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Intermittent Catheters and Clean Intermittent Catheterization (CIC)

Intermittent catheterization drains the bladder at intervals, with removal of the catheter after each drainage. For adults with neurogenic lower urinary tract dysfunction (NLUTD), AUA/SUFU recommends intermittent over indwelling catheterization when it is feasible . Selection depends on bladder pressures, anatomy, hand function, cognition, caregiver support and the patient's goals.[1][2]

CIC uses a single-lumen, non-balloon catheter passed through the urethra, or through a continent catheterizable channel, and removed immediately after the bladder empties. It can be performed by the patient (clean intermittent self-catheterization, CISC), a caregiver or a clinician. It is the long-term emptying method for many patients with neurogenic bladder, after augmentation cystoplasty and with continent channels. A continent catheterizable channel has its own anatomical and follow-up requirements; see Catheterizable Channels.

When intermittent drainage is appropriate​

Consider intermittent drainage for clinically important incomplete emptying or retention, including selected neurogenic, postoperative, medication-related and chronic non-neurogenic cases.[1][2]

  • Unsafe storage pressures require treatment as well as emptying. Adjust storage treatment and drainage when pressures, reflux, renal deterioration or autonomic dysreflexia indicate an unsafe regimen.
  • A urethral route must be passable without force. Suspected injury, a false passage or a difficult stricture requires assessment and an alternative access plan; repeated blind attempts can worsen injury.
  • Reconstruction does not impose one universal regimen. Catheterizable reservoirs or channels require a reliable emptying plan, but not every augmentation requires lifelong CIC. Bladder-neck closure may be paired with a catheterizable channel or suprapubic drainage, depending on the reconstruction.
  • Feasibility includes assistance and supplies. A caregiver, handling aid or different catheter may make CIC possible. If timely, safe drainage cannot be maintained, discuss an indwelling or surgical alternative.[1][2]

Typical settings​

  • Neurogenic bladder. Spinal cord injury, multiple sclerosis, Parkinson disease, spina bifida and cauda equina syndrome, and persistent voiding dysfunction after stroke.
  • Retention after treatment. Retention that follows intradetrusor onabotulinumtoxinA or anticholinergic therapy.
  • Non-neurogenic retention. Acute or chronic retention without outlet obstruction, and overflow incontinence.
  • Reconstruction. Augmentation cystoplasty, catheterizable channels (Mitrofanoff, Monti or Yang-Monti), continent cutaneous diversion and bladder-neck closure with a channel.
  • Postoperative retention after pelvic surgery. In a Markov cost model, CIC was the least costly pathway ($79 per patient, versus $128 for self-removal of an indwelling catheter and $185 for an office voiding trial), but only if patients were taught CIC after surgery. If all patients were taught CIC routinely before surgery, it became the most costly option.[19]
  • Bladder voiding efficiency. A multidisciplinary consensus statement recommends individualized assessment, including bladder voiding efficiency, to decide when to start CISC.[22]

High intravesical pressure requiring continuous free drainage to protect the kidneys is an absolute contraindication to intermittent catheterization. Difficulty following a schedule without support, anatomy that prevents safe passage, or autonomic dysreflexia triggered by bladder filling requires an individualized drainage plan; EAUN lists poor manual dexterity without a trained caregiver as a relative contraindication.[1][2]

Catheter selection​

Most intermittent drainage catheters have no retention balloon. Material, coating, length, tip, packaging and approved use life vary by product; neither “PVC” nor “hydrophilic” describes every device.[2]

FeaturePractical selection
UncoatedRequires the compatible lubricant specified for that product. Do not substitute water alone for required lubrication.
Hydrophilic or prelubricatedMay improve handling and comfort. Some require activation; others are ready to use. Follow the package instructions.
Gel-reservoirPre-applied gel lubricant coats the catheter on use, with no water activation.
Sleeve / no-touch / collection-bag systemCan help avoid touching the insertion surface and assist patients who cannot readily use a toilet. In vitro, no-touch designs transferred about 5 CFU per plate versus 210 to 440 CFU for traditional hydrophilic catheters handled with contaminated gloves. In a simulation with nurses and students, the no-touch method took 92 seconds less and produced fewer sterility errors.[13][14]
Straight or coudé tipSelect for the patient's anatomy and prior successful technique. A curved tip is not permission to push through resistance. See Coudé Catheter.
SizeUse a comfortable size that drains effectively. EAUN adult examples are approximately 12–14 Fr for men and 10–14 Fr for women; individual anatomy or a reconstructed channel may require a different prescription.
LengthStandard male catheters are commonly about 40 cm; shorter female products and purpose-designed compact male products are distinct. Do not substitute a female-length catheter for a male catheter without a specifically assessed, appropriate device.
Tip and examplesStraight (Nelaton) and coudé tips exist. Product examples include SpeediCath (Coloplast) and LoFric (Wellspect), which are hydrophilic; availability varies by market.
Use lifeCheck the exact product label for single-use or reusable status, replacement limit and cleaning requirements; coating or appearance alone does not establish use life.

