munn Z (Ed.). Joanna Briggs Institute Reviewer's Manual [Internet]. JBI, 2017. Disponível em: https://wiki.joannabriggs.org/display/MANUAL/Chapter+11%3A+Scoping+reviews

Galvão CM, Sawada NO, Trevizan MA. Revisão sistemática: recurso que proporciona a incorporação das evidências na prática da enfermagem. Rev Latino-Am. Enfermagem. 2004 Mai/Jun;12(3):549-56. https://doi.org/10.1590/S0104-11692004000300014.

Bennett CJ, Diokno AC. Clean intermittent self-catheterrization in the elderly. Urology. 1984 Jul;24(1):43-45.

Robinson RO, Cockram M, Strode M. Severe handicap in spina bifida: no bar to intermittent self catheterisation. Arch Dis Child. 1985 Ago;60(8):760-62. https://doi.org/10.1136/adc.60.8.760

Perkash I, Friedland GW. Posterior ledge at the bladder neck: crucial diagnostic role of ultrasonography. Urol Radiol. 1986 Dez;8(4):175-83. https://doi.org/10.1007/bf02924101

Neal DE, Lawson AL, Webb RJ, Robertson AS. Clean intermittent self-catheterization. Int Urogynecol J. 1993;4(1):50-55. https://doi.org/10.1007/BF00372814

Boemers TML, Soorani-Lunsing IJ, De Jong TPVM, Pruijs HEH. Urological problems after surgical treatment of scoliosis in children with myelomeningocele. J Urol. 1996 Mar;155(3):1066-69.

Boemers TML, De Jong TPVM, van Gool JD, Bax KMA. Urologic problems in anorectal malformations. Part 2: functional urologic sequelae. J Pediatr Surg. 1996 Mai;31(5):634-37. https://doi.org/10.1016/s0022-3468(96)90663-6

Salle JLP, McLorie GA, Bägi DJ, Khoury AE. Modifications of and extended indications for the Pippi Salle procedure. J Urol. 1998;16(4):279-84. https://doi.org/10.1097/00005392-199708000-00092

Wyndaele JJ, De Ridder D, Everaert K, Heilporn A, Congard-Chassol B. Evaluation of the use of Urocath-Gel catheters for intermittent self-catheterization by male patients using conventional catheters for a long time. Spinal Cord. 2000 Fev;38(2):97-99. https://doi.org/10.1038/sj.sc.3100958

Pereira PL, Martínez Urrutia MJ, Lobato L, Rivas S, Jaureguizar Monereo E. Estudio comparative del grado de satisfacción del paciente en cateterismo intermitente con el uso de las sondas Lofric y las de cloruro de polivinilo. Actas Urológicas Españolas. 2001;25(10):725-30. https://doi.org/10.1016/S0210-4806(01)72708-8

Vapnek JM, Maynard FM, Kim J. A prospective randomized trial of the lofric hydrophilic coated catheter versus conventional plastic catheter for clean intermittent catheterization. J Urol. 2003 Mar;169(3):994-98. https://doi.org/10.1097/01.ju.0000051160.72187.e9

Suzuki K, Sugaya Y, Tokue A. Giant stercoral stone and catheterization difficulty. International Journal of Urology. 2003 Out;10(10):554-555. https://doi.org/10.1046/j.1442-2042.2003.00675.x

Alpert SA, Cheng EY, Zebold KF, Kaplan WE. Clean intermittent catheterization in genitally sensate children: patient experience and health related quality of life. J Urol. 2005 Out;174(4 pt 2):1616-19. https://doi.org/10.1097/01.ju.0000176620.02031.67

Lindehall B, Abrahamsson K, Jodal U, Olsson I, Sillén U. Complications of clean intermittent catheterization in young females with myelomeningocele: 10 to 19 years of followup. J Urol. 2007 Set;178(3 pt 1):1053-55. https://doi.org/10.1016/j.juro.2007.05.071

Shaw C, Logan K, Webber I, Broome L, Samuel S. Effect of clean intermittent self-catheterization on quality of life: a qualitative study. J Adv Nurs. 2008 Mar;61(6):641-650. https://doi.org/10.1111/j.1365-2648.2007.04556.x

Vaidyanathan S, Soni BM, Singh G, Oo T, Hughes PL. Barriers to implementing intermittent catheterisation in Spinal Cord Injury Patients in Northwest Regional Spinal Injuries Centre, Southport, U.K. Scientific World Journal. 2011 Jan;5(11):77-85. https://doi.org/10.1100/tsw.2011.12.

