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Management and implementation of intermittent catheterisation in neurogenic lower urinary tract dysfunction: a
Ines Kurze1, Veronika Geng2, Peter Wenig3
1Department of Paraplegiology and Neuro-Urology, Centre for Spinal Cord Injuries, Zentralklinik Bad Berka, Bad Berka, Germany.
Background:
Although intermittent catheterisation (IC) has been established as the standard method of bladder emptying in cases of neurogenic bladder dysfunction since the 1960s, there are still many uncertainties in everyday nursing practice regarding the specific implementation of IC. It, therefore, seemed necessary to standardise the IC procedure and develop specific recommendations for performing IC based on an interprofessional, interdisciplinary consensus process.
Methods:
In 2014, an interprofessional, interdisciplinary working group developed initial Clinical Practice Guidelines (CPG) in accordance with the rules of the Association of the Scientific Medical Societies in Germany (AWMF) based on the evidence level of a structured consensus process. The methods used to develop the CPG and the professional associations involved are described in detail. These CPG have been consistently refined and have been available as update 3.0 since 2026.
Results:
The CPG describes in detail the topics of indications for IC, definitions, detailed descriptions of the various catheter characteristics, specific implementation of IC including disinfection of hands and meatus urethrae, management of complications such as urinary tract infections (UTIs) or autonomic dysreflexia, and options for UTI prophylaxis, and provides specific recommendations for action.
Conclusions:
This CPG, based on consensus-based evidence, has proven itself in clinical and everyday use for over 10 years. Due to the regular further development of the CPG, the guideline will also be able to meet future challenges such as changing demographic conditions of our patients with an increase in older patients with complex medical situations and increased use of permanent urinary catheter drainage or increased cost pressure in the healthcare system, even in developed countries. Consensus-based CPGs are an important component of evidence-based medicine, especially in situations where there are few randomised-controlled trials and none are expected in the future. Such CPGs can also address aspects that are likely to become even more important in the future, such as sustainability and environmental issues.
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