Guidelines for clean intermittent catheterization in children

Clean intermittent catheterization (CIC) is an effective method of bladder emptying in children with neurogenic and non-neurogenic disorders that cause difficulty in urination. However, there is a lack of expert consensus on the standardized application of CIC in pediatric populations. This guideline intends to outline recommendations for standardizing CIC in children.

A comprehensive literature review was performed by searching key academic databases, specifically PubMed, Embase, the Cochrane Library, and Web of Science. Eligible literature-including peer-reviewed clinical trials, cohort studies, case series, and expert consensus statements-was systematically identified, screened, and critically appraised. This guideline was developed according to the "WHO Handbook for Guideline Development (2nd edition)".

For children with symptoms of increased post-void residual (PVR) that may threaten the upper urinary tract, CIC is recommended regardless of the cause. Safe bladder capacity (SBC) and maximum bladder capacity measurement could guide optimal CIC frequency. When infants or young children require CIC, their caregivers should receive specialized training. The CIC procedure includes thorough hand and genital area cleansing, followed by careful catheter insertion to avoid contamination of surrounding tissues. Depending on the individual's ability to void, CIC will be either partial or complete. Partial CIC is recommended for individuals who are able to void partially. When implementing CIC, a collaborative model involving the patient, caregivers, and a multidisciplinary pediatric team specializing in lower urinary tract management should be adopted, and regular follow-up and efficacy assessments are required. Urodynamic study to determine the PVR and SBC in conjunction with a voiding/catheterization diary provides an objective basis for adjusting the frequency of catheterization and for determining whether to continue catheterization.

This guideline established a standardized protocol for children who require CIC to facilitate bladder emptying.