Coating evidence​

The 2021 Cochrane review found low-certainty evidence for symptomatic UTI differences between hydrophilic and uncoated catheters (RR 0.89, 95% CI 0.69–1.14; two studies, 98 participants).[3] The EAU 2026 infections guideline cites a meta-analysis of seven randomized trials (RR 0.84 for UTI with hydrophilic-coated versus standard PVC catheters; level 1a) and gives a strong recommendation to use hydrophilic-coated catheters to reduce catheter-associated UTI.[24] A later nine-study meta-analysis found a lower pooled UTI risk with hydrophilic catheters (RR 0.78, 95% CI 0.62–0.97; 525 participants); its adult subgroup estimate was RR 0.83 (95% CI 0.74–0.93).[4] Differences in populations, comparators and outcome definitions limit a single universal estimate.[3][4]

In the AUA/SUFU guideline text, hydrophilic catheters may be associated with lower UTI and urethral trauma rates than other catheter types, specifically among patients with spinal cord injury.[1] A systematic review and cost analysis found little difference in symptomatic UTI risk with catheter type, although hydrophilic and gel-reservoir catheters were associated with fewer patients reporting one or more UTIs than sterile non-coated catheters. It concluded that clean non-coated catheters were the most cost effective and advised offering hydrophilic or gel-reservoir catheters as a precaution.[12] The Cochrane review found that uncoated catheters probably slightly reduce urethral trauma and bleeding compared with hydrophilic catheters (RR 1.37, 95% CI 1.01–1.87; moderate certainty), and the nine-study meta-analysis found no hematuria difference (RR 1.02, 95% CI 0.66–1.60).[3][4]

EAUN favors hydrophilic or prelubricated catheters for reducing trauma, but comparative reviews do not agree on every bleeding outcome.[2][3][4] Choose for comfort, ease of use, access and prior problems.

Training and drainage schedule​

Clean technique is acceptable for chronic intermittent catheterization outside acute care. The 2021 Cochrane review found no certain difference in symptomatic UTI between aseptic and clean technique (RR 1.20, 95% CI 0.54–2.66; one study, 36 participants; low certainty).[3] Healthcare insertion follows the facility's aseptic technique and single-use supply requirements. Clean home technique still requires hand hygiene, appropriate equipment handling and a taught procedure.[2][5]

  1. Confirm the prescribed catheter and any lubricant or activation step. Prepare a clean working area and collection method; perform hand hygiene and genital cleansing as taught.
  2. Use the patient's practiced position and anatomical landmarks. Avoid touching the part that enters the urethra where the device permits a non-touch technique.
  3. Insert gently until urine drains, then advance only as needed to keep the drainage eyes in the bladder. Stop for significant resistance, pain or new bleeding; do not use a fixed insertion depth for every patient.
  4. Allow drainage, withdrawing slowly and pausing if more urine appears. Routine abdominal straining or a Credé maneuver is not part of this general technique.
  5. Discard a single-use catheter. For a reusable-labeled product, follow its agreed cleaning, storage and replacement protocol. Record volumes when establishing or reassessing the regimen.[2]

Patients who do not void often need four to six catheterizations per day, but frequency is individualized. A common aim is to avoid bladder volumes above roughly 400–500 mL; lower limits may be needed for low capacity, unsafe pressure or reflux.[2] Review unexpectedly large or very small drainage volumes, fluid intake, leakage, overnight needs and missed catheterizations. A volume target is not a substitute for risk-based urodynamic and renal follow-up.[1][2]

Use supervised practice and teach-back, with early follow-up to address dexterity, vision, pain, positioning, access to toilets and supply cost. Provide a backup plan for inability to drain, significant hematuria, febrile illness or autonomic dysreflexia.[1][2] Ask specifically how the patient manages the preparation and supply-carrying burden away from home, since patients have described this as harder than the insertion itself, and whether catheterization has affected sexuality or sexual function.[1][2]

Single-use and reusable catheters​

The 2021 Cochrane review found no certain difference in symptomatic UTI between single-use and multiple-use catheters (RR 0.98, 95% CI 0.55–1.74; two studies, 97 participants; low certainty).[3] A review of 11 comparative studies found no appreciable evidence that reusable catheters were inferior from an infection or usability standpoint, and it raised the cost and environmental burden of single-use catheters.[20] Reuse is common in some regions (about 50% in Australia, Canada and the United States in one review), with no consensus on cleaning method or reuse limit, and off-label reuse of single-use products is not legally supported.[21] A patient catheterizing five times daily uses about 1,825 single-use catheters a year.