Rantell A. Intermittent self-catheterisation in women. Nurs Stand. 2012 Jun;26(42):61-68. https://doi.org/10.7748/ns2012.

Spernat D, Woo HH. Mini-photoselective vaporization of the prostate for difficult intermittent self-catheterization. Koren J Urol. 2012 Set;53(9):654-56. https://doi.org/10.4111/kju.2012.53.9.654

Wu JA, Braschi EJ, Gulminello PL, Comiter CV. Labioplasty for hypertrophic labia minora contributing to recurrent urinary tract infections. Female Pelvic Med Reconstr Surg. 2013 Mar/Abr;19(2):121-23. https://doi.org/10.1097/SPV.0b013e31827de473.

Bolinger R, Engberg S. Barriers, complications, adherence, and self-reported quality of life for people using clean intermittent catheterization. J Wound Ostomy Continence Nurs. 2013 Jan/Fev;40(1):83-89. https://doi.org/10.1097/WON.0b013e3182750117.

Souza SM. Práticas de cuidado e desafios do autocateterismo intermitente limpo: as vozes dos escolares [dissertação]. Rio de Janeiro (RJ): Faculdade de Enfermagem, Universidade do Estado do Rio de Janeiro; 2015.

Pastre-Alencar V. Cateterismo vesical intermitente limpo em crianças e adolescentes: análise da qualidade de vida do binômio cuidador-criança e dos fatores envolvidos [tese]. São Paulo (SP): Faculdade de Medicina da Universidade de São Paulo, Universidade de São Paulo; 2016.

Guinet-Lacoste A, Jousse M, Tan E, Caillebot M, Breton F, Amarenco G. Intermittent Catheterization Difficulty Questionnaire (ICDQ): a new tool for the evaluation of patient difficulties with clean intermittent self- catheterization. Neurourology and Urodynamics. 2016 Jan;35(1):85-89. https://doi.org/10.1002/nau.22686

Cobussen-Boekhorst H, Hermeling E, Heesakkers J, van Gaal B. Patients’ experience with intermittent catheterisation in everyday life. J Clin Nurs. 2016 Mai;25(9-10):1253-61. https://doi.org/10.1111/jocn.13146

Lim SW, Lee HE, Davis M, Park K. Perceived barriers and difficulties of intermittent catheterization: In Korean patients with spinal dysraphism and their parentes. Neurourol Urodyn. 2016 Mar;35(3):395-99. https://doi.org/10.1002/nau.22716.

Antonio S, Pacheco STA, Gomes MPF, Bossa PMA, Castro FM, Pereira MCR. Tradução dos sentimentos de familiares no cuidar da criança dependente do cateterismo urinário limpo. Rev enferm UERJ [on line]. 2016;24(4):e19990. Disponível em: https://www.e-publicacoes.uerj.br/index.php/enfermagemuerj/article/view/19990. https://doi.org/10.12957/reuerj.2016.19990.

DeFoor W, Reddy P, Reed M, VanderBrink B, Jackson E, Zhang B, et al. Results of a prospective randomized control trial comparing hydrophilic to uncoated catheters in children with neurogenic bladder. J Pediatr Urol. 2017 Ago;13(4):373.e1-373.e5. https://doi.org/10.1016/j.jpurol.2017.06.003

Hentzen C, Haddad R, Ismael SS, Peyronnet B, Gamé X, Denys P, et al. Intermittent self-catheterization in older adults: predictors of success for technique learning. Int Neurourol J. 2018 Ago;22(4):65-71. https://doi.org/10.5213/inj.1835008.504

Montovasseli D, Chesnel C, Charlanes A, Menoux D, Charoenwong F, Le Breton F, et al. Adherence to anticholinergic therapy and clean intermittent self-catheterization in patients with multiple sclerosis. Int Neurourol J. 2018 Jun;22(2):133-141. https://doi.org/10.5213/inj.1836054.027

Sharif MM, Kazmi SAM, Mukhtar M, Khan AZ. Role of intermittent self catheterization after cauda equina syndrome surgery. Journal of Rawalpindi Medical College. 2018 Jan/Mar;22(1):54-57.

Jhanwar A, Sokhal AK, Singh K, Sankhwar S, Saini DK. Assessment of quality of life in patients of urethral stricture on clean intermittent catheterization following direct vision internal urethrotomy. Urol Ann. 2018 Out/Dez;10(4):395-399. https://doi.org/10.4103/UA.UA_34_17

Baniya M, Groves CC, Bhattarai M. Intermittent catheterisation practice of people with spinal cord injury in five districts of Nepal. New Zealand Continence Journal. 2019;25(1):10-15.

