History of CIC 

  • The use of catheters for bladder emptying dates back to many thousands of years.
  • CIC was first described over a century ago [Teevan 1880]. The technique was used by patients with flaccid bladder dysfunction related to neurological complications of syphilis in England. Patients were said to carry their catheters in their hat bands.
  • Guttmann (1954) in England: described a sterile non-touch technique of intermittent catheterization for the initial management of neurogenic bladder in SCI patients. The use of sterile materials, sterile gloves and forceps was to prevent “infection” These was no pressure measurement made. In an intensive care unit setting some advocates sterile intermittent catherization presently because of the risk of infection. In the initial use of the technique during a bladder training program catheterization was done only by a catheter team. This was proven to obtain a very low infection rate [Guttmann 1966].
    • Nowadays the sterile technique is mostly used only during a restricted period of time and in a hospital setting. In the majority of cases a clean technique is used.
    • While the sterile technique was associated with a sterile urine for a time the technique was used only to achieve “balanced bladder function” or voiding spontaneously with a residual urine measured to be less than the amount voided. The technique was never widely used because of the need for trained medical personnel and sterile technique. It was never intended to be a long term method of management, nor did it produce satisfactory bladder function in most patients.
  • In 1971, Lapides reintroduced CIC in the belief that host resistance factors were sufficient to prevent symptomatic urinary infection provided the bladder was emptied frequently [Lapides 1971]. At first used to treat chronic retention states the techniques was quickly applied to neurogenic bladder conditions and revolutionized the management of that condition. It has only become an established practice during the last 3 decades.
    • It aims to prevent high residual volumes and reduce the risk of UTI.
    • The reason that CIC was developed is that true sterile self catheterization is extremely hard for a person to do in a normal living environment.

“Lapides and his nurse, Betty S. Lowe, first applied the technique of clean, intermittent, self-catheterization in the early winter of 1970 to a 30-year old woman with diurnal incontinence and recurrent urinary tract infections secondary to neurogenic bladder from multiple sclerosis. Cutaneous vesicostomy had been advised but the patient refused. A clean but not sterile technique was taught in a day at the hospital and catheterization was recommended every 2 to 3 hours during the day and several times at night. An effort was initially made to use a clean technique, although the catheter was sterilized between applications with benzalkonium chloride soaks for 20 minutes. The patient was additionally treated with oral propantheline bromide. She became completely continent and the urine remained free of cellular elements or bacteria. The recognition that sterility of the catheter was unimportant was provided by the patient herself: (Nurse Betty Lowe relates to Bloom that,) while traveling in Europe she dropped her sterile catheter on the floor of a public restroom and, unable to re-sterilize it, she simply proceeded with her catheterization with no ill effects.” -- from Dr. David Bloom [Konnak 2002]

  • In 1972, Lapides published more clinical results of CIC in the Journal of Urology [Lapides 1972].

A follow-up article published in 1972 was cited in the American Urological Association’s centennial issue of The Journal of Urology as one of the landmark articles in the last 100 years. In an editorial comment accompanying the article, Ed McGuire states, “We owe Doctor Lapides a great debt, and this brief article is a record of an enormous contribution to our knowledge, while saved the lives of countless patients and led to a revolution in urologic care which continues to evolve.” As might be expected, this technique was not quickly nor universally embraced. Aversion to CIC ran deep in American medicine. Lapides continued to publish his results, and in 1974 he reviewed 218 patients who were placed on a program of intermittent self-catheterization, including 128 female and 90 male patients ranging from age four to eighty-four. –[Konnak 2002]

Key Points of This Section
  • Intermittent catheterization has been used sporadically for hundreds of years to treat chronic low pressure retentions states. It was first used in SCI patients in an effort to achieve “adequate” spontaneous voiding. A strict sterile technique was used. Most of the patients so treated were in spinal shock and thus had low pressure bladders.
  • CIC was introduced by Lapides. It quickly became obvious that if bladder pressures were controlled CIC was safe and very effective. Originally it was thought that bacteriuira was uncommon in these patients but later it was recognized that most, if not all were chronically colonized, and that seemed to make little difference in outcome.

References

  • Teevan WF. The treatment of stricture of the urethra, enlarged prostate and stone in the bladder. Lancet 1 (1880), pp. 591–596.
  • Guttmann L, Frankel H. The value of intermittent catheterisation in the early management of traumatic paraplegia and tetraplegia. Paraplegia. 1966 Aug;4(2):63-84.
  • Konnak JW, Pardanami DS. The Lapides Years: “Black Jack” 1968-1983. In: Konnak JW, Pardanami DS (eds). A History of Urology at the University of Michigan 1920-2001, The University of Michigan Historical Center for the Health Sciences, Ann Arbor, MI, U.S.A. 2002;109-80.
  • Lapides J, Diokno AC, Silber SJ, Lowe BS. Clean, intermittent self-catheterization in the treatment of urinary tract disease. J Urol. 1972 Mar;107(3):458-61.

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