Reusable catheters: two important 2026 trials​

The small, uncertain reuse evidence summarized by Cochrane in 2021 has been supplemented by two larger randomized trials. Both tested specified reusable products, training and cleaning systems, with access to single-use catheters. They support a structured option for selected users, while leaving important tolerability and generalizability limits.[3][6][7]

TrialPrimary findingWhat limits application
COMPARE, Netherlands, 2026 — 386 randomized, 12-month follow-upAmong 326 modified intention-to-treat participants, UTI rates were 0.050/month with reusable versus 0.054/month with single-use catheters; difference −0.004 (95% CI −0.025 to 0.019), meeting the prespecified noninferiority margin of 0.07 UTI/month.That margin exceeded the observed single-use rate. Reusable use was discontinued by 72/185 participants (39%); reported urethral irritation was 20% versus 4.7%. The trial excluded augmentation, nonurethral catheterization and several other complex conditions.[6]
MultICath, UK, 2026 — 578 randomized, 12 monthsIn the per-protocol analysis, at least one symptomatic, microbiologically confirmed UTI occurred in 49/171 mixed-use versus 84/244 single-use participants: OR 0.77 (95% CI 0.50–1.17), meeting the prespecified OR 2.0 noninferiority margin.There was substantial differential withdrawal and a smaller mixed-use analysis population. Catheter sticking was reported more often with mixed use (24.6% versus 15.2%). Participants were community adults, predominantly self-catheterizing through the urethra.[7]

COMPARE used reusable catheters replaced every two weeks, a prescribed disinfection regimen and limited additional single-use catheterization. MultICath used a Cliny silicone catheter labeled for up to 28 days, a supplied cleaning kit with soap and water and chlorine-based disinfection, training and flexible use of the person's usual single-use catheters.[6][7][8][9]

Clinical implication: discuss a supported reusable or mixed regimen where an appropriate reusable-labeled product and reliable cleaning arrangements are available.[6][7][8][9]

Complications and UTI prevention​

UTI is the commonest complication. Repeated symptomatic UTIs affect about 25% of people who use CISC.[11] In a cross-sectional NLUTD cohort, UTI prevalence at the visit was 8% (24/299) with intermittent catheterization and 8% (16/206) with indwelling catheters (p = 0.782).[15] The indwelling group was older with more comorbidity.[15]

Urethral stricture is associated with long-term CIC in men. In a retrospective spinal cord injury center series, strictures occurred in 25% (95% CI 21–30%) of 415 men using intermittent catheterization, at a median of 5.9 years, versus 14% (95% CI 11–17%) of 629 men using other evacuation methods (p = 0.0001).[16] About one-third had internal urethrotomy, and radiographic recurrence after urethrotomy was 100% at a median of 14 years.[16] A single-institution spinal cord injury cohort of 333 patients reported 14 urethral strictures (4.2%); the mean duration of CISC at stricture was 9 years among those 14 patients, which shows the case-mix variability.[17]

Other complications. Hematuria is common at initiation. In 28 boys and young men with neurogenic bladder followed for a median of 16 years (438 catheterization-years), major urethral lesions were seen on cystoscopy in 7 patients on 9 occasions, including 5 false passages.[18] None occurred during self-catheterization or with catheters of 12 Ch or larger, so both seemed protective.[18] Channel stenosis can occur with Mitrofanoff or Monti channels and may need dilation or revision.

