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To completely empty the bladder, repositioning is needed, but there is a greater risk of bladder microtrauma when repositioning.1 Both residual urine due to incomplete bladder emptying and microtrauma constitute a risk for UTIs.2

Of the 90% ISC users that reposition their catheter, 78% experience that the urine starts to run again. This means that the bladder is not completely empty at first flow stop.3

Flow stops make complete bladder emptying uncertain and complex:

  • Uncertain as flow stops give a false indication of an emptied bladder
  • Complex because the user needs to reposition1

The importance of repositioning is also underlined in the EAUN clinical guidance.4

"When urine flow stops, withdraw the catheter very slowly, in centimetre steps. If the urine flow starts again during withdrawal, discontinue withdrawal and wait for the flow to stop before resuming catheter withdrawal"

Why catheter repositioning is necessary / 0.38 min

What are flow stops and how do they occur?

Draining of urine during catheterisation creates negative pressure inside the catheter. This causes the bladder mucosa to get sucked into the eyelets of the catheter, blocking them, leading to a urine flow stop.1

CEC seen from the inside of the catheter, OUH, DK / 1 Minutes

Repositioning of the catheter helps to release the mucosa and continue the draining of urine. Mucosal suction can additionally cause trauma to the bladder wall and compromise the protective layer of the epithelial cells.1 This allows bacteria to attach to and invade the bladder cells, thus increasing the risk of UTI.5,6

“

Quote

Repositioning the catheter needs very fine adjustments and so if you’re not used to it, it’s quite easy to pull it in and out in a way that makes it painful, so it’s definitely the part of catheterisation that requires most concentration

- Kjell Bjørn Rønning

  1. Tentor F, Schrøder BG, Nielsen S et al., Development of an ex-vivo porcine lower urinary tract model to evaluate the performance of urinary catheters. Scientific Reports. 2022; Oct 24;12(1):17818
  2. Kennelly M, Thiruchelvam N, Averbeck MA et al., Adult neurogenic lower urinary tract dysfunction and intermittent catheterisation in a community setting: Risk factors model for urinary tract infections. Advances in Urology. 2019; Apr 2;1–13
  3. Islamoska S, Landauro MH, Zeeberg R, Jacobsen L, Vaabengaard R. Patient-reported risk factors for urinary tract infections are associated with lower quality of life among users of clean intermittent catheterisation. BAUN; Edinburgh 2022. PM-25007
  4. Vahr S, Cobussen-Boekhorst H, Eikenboom J et al., Catheterisation, Urethral Intermittent in adults, Dilatation, urethral intermittent in adults Evidence-based Guidelines for Best Practice in Urological Health Care. Arnheim: EAUN; 2013. Available from
  5. Vasudeva P and Madersbacher H, Factors implicated in pathogenesis of urinary tract infections in neurogenic bladders: some revered, few forgotten, others ignored. Neurology and Urodynamics. 2014 Jan;33(1):95-100
  6. Barber AE, Norton JP, Spivak AM et al., Urinary tract infections: current and emerging management strategies. Clinical Infectious Diseases. 2013; Sep;57(5):719-24
  7. Vaabengaard R, Zeeberg R, Zupet N, Bagger M, Nalbandian MT. Dependence on urinary intermittent catheterisation elicits considerable worry about urinary tract infections. INUS; Athens, Greece 2023. PM-27336