Clean intermittent catheterization (CIC) is a validated and widely accepted tool in managing both neurogenic and non-neurogenic patients presenting with voiding dysfunction. Currently, very few concerns on this well known, established, and widely recognized procedure attract our attention. A critical aspect is still represented by patient reluctance and barriers in accepting CIC [1,2]. Aim of our scoping review was to identify the reasons affecting and limiting patient adherence to CIC.

We conducted a literature search on PubMed using the terms [clean intermittent catheterization] AND [learning OR teaching OR reluctance]. Papers reporting on chronic CIC for voiding dysfunction in adults were included. Studies simply reporting on CIC technique or author personal experiences were excluded. Also, articles on non-transurethral CIC and CIC in any kind of urinary diversion, surgical reconstruction or anatomical abnormalities were excluded.

After removing duplicates, 504 articles were identified. After abstracts screening according to the inclusion criteria, a total of 45 articles were selected and considered for the review.

The included papers were classified into the following categories: education and nurses, general practitioner role, role of media, family role, and patients. An overlapping between the categories was observed and it did not represent a limitation, according to our idea of identifying multiple and diverse causes of obstacles to CIC [1-3]. Most of papers focused on patient education performed by nurses, including the question if starting it from a referral centre and then move to peripheral offices, or – on the contrary – schedule the teaching directly in smaller and dedicated centres. A fundamental aspect to be considered is patient ability in performing the manouvre and some papers aimed to define score criteria to screen and select neurologic patients in routine practice [3]. Also, the role of family has been investigated in providing the patient with both psycological and practical support. Recently, an increasing attention to the role of media has been reported in the literature. We identified articles describing the use of web tutorials and smartphone apps. Few papers focused on general practitioners education and involvement, and this may also play an important role. Results are summarised in Table 1.

In our opinion, despite the huge efforts already dedicated to CIC education in routine clinical practice, exploring the current limitations may be of help in taking further actions to discourage patients from dropping out. The present scoping review lays the foundations for our future project of a multicentre survey, followed by a Delphi consensus.

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Guinet-Lacoste A, Kerdraon J, Rousseau A, Gallien P, Previnaire JG, Perrouin-Verbe B, Amarenco G. Intermittent catheterization acceptance test (I-CAT): A tool to evaluate the global acceptance to practice clean intermittent self-catheterization. Neurourol Urodyn. 2017 Sep;36(7):1846-1854. doi: 10.1002/nau.23195. Epub 2017 Jan 16. PMID: 28090660.
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