A 50-Year Review of Lapides' Clean Intermittent Catheterization

A Revolutionary, Life-Saving, Quality-of-Life Improving Technique for Bladder Management

Ananias C. Diokno


Urol Nurs. 2019;39(5):229-234. 

In This Article

Abstract and Introduction


Lapides introduced clean intermittent catheterization (CIC) in 1972, and since, has gained widespread acceptability in managing many patients with bladder-emptying dysfunctions regardless of the etiology. This article will present the background, indications, and helpful hints in implementing a successful CIC program.


The classic paper, "Clean, Intermittent Self-Catheterization in the Treatment of Urinary Tract Disease" authored by Lapides, Diokno, Silber, and Lowe was published in the Journal of Urology in 1972. It started a new era in the management of patients with all sorts of bladder-emptying dysfunctions (Lapides et al., 1972). It was applicable for women, men, boys, girls, and older adult patients needing help to empty their bladders or patients suffering from overflow type of urinary incontinence.

In the beginning, there was resistance to the concept of the clean technique; the prevailing approach started by Guttman and Frankel (1966) in England was the sterile technique performed by staff. Staff wore masks, gowns, and gloves, and used sterile catheters. It took a few years to gain widespread and worldwide acceptance of clean intermittent catheterization (CIC). Once embraced by providers, the technique's use extended not only in its original intended indications, but also in new situations, such as the creation of urinary reservoirs with continent catheterizable stomas. The result of successful CIC was avoidance of recurrent lower and upper tract infections, sepsis, kidney stones, and bladder stones. This led to saving lives and improving quality of life. It is now so widely used and prescribed that prescribers do not think twice when ordering it; however, few remember the struggles providers had to endure to get to here. In addition, the rationale of why this technique prevents rather than causes infection has also been taken for granted. Indeed, this technique has withstood the test of time.