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Optimizing Intermittent Catheterization Following Spinal Cord Injury: A Narrative Review Using the WHO Health System
Yacoub Abuzied1,2, Aidalina Mahmud3, Rasmieh Al-Amer4
1Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia, upm.edu.my.
Advances in Urology
|August 4, 2026
Summary
Effective intermittent catheterization (IC) for spinal cord injury (SCI) requires robust health systems. Addressing systemic barriers like supply access and workforce training is crucial for long-term patient adherence and improved quality of life.
Area of Science:
- Health Systems Research
- Rehabilitation Medicine
- Urology
Background:
- Intermittent catheterization (IC) is the standard for neurogenic bladder in spinal cord injury (SCI).
- Long-term IC effectiveness hinges on integrated, sustainable, and patient-centered healthcare systems.
- System-level factors significantly impact the success of IC delivery.
Purpose of the Study:
- To examine intermittent catheterization (IC) for spinal cord injury (SCI) through a health systems lens.
- To identify system-level challenges and strategies for optimizing IC delivery.
- To utilize the World Health Organization (WHO) Health System Building Blocks framework.
Main Methods:
- A narrative review synthesizing evidence from January 2015 to June 2026.
- Literature search across major scientific databases (CINAHL, MEDLINE, PubMed, Scopus, etc.).
- Analysis guided by the WHO Health System Building Blocks framework, focusing on clinical outcomes, delivery, workforce, access, financing, and governance.
Main Results:
- Significant systemic barriers impede effective IC implementation despite strong clinical evidence.
- Key challenges include limited access to supplies, inadequate workforce training, fragmented follow-up, and inconsistent patient education.
- Service delivery, workforce capacity, and access to technology are critical determinants of successful IC implementation and adherence.
Conclusions:
- Optimizing IC outcomes in SCI necessitates strengthened health systems for coordinated, accessible, and sustainable care.
- Integrating IC services into health system strengthening initiatives can reduce complications and improve quality of life (QoL).
- Enhanced health systems support Sustainable Development Goal 3 (SDG 3) for health and well-being.
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