This educational material is provided by Convatec Continence Care in an effort to answer questions and address possible concerns about the intermittent catheterization process. By following the simple steps for clean self-intermittent catheterization, it is possible to quickly master the technique and make the
process part of your daily routine for bladder management and urinary tract health.

Convatec Continence Care wishes to thank Anne Boisclair-Fahey, DNP, RN, CPNP, for writing this educational material. Her experience as a Senior Director of Advanced Practice Providers (APPS) at Children's Minnesota Hospital, combined with over 20 years of clinical expertise in pediatric urology as a pediatric nurse practitioner, make her contribution to this instruction guide invaluable.

This instruction guide is not a substitute for medical advice from your healthcare provider.

The Urinary SystemThe Urinary System

The urinary system contains two kidneys, two ureters, the bladder and the urethra. The kidneys filter the blood and produce urine. The urine travels from the kidneys down the ureters and into the bladder, where it is stored until emptied during urination or catheterization. The urethra is the tube that empties the urine out of the body.

When the bladder is full, the brain sends a signal down the spinal cord to the bladder, causing it to empty. For people with spinal cord issues, the signal from the bladder to the brain gets interrupted, making them unable to empty their bladder.
When people are unable to empty their bladder on their own, they are at risk for urinary tract infections, as well as incontinence or involuntary loss of urine. When urine stays in the bladder and is not emptied, bacteria can grow, causing infections which can lead to illness. Research has shown that self-intermittent catheterization helps reduce urinary tract infections, control urinary leakage (incontinence) and prevent urinary tract damage.

Introduction to Self-Intermittent Catheterization

Intermittent catheterization is the periodic emptying of the bladder by the insertion of a hollow plastic tube (catheter) into the urethra, past the sphincter muscles and into the bladder. Urine then passes out of the bladder through the catheter.

Intermittent catheterization is used when a person is unable to empty his bladder. Medical conditions that often require intermittent catheterization include spinal cord injuries, spina bifida and multiple sclerosis, to name a few.

Intermittent catheterization must be done at regular intervals each day to keep the bladder healthy.

Your healthcare provider has recommended clean self-intermittent catheterization to help empty your bladder and keep your urinary system healthy.

How Often Should I Catheterize?

Your healthcare provider will let you know how often you will need to perform clean self-intermittent catheterization and the size of the catheter you will need. Normally, self-intermittent catheterization is performed every four hours starting when you wake up in the morning and continues every four hours until bedtime. Some people catheterize on a more frequent schedule. Most people who catheterize do not need catheterization at night. Your healthcare provider will let you know if you need catheterization at night.

Where Do I Get Catheters?

You will be taught clean self-intermittent catheterization by your healthcare provider who will decide the size and style of catheter that you will need. Your healthcare provider will provide a prescription for the catheter supplies. The prescription will be sent to a medical supply company that will provide you with the supplies.

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Self-Intermittent Catheterization Instructions for Men

Self-intermittent catheterization can be performed standing in front of the toilet, sitting on a
chair or wheelchair near a toilet, or laying on an underpad. Do what is most comfortable for you.

1. Before you begin, gather the following materials: Cure Ultra® in a sealed wrapper.
Something to cleanse the area:
Soap, water and a washcloth or unscented disposable wipes.

Hand towel.
The Cure Ultra® for men is a 16",
pre-lubricated catheter with smooth, fire polished eyelets on a straight or coude tip, a unique 'No Roll' funnel end, and proprietary CoverAll lubricant application process. Not made with DEHP/DINP, BPA, or NR-latex

A container to collect the urine if not cathing on or near a toilet.

2. Inspect catheter before use. If the catheter or package are damaged, do not use.

3. Wash hands thoroughly with soap and water or, if not available, use an antibacterial hand cleaner.

4. Lay out the equipment so it is within easy reach. Open the catheter package. The Cure Ultra® package uses a notched opening system that allows for easy, one piece opening. It also features a proprietary CoverAll application process for even distribution of lubricant as the catheter is removed from the package.

5. Position yourself comfortably. Arrange clothing out of the way. If sitting on the toilet, spread your legs apart. If lying down, knees can be straight or bent.

6. Hold the penis upright on the sides so that the urethra is not pinched.

7. Retract the foreskin if the penis is uncircumcised. Wash the glans penis from the urethral opening (tip) to the base of the glans with soap, water and washcloth or unscented disposable wipe. Wash with a circular motion from the tip outward. Do not wash back and forth over the urethral opening. Repeat the washing two more times with different areas of the wash cloth or with a new unscented wipe each time.

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Self-Intermittent Catheterization Instructions for Men Continued

8. While holding the penis upright with one hand at a 45 to 60-degree angle from the body, slowly insert the pre-lubricated catheter into the penis using your dominant hand. A unique, textured gripper enables you to easily hold and advance the catheter without direct contact.

9. Gently slide the catheter until you meet resistance
at the urethral sphincters. Do not pull the catheter in and out when you meet resistance; just apply gentle but firm continuous pressure until the catheter advances into the bladder.

10. Continue to insert the catheter until urine begins to flow. If you are standing in front of the toilet or sitting on it with legs spread apart, the urine can drain into the toilet. If you are lying down, place the funnel end of the catheter into a container to collect the urine. Hold it in place until urine stops flowing.

11. When urine stops flowing, slowly rotate the catheter between your fingers while withdrawing the catheter. If urine starts to flow again when withdrawing the catheter, stop each time it flows and let the urine drain. Continue to slowly withdraw the catheter until the bladder is empty and the catheter is removed. If you are uncircumcised, make sure you bring the foreskin back over the glans penis when you are finished.

12. Some men have very tight sphincters or an enlarged prostate which makes it difficult to pass the catheter into the bladder. A catheter with a special, curved (Coude) tip may make passing the catheter easier. If a catheter with a Coude tip is needed, your
doctor or nurse will show you how to use it to ensure that the control stripe is oriented correctly for proper insertion and withdrawal.