Intermittent Catheterization Across the Ages

Bladder drainage isn’t a modern invention—it’s a story that stretches back to ancient Egypt and Greece, where hollow reeds, metal tubes, and even onion stalks were used to empty the bladder. Those early methods, while often painful and carried high risks of injury and infection, mark the beginning of an evolving journey toward safer, more empowering solutions.

The Shift That Changed Everything

Fast forward to the 1970s, and a major breakthrough arrived thanks to urologist Jack Lapides and his team. They introduced clean intermittent self-catheterization (CIC)—a method that allowed patients to catheterize themselves using clean (not sterile) technique. Their research showed that CIC could reduce complications, improve quality of life, and offer patients a greater sense of independence. It was a transformative step that helped establish CIC as the gold standard for many people living with neurogenic bladder dysfunction.[1–4]

When Intermittent Catheterization Isn’t an Option

Not everyone can perform CIC, and in those cases, other options like indwelling urethral or suprapubic catheters come into play. While indwelling catheters are simple to place, they’re often linked to higher rates of urinary tract infections (UTIs), discomfort, and complications like strictures or urethral trauma.

Suprapubic catheters—inserted through the lower abdomen—can be a better long-term choice for some. They help avoid urethral damage and are the preferred alternative when CIC isn’t feasible. In fact, the American Urological Association recommends suprapubic over indwelling urethral catheters for people with chronic neurogenic lower urinary tract dysfunction (NLUTD).[5]

Still, both types of long-term catheter use carry a risk of infection. Some studies suggest that suprapubic catheters may reduce the rate of asymptomatic bacteriuria and pain, but there’s still no clear consensus on whether they lower the risk of symptomatic UTIs.[6]

Why CIC Remains the Preferred Approach

CIC continues to stand out as the method with the fewest long-term complications and the lowest risk of symptomatic UTI—especially when done correctly and consistently. It’s now widely recognized as the first-line approach for individuals with NLUTD who have the dexterity and cognitive ability to perform it safely.[7,8]

The American Spinal Injury Association and the American Urological Association both highlight CIC as the go-to method—offering not just medical benefits but also more control and freedom for patients managing their urinary health.

What About Mitrofanoff Channels?

For some people, especially those who’ve had surgical procedures to create a continent catheterizable channel (known as a Mitrofanoff), intermittent catheterization doesn’t involve the urethra at all. Instead, catheters are inserted through a small stoma on the abdomen.

When performed properly, CIC through a Mitrofanoff channel carries a similar infection profile to urethral catheterization. However, there are some added considerations, including potential stomal complications or channel narrowing. With the right education and regular follow-up, most people using a Mitrofanoff can continue to benefit from the same advantages CIC offers—lower UTI rates, fewer complications, and greater independence.[2,5]

Intermittent catheterization isn’t just a medical procedure—it’s a pathway to greater freedom, confidence, and well-being for many individuals navigating life with neurogenic bladder. From ancient reed tubes to today’s clean, self-directed methods, the story of CIC is one of progress—and it’s still being written.

References

[1] Lapides J, Diokno AC, Gould FR, Lowe BS. Further Observations on Self-Catheterization. The Journal of Urology. 1976;116(2):169–71. doi:10.1016/s0022-5347(17)58730-3.

[2] Di Benedetto P. Clean Intermittent Self-Catheterization in Neuro-Urology. European Journal of Physical and Rehabilitation Medicine. 2011;47(4):651–9.

[3] Orikasa S, Koyanagi T, Motomura M, Kudo T, Togashi M. Experience With Non-Sterile Intermittent Self-Catheterization. The Journal of Urology. 1976;115(2):141–2. doi:10.1016/s0022-5347(17)59103-x.

[4] Hinman F. Intermittent Catheterization and Vesical Defenses. The Journal of Urology. 1977;117(1):57–60. doi:10.1016/s0022-5347(17)58336-6.

[5] Ginsberg DA, Boone TB, Cameron AP, et al. The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Treatment and Follow-Up. The Journal of Urology. 2021;206(5):1106–1113. doi:10.1097/JU.0000000000002239.

[6] Kidd EA, Stewart F, Kassis NC, Hom E, Omar MI. Urethral (Indwelling or Intermittent) or Suprapubic Routes for Short-Term Catheterisation in Hospitalised Adults. The Cochrane Database of Systematic Reviews. 2015;(12):CD004203. doi:10.1002/14651858.CD004203.pub3.

[7] Milligan J, Goetz LL, Kennelly MJ. A Primary Care Provider's Guide to Management of Neurogenic Lower Urinary Tract Dysfunction and Urinary Tract Infection After Spinal Cord Injury. Topics in Spinal Cord Injury Rehabilitation. 2020;26(2):108–115. doi:10.46292/sci2602-108.

[8] Wyndaele JJ, Brauner A, Geerlings SE, et al. Clean Intermittent Catheterization and Urinary Tract Infection: Review and Guide for Future Research. BJU International. 2012;110(11 Pt C):E910–7. doi:10.1111/j.1464-410X.2012.11549.x.