A new prospective multicenter study explores how catheter design may help address some of the practical challenges women experience during intermittent catheterisation. Discover what the findings suggest about convenience, handling and the potential value of a more individualised approach to catheterisation support.
Supporting women in intermittent catheterisation: Can catheter design help make a difference?
Women performing intermittent catheterisation often experience difficulty locating the urethral opening, a challenge that can impair confidence, independence, and adherence to catheterisation regimens. Anatomical constraints, limited visibility, reduced mobility, obesity, and neurological impairments may further complicate catheter insertion, highlighting the need for user-centered catheter designs that facilitate urethral localisation and improve the catheterisation experience.
A prospective multicenter study, published in the International Journal of Urological Nursing, evaluated the impact of LoFric® Elle, a novel hydrophilic intermittent catheter with an angulated handle designed to facilitate urethral localisation in women performing intermittent self-catheterisation (IC). Twenty experienced female IC users were followed for two weeks across four centers in Sweden and Spain.
Why can intermittent catheterisation be challenging for women?
Unlike the male urethral opening, the female urethra is not easily visible during catheterisation. Finding and accessing the urethra can therefore be challenging, particularly when learning the technique.
Several factors may make catheterisation more difficult, including reduced mobility or dexterity, neurological impairment, positioning difficulties and obesity. Difficulties locating the urethra can also contribute to repeated insertion attempts and frustration during catheterisation.
These practical challenges may have a psychological impact. Catheter users can experience anxiety, concerns about causing urethral trauma, embarrassment, loss of confidence and fear of becoming dependent on others for bladder management. Together, physical and psychological barriers may influence long-term adherence to intermittent catheterisation.
Can catheter design help women locate the urethra?
The design of an intermittent catheter can influence how it is held, positioned and inserted. LoFric® Elle incorporates a container that can be connected to the catheter funnel to create an L-shaped, angulated handle. The handle is intended to provide greater distance between the user's hand and the urethra while allowing an alternative grip and improved control during catheterisation.
The concept was developed to address some of the practical challenges women may experience when locating the urethra and inserting a catheter, while also supporting hygienic handling.
How was LoFric® Elle evaluated?
The prospective, single-arm, multicenter study included 20 experienced female IC users across four clinical sites in Sweden and Spain. Participants had been performing IC for at least three months and catheterised at least twice per day.
The women used LoFric® Elle for two weeks and were instructed to use the angulated handle at least twice daily.
Quality of life was assessed using the validated Intermittent Self-Catheterisation Questionnaire (ISC-Q), which evaluates four domains:
- Ease of use
- Convenience
- Discreetness
- Psychological well-being
Participants also completed a study-specific questionnaire assessing satisfaction, versatility and perceptions of the catheter and angulated handle.
Importantly, the participants were already experienced catheter users: 95% were satisfied with the catheter they were using before entering the study. This provides useful context when interpreting satisfaction and quality-of-life outcomes with the study catheter.
What did the study find?
Participants reported a high overall quality of life (ISC-Q score 75.9/100), with particularly strong ratings for ease of use (78.1) and discreetness (88.3).
The mean ISC-Q convenience score increased from 56.9 at baseline to 67.5 after two weeks, representing a statistically significant improvement (p=0.026).
Did the women use the angulated handle?
Adherence was high, with 80% of women using the angulated handle at every catheterisation, and 80% reporting satisfaction with the device. Most participants perceived the handle as easy to hold, hygienic, and helpful for catheterisation.
While 60% indicated that they would continue using the angulated handle after study completion, LoFric® Elle can also be used without the handle. This versatility allows women to adapt how they use the catheter according to their individual needs, preferences and level of confidence with the technique.
For some users, an alternative grip and increased distance between the hand and urethra may be particularly valuable when additional support with positioning, reach or control is needed. As confidence and familiarity with catheterisation develop, others may prefer conventional handling for some or all catheterisations. Rather than requiring a single approach, the design therefore provides different handling options within the same catheter, supporting a more individualized approach to intermittent catheterisation.
Can a handle support different catheterisation needs?
The study population included women catheterising because of urological, neurological and surgical conditions, and the authors observed differences between participants in how they perceived positioning and reach with the angulated handle.
They suggest that the potential benefit of the handle may therefore differ depending on the individual user’s physical needs. For example, women with difficulty reaching the urethra, reduced trunk mobility or challenges with positioning may potentially benefit from having an alternative way to grip and control the catheter. The authors also discuss the possible relevance for women with obesity, for whom accessing the urethra may be more difficult.
This reinforces the importance of an individualised approach to catheter selection and training, rather than assuming that the same technique and device features will suit every user.
Key takeaways
In this prospective multicenter study, LoFric Elle was associated with high quality of life scores and a significant improvement in the ISX-Q convenience domain. Most participants consistently used the angulated handle, and many perceived it as easy to hold and hygienic.
The findings suggest that providing different handling options may help HCPs individualise catheterisation support and address some of the practical barriers experienced by women performing IC.