Tab. II.

Extraction data from primary studies.

1st Author, year [Ref.]	Study type	Aim of the study	Target population (tot, gender, median age)	MS subtype	Causes requiring IC	Type of IC	IC-related complications	Risk factors for complications	Impact of IC on QoL	Main findings
Haddad R, 2022 [16]	Single-center observational study	Determine if FIM can predict the outcome of CIC training in pwMS	Tot: 395 M: 117 F: 278 (70%) Median age: 49.8 years	RR (50%) PP (19%) SP (30%)	DSD, with DO: (71%) or without DO (14%) (only 13% DU)	CIC	-	EDSS (≥ 6) Others probably implicated: • Female genre (70%) • Obesity (12% of tot. participants)	FIM is used to assess the degree of disability: FIM total score: 108.0; FIM motor score: 75.9; FIM cognitive score: 32.1	FIM is an independent predictor of successful CIC training in pwMS 87% of patients were successful in learning CIC
McClurg D, 2019 [17]	Prospective longitudinal study + Qualitative interviews + Retrospective survey	Explore the factors that affect continuation or discontinuation use of CIC	Tot: 204 Non-ISC: 135 ISC-resistant: 13 ISC: 56 (27%) Started/continued (63%): 43 (tot) Median age: 49.9 years F 31 (72%) Started/discontinued (36%): 13 (tot) Median age: 51.3 F: 11 (85%)	Started/ continued: RR: 21 (49%) PP: 8 (19%) SP: 13 (30%) NK: 1 (2%) Started/discontinued: RR: 7 (58%) PP: 3 (25%) SP: 2 (17%) NK: 1 (2%)	MS referred to the continence service	ISC (Single use)	UTIs Started/continued: 22 (51%) Started/discontinued: 3 (23%)	-	EQ-5D (questionnaires to measure health-related QoL self-assessment in five dimensions) Started/continued: Mean: 62 General Health Status: Good: 7 (58%) Fair: 5 (42%) Started/discontinued: Mean: 61 General Health Status: Good: 33 (77%) Fair: 10 (23%)	Although CIC may benefit many PwMS, continuation is dependent on the individual’s perception of improvement in symptoms versus the burden of use. In qualitative interviews, patients reported reduced nocturia and being more comfortable and confident going out. Retrospective survey (n = 456) was undertaken, which identified the variables that influenced CIC continuation/discontinuation, in particular development of UTIs during learning period.
Bolinger R, 2013 [18]	Cross-sectional study	To examine barriers, complications, adherence, and health-related QoL in people using CIC	Tot: 44 M: 18 (41%) F: 26 (59%) MS: 21 (47.7%) Median age: 56.6 years	-	NB 9 (20.5%) SCI 2 (0.05%) UTI 2 (0.05%) HPB 1 (0.02%)	CIC	• UTI: 34 (77.2%) Bleeding: 10 (22.7%) • Difficulty passing the catheter: 2 (4.5%) • Not comfortable doing CIC: 2 (4.5%) • Stone formation: 5 (11.4%) • Prostatitis: 2 (4.5%)	-	SF-36 for the assessment of health-related QoL: Inadequate access to public bathrooms equipped with sinks, shelves, and adequate space Skeletal muscle spasticity in PwMS often rendered participants dependent on others to perform CIC	This study identified both personal and environmental barriers that might have increased the risk for UTI, that is the most commonly reported complication associated with CIC.
Castel-Lacanal E, 2013 [19]	Single-center prospective observational study	To evaluate the impact of IC on the QoL of pwMS	Tot. 22 M: 8 F: 15 (68.18%) Median age: 49.3 years	RR: 9 (39.1%) PP: 9 (39.1%) SP: 5 (21.7%)	DSD: 16 DU: 5 Non-relaxing urethral sphincter obstruction: 2	CISC	-	-	Self-administered questionnaire (Qualiveen): Before CISC – score: 1.63 ± 0.13 After CISC – score: 1.31 ± 0.15 Significant decrease in the impact of urinary disorders on the quality of life, with a decrease of the scores of three domains (bother with limitation, fears, feelings and the overall QoL score). No changes in theoverall QoL assessed by the SF-36	In patients affected by MS, IC is possible, with specialized medical and paramedical support. IC must be proposed to pwMS, as soon as it is recommended by experts. IC is well accepted by pwMS due to QoL improvement.
Fakas N, 2010 [20]	Cross-sectional study	Evaluate the rate of asymptomatic bacteriuria and symptomatic UTIs in pwMS and bladder dysfunction who practice CISC	Tot: 167 SIC group (group A): Tot.: 39 (23.4%) M 7(17.9%) F 32 (82.1%) Median age: 44.92 years	-	Incomplete bladder emptying	CISC	Bacteriuria (90% of group A) Symptomatic UTIs (14% of group A)	High PVR EDSS ≥ 6	-	Significant proportion of pwMS who used S-IC developed asymptomatic bacteriuria. It seems that prophylaxis can be effective in MS patients with bladder dysfunction and bacteriuria, independently of SIC use, if they are ambulatory and have efficient mobility (EDSS score < 6.0).
Vahter L, 2009 [21]	Observational study	Investigate the ability of PwMS to learn CISC	Tot: 23 pwMS M: 11 F: 12 (52.17%) Median age: 45.7 years	RR: 1311 (56.5%) PP: 1 (4.3%) SP: 6 (26.1%) Benign: 3 (13%)	Incomplete bladder emptying and a residual volume of urine of more than 100 mL	CISC	-	-	The majority of PwMS are able to learn CISC (87%) and therefore to profoundly improve their quality of life. The time needed to acquire CISC skills differed considerably depending on physical disability but not on cognitive abilities	Strong statistical evidence that an increase in disability (measured by EDSS) is associated with an increase in the number of lessons needed to acquire CISC. The time needed to acquire CISC skills differed considerably depending on physical disability but not on cognitive abilities or on the course of the disease.
FIM: Functional Independence Measure; MS: Multiple Sclerosis; pwMS: Patients with Multiple Sclerosis; IC: Intermittent Catheterization; CIC: Clean Intermittent Catheterization; SIC: Self-Intermittent Catheterization; CISC: Clean Intermittent Self Catheterization; RR: Relapsing Remitting; PP: Primary Progressive; SP: Secondary Progressive; DSD: Detrusor Sphincter Dyssynergy; DU: Detrusor Underactivity; DO: Detrusor Overactivity; C-ISC: Clean Intermittent Self Catheterization; NK: Not Known; EDSS: Expanded Disability Status Scale; LUTS: Lower Urinary Tract Symptom; NB: Neurogenic Bladder; HPB: Hypertrophy Prostatic Benign; UTI: Urinary Tract Infection; SCI: Spinal Cord Injury; QoL: Quality of Life; PVR: Post Volume Residual.