Decision-making algorithm for difficult intermittent self-catheterization: construction and validation using the Delphi method.

Purpose: Intermittent Self Catheterization (ISC) is the gold standard for chronic neurogenic and non neurogenic urinary retention. However, difficulties encountered may lead to poor adherence and discontinuation. This study aimed to develop and validate a decision-making algorithm to guide first and second line management of the more common difficulties reported by patients performing ISC.

Methods: A survey conducted amongst patients, nurses and physicians identified the most frequent difficulties encountered with ISC. Based on a literature review and expert experience, a steering committee, composed of 14 urologists and physical medicine and rehabilitation practitioners, developed a preliminary algorithm outlining management strategies for each identified issues. The algorithm was then validated by a panel of experts through a Delphi process.

Results: Six difficulties were identified: pain, infections, bleeding, blockage, technical issues and neuro-psychological barriers. Twenty experts participated in the voting group. Of the 68 initial items, 61 were validated and included in the final algorithm (30 with a strong agreement, 31 with a relative agreement).

Conclusions: This multidisciplinary collaborative work resulted in a validated decision-making algorithm designed to complement to existing guidelines. It supports healthcare professionals from different backgrounds in managing patients who report difficulties with ISC.

Supplementary Information: The online version contains supplementary material available at 10.1007/s00345-025-05838-4.