Pain, bleeding, false passage, urethral stricture and symptomatic UTI can occur. New difficulty passing a previously reliable catheter warrants assessment of technique and anatomy. Persistent or substantial hematuria should not automatically be attributed to catheter trauma. A reconstructed channel that becomes difficult to catheterize needs its own specialist access plan.[1][2]

Asymptomatic bacteriuria is common but not universal. Do not routinely screen or treat asymptomatic NLUTD patients; pregnancy and selected urologic procedures are exceptions requiring their specific guidance. With compatible new symptoms, obtain appropriate urine testing and evaluate drainage, stones, obstruction or another cause of recurrent infection.[10]

For recurrent symptomatic UTI, first review emptying, catheter handling and the patient's underlying urinary tract. The AnTIC trial randomized 404 adults with recurrent UTI who used intermittent self-catheterization: in 361 participants with at least six months of follow-up, daily prophylaxis reduced symptomatic antibiotic-treated UTI frequency (IRR 0.52, 95% CI 0.44–0.61), but increased antimicrobial resistance.[11] AUA/SUFU permits oral prophylaxis in NLUTD patients who perform CIC and have recurrent UTI, after a discussion of that tradeoff (Statement 37) and recommends against daily antibiotic prophylaxis in CIC users without recurrent UTI .[1][10][11] The EAU 2026 infections guideline, citing the same trial (a 48% reduction in symptomatic antibiotic-treated UTI, with more resistance at 9–12 months), gives a weak recommendation against routine antibiotic prophylaxis in patients who perform intermittent self-catheterization.[24]

The AnTIC trial also measured resistance at 9–12 months in urinary isolates from participants who had at least one isolate:

ResistanceProphylaxisControlp
Nitrofurantoin12/51 (24%)6/64 (9%)0.038[11]
Trimethoprim34/51 (67%)21/64 (33%)0.0003[11]
Co-trimoxazole26/49 (53%)15/62 (24%)0.002[11]

The guideline statement (37) is conditional: clinicians may offer oral antimicrobial prophylaxis to NLUTD patients who perform CIC and have recurrent UTI after shared decision-making about resistance risk .[1] It also states that cranberry extract has not been demonstrated to reduce UTI rates in NLUTD patients with recurrent UTI , and that clinicians may offer bladder instillations to NLUTD patients who perform CIC and have recurrent UTI .[1][11]

Special situations​

  • Postoperative retention. The URECA algorithm, developed by an expert panel with the RAND/UCLA method, prefers intermittent to indwelling catheterization for managing lower bladder volumes. It sets bladder scanner volumes appropriate to prompt catheterization at 300 mL or greater in symptomatic patients and 500 mL or greater in asymptomatic patients.[23]
  • Children. CIC is widely used in spina bifida, often started in infancy with parental help. Long-term data are in the complications above.[18]
  • Barriers. Poor hand dexterity (arthritis, tremor, spasticity, weakness), cognitive or visual impairment, obesity, psychological barriers, catheter cost and lack of a clean catheterization space can limit CIC.[2]

For drug selection, methenamine, intravesical regimens and the distinction between uncomplicated recurrent UTI and catheter-associated populations, see UTI Suppressive & Prophylactic Therapy.

See Also​

Foley Catheter · Suprapubic Catheter · Council Tip Catheter · Catheterizable Channels · Acute Urinary Retention

References​

1. Ginsberg DA, Boone TB, Cameron AP, et al. The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: treatment and follow-up. J Urol. 2021;206:1106–1113. doi:10.1097/JU.0000000000002239

2. European Association of Urology Nurses. Urethral Intermittent Catheterisation in Adults. 2024. Chapters 5–9 and 12. Guideline

3. Prieto JA, Murphy CL, Stewart F, Fader M. Intermittent catheter techniques, strategies and designs for managing long-term bladder conditions. Cochrane Database Syst Rev. 2021;10:CD006008. doi:10.1002/14651858.CD006008.pub5

4. Plata M, Santander J, Zuluaga L, et al. Hydrophilic versus non-hydrophilic catheters for clean intermittent catheterization: a meta-analysis to determine their capacity in reducing urinary tract infections. World J Urol. 2023;41:491–499. doi:10.1007/s00345-022-04235-5

5. CDC. Guideline for prevention of catheter-associated urinary tract infections (2009): summary of recommendations. Web summary, 2024. Recommendations

6. van Veen FEE, Christiaans CHH, Berendsen SA, et al. Single-use vs reusable catheters for intermittent catheterization in patients with urinary retention: the COMPARE randomized clinical trial. JAMA Netw Open. 2026;9:e2620871. doi:10.1001/jamanetworkopen.2026.20871

7. Fader M, Macaulay M, Wilson N, et al. Mixed (reusable/single-use) catheter management versus single-use catheter management for intermittent catheter users (MultICath): a non-inferiority randomised controlled trial. Int J Nurs Stud. 2026;180:105536. doi:10.1016/j.ijnurstu.2026.105536

