Impact of clean intermittent catheterization on quality of life and resource utilization in patients with spinal cord injury and urological complications: A narrative review.

OBJECTIVE

To synthesize the international evidence on the impact of clean intermittent catheterization on quality of life and resource utilization in patients with spinal cord injury and urological complications, to support a review of policies that shift the financial burden of catheterization to families in Chile.

METHODS

A narrative review based on the MEDLINE/PubMed database and gray literature published between 2014 and 2025, in Spanish and English. The research question was structured using the population, concept, and context framework. Two search algorithms were applied, combining MeSH terms, free-text keywords, and Boolean operators. Screening was conducted in three successive stages (title, abstract, and full text), with a second reviewer resolving any uncertainties by consensus.

RESULTS

After screening 880 references, 65 studies met the inclusion criteria. Findings were organized into five dimensions: patient quality of life, caregiver quality of life, urinary tract infections, resource use, and emerging care models. Based on this evidence, an archetype of the chronic catheter user was developed: a man aged between 25 and 45 with a traumatic spinal cord injury, who uses a wheelchair in more than 67% of cases, spends more than 53 minutes a day on catheterization, has a prevalence of urinary tract infection exceeding 50% (two-thirds of which are antimicrobial resistant), and reports a 36% dissatisfaction with his urinary quality of life. Furthermore, he reuses catheters primarily for economic reasons; 90% of patients who used reusable catheters preferred switching to single-use catheters, and 84% reported greater satisfaction. Multiple cost-effectiveness analyses show that hydrophilic single-use catheters are cost-effective or dominant strategies in high-income settings. Caregivers -mostly mothers or partners- report insufficient training, social restriction, and work-related difficulties that the healthcare system fails to address.

CONCLUSIONS

Access to appropriate catheterization supplies, combined with structured patient and caregiver education and continuity of care, improves quality of life, reduces urinary complications, and is cost-effective. Chile's current policy of shifting the financial burden of catheterization to families is inconsistent with the available international evidence.