Woodward S, Rew M. Patients’ quality of life and clean intermittent self-catheterization. British Journal of Nursing. 2003 Out;12(18):1066-74. https://doi.org/10.12968/bjon.2003.12.18.11782

Assis GM, Faro ACM. Autocateterismo vesical intermitente na lesão medular. Rev Esc Enferm USP. 2011 Mar;45(1):289-93. https://doi.org/10.1590/S0080-62342011000100041.

Lapides J, Diokno AC, Silber SJ, Lowe BS. Clean, intermittent self-catheterization in the treatment of urinary tract disease. J Urol. 1972 Mar;107(3):458-61. https://doi.org/10.1016/s0022-5347(17)61055-3

Zambon JP, Cintra CC, Bezerra CA, Bicudo MC, Wroclawsk ER. What is the best choice for chronic urinary retention: indwelling catheter or clean intermittent catheterization?. 2009;7(4):520-24, 2009.

Mazzo A, Godoy S, Alves LM, Mendes IAC, Trevizan MA, Rangel EML. Urinary catheterization: facilities and difficulties related to its standardization. Texto Contexto Enferm. 2011 Abr/Jun;20(2):333-339. https://doi.org/10.1590/S0104-07072011000200016.

Dourado DX, Valença MP. Avaliação do conhecimento dos enfermeiros sobre o Cateterismo Intermitente Limpo em um hospital escola da cidade do Recife. Revista Estima [Internet]. 2013;[citado 2019 out 23];11(1):22-27. Disponível em: https://www.revistaestima.com.br/index.php/estima/article/view/82.

Kopf A, Patel NB. Guide to Pain Management in Low-Resource Settings. Seattle: International Association for the Study of Pain; 2010.

Bardsley A. Use of lubricant gels in urinary catheterisation. Nurs Stand. 2005 Nov;20(8):41-6. https://doi.org/10.7748/ns2005.

Kashefi C, Messer K, Barden R, Sexton C, Parsons JK. Incidence and prevention of iatrogenic urethral injuries. J Urol. 2008 Jun;176(6):2254-57. https://doi.org/10.1016/j.juro.2008.01.108.

Mazzo A, Martins JC, Jorge BM, Baptista RCN, Almeida RGS, Henriques FMD, et al. Validation of the self-confidence scale of nursing care in urinary retention. Rev Latino-Am. Enfermagem. 2015 Set/Out;23(5):814-20. https://doi.org/10.1590/0104-1169.0256.2619

Silva DR, Mazzo A, Jorge BM, Souza Júnior VD, Fumincelli L, Almeida RG. Intermittent urinary catheterization: the impact of training on a low-fidelity simulator on the self-confidence of patients and caregivers. Rehabil Nurs. 2017 Mar/Abr;42(2):97-103. https://doi.org/10.1002/rnj.226.

Fumincelli L, Mazzo A, Martins JCA, Henriques FMD, Orlandin L. Qualidade de vida de pacientes usuários do cateterismo urinário intermitente. Rev. Latino-Am. Enfermagem [Internet]. 2017;[citado 2019 nov 4];25:e2906. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100356&lng=en. https://doi.org/10.1590/1518-8345.1816.2906.

Silva MB, Oliveira LFT, Ferreira ML, Santos LCR. Cateterismo vesical intermitente: análise epidemiológica. Revista Estima [Internet]. 2005;[citado 2019 out 23];3(1). Disponível em: https://www.revistaestima.com.br/index.php/estima/article/view/9.

Mazzo A, Souza Júnior VD, Jorge BM, Fumincelli L, Trevizan MA, Ventura CAA, et al. Qualidade e segurança do cuidado de enfermagem ao paciente usuário de cateterismo urinário intermitente. Esc. Anna Nery [Internet]. 2017;[citado 2019 out 17];21(2):e20170045. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1414-81452017000200216&lng=en. https://doi.org/10.5935/1414-8145.20170045.

Pavan K, Marangoni BEM, Shimizu WAA, Mattos SE, Ferrari PP, Martins SRG, et al. Validação da escala de avaliação da espasticidade Santa Casa. Arq. Neuro-Psiquiatr. 2010;68(1):56-61. https://doi.org/10.1590/S0004-282X2010000100013.