8. van Doorn T, Berendsen SA, Scheepe JR, Blok BFM. Single use versus reusable catheters in intermittent catheterisation for treatment of urinary retention: a protocol for a multicentre, prospective, randomised controlled, non-inferiority trial (COMPaRE). BMJ Open. 2022;12:e056649. doi:10.1136/bmjopen-2021-056649

9. Fader M, Macaulay M, Wilson N, et al. Trial to compare mixed-use (multi-use and single-use) intermittent catheter management with single-use management over 12 months (The MultICath Trial): protocol for a non-inferiority randomised controlled trial. BMJ Open. 2024;14:e088483. doi:10.1136/bmjopen-2024-088483

10. Ginsberg DA, Boone TB, Cameron AP, et al. The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: diagnosis and evaluation. J Urol. 2021;206:1097–1105. doi:10.1097/JU.0000000000002235

11. Fisher H, Oluboyede Y, Chadwick T, et al. Continuous low-dose antibiotic prophylaxis for adults with repeated urinary tract infections (AnTIC): a randomised, open-label trial. Lancet Infect Dis. 2018;18:957–968. doi:10.1016/S1473-3099(18)30279-2

12. Bermingham SL, Hodgkinson S, Wright S, Hayter E, Spinks J, Pellowe C. Intermittent self catheterisation with hydrophilic, gel reservoir, and non-coated catheters: a systematic review and cost effectiveness analysis. BMJ. 2013;346:e8639. doi:10.1136/bmj.e8639

13. Hudson E, Murahata RI. The 'no-touch' method of intermittent urinary catheter insertion: can it reduce the risk of bacteria entering the bladder? Spinal Cord. 2005;43(10):611-614. doi:10.1038/sj.sc.3101760

14. Goessaert AS, Antoons S, Van Den Driessche M, et al. No-touch intermittent catheterization: caregiver point of view on sterility errors, duration, comfort and costs. J Adv Nurs. 2013;69(9):2000-2007. doi:10.1111/jan.12062

15. Neumeier V, Stangl FP, Borer J, et al. Indwelling catheter vs intermittent catheterization: is there a difference in UTI susceptibility? BMC Infect Dis. 2023;23(1):507. doi:10.1186/s12879-023-08475-7

16. Krebs J, Wöllner J, Pannek J. Urethral strictures in men with neurogenic lower urinary tract dysfunction using intermittent catheterization for bladder evacuation. Spinal Cord. 2015;53(4):310-313. doi:10.1038/sc.2015.15

17. Cornejo-Dávila V, Durán-Ortiz S, Pacheco-Gahbler C. Incidence of urethral stricture in patients with spinal cord injury treated with clean intermittent self-catheterization. Urology. 2017;99:260-264. doi:10.1016/j.urology.2016.08.024

18. Lindehall B, Abrahamsson K, Hjälmås K, Jodal U, Olsson I, Sillén U. Complications of clean intermittent catheterization in boys and young males with neurogenic bladder dysfunction. J Urol. 2004;172(4 Pt 2):1686-1688. doi:10.1097/01.ju.0000138847.14680.7d

19. Wang R, Tunitsky-Bitton E. Short-term catheter management options for urinary retention following pelvic surgery: a cost analysis. Am J Obstet Gynecol. 2022;226(1):102.e1-102.e9. doi:10.1016/j.ajog.2021.07.025

20. Zhao CC, Comiter CV, Elliott CS. Perspectives on technology: single-use catheters, evidence and environmental impact. BJU Int. 2024;133(6):638-645. doi:10.1111/bju.16313

21. Håkansson MÅ. Reuse versus single-use catheters for intermittent catheterization: what is safe and preferred? Review of current status. Spinal Cord. 2014;52(7):511-516. doi:10.1038/sc.2014.79

22. Chapple C, Abrams P, Lam T, et al. A consensus statement on when to start clean intermittent self-catheterization: an untapped resource? Neurourol Urodyn. 2024;43(2):459-463. doi:10.1002/nau.25353

23. Chrouser K, Fowler KE, Mann JD, et al. Urinary retention evaluation and catheterization algorithm for adult inpatients. JAMA Netw Open. 2024;7(7):e2422281. doi:10.1001/jamanetworkopen.2024.22281

24. European Association of Urology. EAU Guidelines on Urological Infections (section 3.8, catheter-associated UTI). 2026 limited update, March 2026. Full guideline.