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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 (strong recommendation, evidence grade C). Selection still depends on bladder pressures, anatomy, hand function, cognition, caregiver support and the patient's goals; comparative evidence does not establish a universal ranking of infection risk or quality of life for every patient.[1][2]

This page covers catheter selection and practical long-term use. 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. A single postvoid residual threshold does not determine the long-term catheter plan. Symptoms, renal risk, bladder capacity and pressure, residual trend, reversible causes and the ability to catheterize reliably all matter.[1][2]

  • Unsafe storage pressures require treatment as well as emptying. CIC alone does not guarantee upper-tract protection. 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/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]

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.
Sleeve / no-touch / collection-bag systemCan help avoid touching the insertion surface and assist patients who cannot readily use a toilet. A laboratory reduction in bacterial transfer is not proof of a particular clinical UTI reduction.
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.
Use lifeCheck whether the exact product is labeled single-use or reusable, its replacement limit and any cleaning requirements. Coating or appearance alone does not establish this.

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). 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). Differences in populations, comparators and outcome definitions limit a single universal estimate.[3][4]

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

Training and drainage schedule​

Clean technique is acceptable for chronic intermittent catheterization outside acute care. 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. 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]

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-upModified intention-to-treat 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.
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.

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/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. These trials do not authorize reprocessing any single-use catheter, establish an interchangeable household disinfectant recipe, or demonstrate safety in every reconstructed reservoir, child or caregiver-dependent patient. Comfort, sticking, cleaning burden and willingness to continue matter alongside infection outcomes.[6][7][8][9]

Complications and UTI prevention​

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, 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: daily prophylaxis reduced symptomatic antibiotic-treated UTI frequency (IRR 0.52, 95% CI 0.44–0.61), but increased antimicrobial resistance. AUA/SUFU permits prophylaxis in selected NLUTD patients with recurrent UTI after a discussion of that tradeoff; it is not routine treatment for every CIC user.[1][11]

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