Bolaños-Jiménez R, Arizmendi-Vargas J, Calderón-Álvarez TJL, Carrillo-Ruiz JD, Rivera-Silva G, Jiménez-Ponce F. Espasticidad, conceptos fisiológicos y fisiopatológicos aplicados a la clínica. Rev Mex Neuroci. 2011;12(3):141-48.

Seth JH, Haslam C, Panicker JN. Ensuring patient adherence to clean intermittent self-catheterization. Patient Prefer Adherence. 2014 Fev;8:191-98. https://doi.org/10.2147/PPA.S49060

Amarenco G, Guinet A, Jousse M, Verollet D, Ismael SS. Pencil and Paper Test: a new tool to predict the ability of neurological patients to practice clean intermitentt self-catheterization. J Urol. 2011 Fev;185(2):578-82. https://doi.org/10.1016/j.juro.2010.09.106

Santos RCR, Fumincelli L, Nassif A, Souza Júnior VD, Jorge BM, Mazzo A. Paciente com bexiga neurogênica: cateterismo urinário intermitente e cuidados intestinais. Rev enferm UFPE on line. 2015;9(Supl 7):8953-60. https://doi.org/10.5205/reuol.8074-70954-1-SM0907supl201503

Lei n. 8.080 de 19 de setembro de 1990 (BR). Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências. Diário Oficial da União [periódico na internet], Brasília (DF). 19 set 1990 [citado 7 set 2019]. Disponível em: http://www.planalto.gov.br/ccivil_03/leis/l8080.htm

Krassioukov A, Cragg JJ, West C, Voss C, Krassioukov-Enns D. The good, the bad and the ugly of catheterization practices among elite athletes with spinal cord injury: a global perspective. Spinal Cord, 2015 Jan;53(1):78-82. https://doi.org/10.1038/sc.2014.208.

Bogaert GA, Goeman L, De Ridder D, Wevers M, Ivens J, Schuermans A. The physical and antimicrobial effects of microwave heating and alcohol immersion on catheters that are reused for clean intermittent catheterisation. Eur Urol. 2004 Nov;46(5):641-46. https://doi.org/10.1016/j.eururo.2004.06.016.

Lie HR, Lagergren J, Rasmussen F, Lagerkvist B, Hagelsteen J, Börjeson MC, et al. Bowel and bladder control of children with myelomeningocele: a nordic study. Dev Med Child Neurol. 1991 Dez;33(12):1053-61. https://doi.org/10.1111/j.1469-8749.1991.tb14827.x

Bruni DS, Strazzieri KC, Gumieiro MN, Giovanazzi R, Sá VG, Faro ACM. Physiopathological aspects and nursing care on rehabilitation of patient with spinal cord injury. Revista da Escola de Enferm da USP. 2004;38(1):71-79.

Furlan MLS, Caliri MHL, Defino HL. Intestino neurogênico: guia prático para pessoas com lesão medular – parte I. COLUNA/COLUMNA. 2005;4(3):113-68.

Pardee C, Bricker D, Rundquist J, Macrae C, Tebben C. Characteristics of neurogenic bowel in spinal cord injury and perceived quality of life. Rehabil Nurs. 2012 Mai/Jun;37(3):128-35. https://doi.org/10.1002/RNJ.00024

Ávila LC editor. AME – dicionário de administração de medicamentos na enfermagem. São Paulo: Epub; 2013.

Potter PA, Perry AG. Fundamentos de Enfermagem. 7ª ed. Rio de Janeiro: Elsevier; 2009.

Panayi DC, Khullar V, Digesu GA, Spiteri M, Hendricken C, Fernando R. Rectal distension: the effect on bladder function. Neurourol Urodyn. 2011 Mar;30(3):344-47. https://doi.org/10.1002/nau.20944.

Knobel B, Rosman P, Gewurtz G. Bilateral hydronephrosis due to fecaloma in an elderly woman. J Clin Gastroenterol. 2000 Abr;30(3):311-13. https://doi.org/10.1097/00004836-200004000-00022

Yuan R, Zhao GG, Papez S, Cleary JP, Heliotis A. Urethral obstruction and bilateral ureteral hydronephroses secondary to fecal impaction. J Clin Gastroenterol. 2000 Abr; 30(3):314-16. https://doi.org/10.1097/00004836-200004000-00023



How to Cite

Orlandin L, Nardi A, Costa RR de O, Mazzo A. Difficulties of patients and caregivers in performing clean intermittent catheterization: scoping review. ESTIMA [Internet]. 2020Sep.10 [cited 2020Sep.25];180. Available from: https://www.revistaestima.com.br/estima/article/view/907



Review article