Development and psychometric evaluation of an expanded urinary catheter self-management scale: A cross-sectional study.

AIM: To develop and test the psychometric properties of an expanded catheter self-management scale for patients with in-dwelling urinary catheters. DESIGN: A cross-sectional validation study. Despite the utility of the original 13-item catheter self-management scale, this instrument did not include bowel management, general hygiene and drainage bag care, which are fundamental skills in urinary catheter self-management to prevent common problems resulting in unnecessary hospital presentations. The expanded catheter self-management scale was developed with 10 additional items to comprehensively assess all five essential aspects of urinary catheter self-management. METHODS: A total of 101 adult community-dwelling patients living with indwelling urinary catheters were recruited from Western Sydney, Australia. Using exploratory factor analysis with Varimax rotation, the number of factors to be extracted from the expanded 23-item expanded catheter self-management scale was determined using a scree plot. The reliability of the overall scale and subscales was measured using Cronbach's alpha. Convergent validity was assessed using Spearman's correlations between clinical characteristics, overall scale and subscales. RESULTS: The 23-item expanded catheter self-management scale yielded a 5-factor solution, labelled as: (i) self-monitoring of catheter function, (ii) proactive, help-seeking behaviour function, (iii) bowel self-care function, (iv) hygiene-related catheter site function and (v) drainage bag care function. Cronbach's alpha of the expanded catheter self-management scale indicating all 23 items contributed to the overall alpha value. Convergent validity results showed a negative correlation between the overall expanded catheter self-management scale and catheter-related problems. CONCLUSION: The 5-factor structure provided a comprehensive assessment of key aspects of urinary catheter self-management essential to reduce the likelihood of catheter-related hospital presentations. IMPLICATIONS: The expanded catheter self-management scale can be used to assess and monitor effective patient-centred interventions for optimal self-management to prevent catheter-related problems and improve the quality of life of patients. IMPACT: Many patients start their journey of living with a urinary catheter unexpectedly and are not supported with quality information to care for their catheter. The findings of this study show the correlation between catheter self-management skills and catheter-related problems. The expanded catheter self-management scale (E-CSM) assists with analysing the self-management skills of patients living with a catheter and developing tailored interventions to prevent problems and improve their quality of life. In addition, this screening tool can be included in policies, guidelines, and care plans as a standard for improving catheter management and developing educational resources for patients. REPORTING METHOD: STROBE checklist was used to report all aspects of this study comprehensively and accurately. PATIENT OR PUBLIC CONTRIBUTION: Patients living with indwelling urinary catheter and their carers have participated in surveys, interviews and co-designing interventions. This paper reports the psychometric analysis of the expanded catheter self-management scale (E-CSM) used in the patient survey as part of the main study 'Improving Quality of Life of Patients Living with Indwelling Urinary Catheters: IQ-IDC Study' (Alex et al. in Collegian, 29:405-413, 2021). We greatly value our consumers' contributions and continue to communicate the progress of the study to them. Their contributions will be acknowledged in all publications and presentations. In addition, all participants will be provided the option of receiving the interventions and publications generated from this study.

Attitudes and Opinions of Adolescent Females Regarding 2 Methods of Bladder Filling for Transabdominal Ultrasound: A Q-Sort Study.

OBJECTIVES: Adolescent female patients who are not sexually active and who present to a pediatric emergency department with abdominal pain require a full bladder prior to transabdominal ultrasound. Procedures to fill the bladder are largely institution or provider dependent. We examined adolescent females' attitudes and opinions toward 2 common methods of bladder filling, intravenous fluid administration and transurethral Foley catheter placement, by means of a Q-sort study. METHODS: Two convenience samples of adolescent female patients in the pediatric emergency department at an academic children's hospital participated in the study. In part 1, subjects underwent a semistructured interview to elicit their opinions regarding 2 methods of bladder filling: intravenous fluid or transurethral catheter. The summation of subject statements was then narrowed down to a final Q set of 25 statements. In part 2, a second sample of subjects independently arranged this Q set according to their own agreement or disagreement with each statement. Principal components analysis was conducted to examine factors or collections of statements representing a shared viewpoint and to describe commonalities. RESULTS: Part 1 was completed with 9 subjects, and part 2 with 26 subjects. Factors revealed from the Q-sort data included acceptance of tests deemed medically necessary, desire for parental involvement, and a wish to minimize discomfort. Most adolescents aligned with 1 of these 3 factors. CONCLUSIONS: Adolescent female patients varied in their attitudes and opinions regarding intravenous catheter hydration and Foley catheter placement for transabdominal ultrasound. Knowledge of adolescent viewpoints may help better inform practitioner-patient communication for this procedure.

In Their Own Words: Adults' Lived Experiences With Intermittent Catheterization.

PURPOSE: The aim of this study was to identify themes related to barriers and facilitators to the integration of intermittent catheterization (IC) in the daily lives or persons using the form of bladder evacuation. DESIGN: Descriptive, qualitative study. SUBJECTS AND SETTING: A purposive sample of 25 adults from 5 countries (United States, United Kingdom, Germany, France, and the Netherlands) was assembled. All participants had used IC as their primary method of bladder emptying for at least 1 year and, in that time, had used as least 2 different IC products. METHODS: Guided telephone interviews with each participant were conducted by professional staff fluent in each participant's local language as well as trained in qualitative data collection. Interviews were digitally recorded and subsequently transcribed verbatim into English for analysis. We used ATLAS.ti qualitative analysis software (version 7.5.11) to assist with data organization and identification of major themes. Descriptive statistics (eg, mean, standard deviation, or frequency) were used to characterize the sample in terms of sociodemographic and clinical characteristics as collected during the interview. RESULTS: Analysis revealed 9 main themes around individuals' lived experiences of IC: initial fear, urinary tract infection, pain/discomfort, independence, choice, community, life quality, resilience, and acceptance. DISCUSSION: Our results indicate that IC is perceived as a burden by some, but not all, users. The challenge, and opportunity, is to learn more about what has gone right for those who have adapted and to leverage the clinical, practical, psychological, and social factors that enable individuals to integrate IC into the rhythm of their daily lives.

Suprapubic versus transurethral bladder drainage following reconstructive pelvic surgery: a comparison of patient satisfaction and quality of life.

INTRODUCTION AND HYPOTHESIS: To assess the differences in patient-reported, catheter-specific satisfaction and quality of life with either suprapubic or transurethral postoperative bladder drainage following reconstructive pelvic surgery. METHODS: This was a prospective study of all eligible women who were scheduled to undergo reconstructive surgery requiring bladder drainage during the study period November 2013 to March 2015. Women who did not undergo the planned procedure(s) or did not require bladder drainage were excluded. The primary outcome was patient-reported quality of life using catheter-specific instruments including the Catheter-related Quality of Life (CIQOL) instrument, and a modified version of the Intermittent Self-Catheterization Questionnaire (ISC-Q), designed to evaluate aspects of catheter-related quality of life and satisfaction specific to the needs of the individual. RESULTS: A total of 178 women were analyzed, 108 in the transurethral catheter group and 70 in the suprapubic group. Women with suprapubic bladder drainage had higher quality of life and satisfaction scores than women with transurethral bladder drainage as measured by the ISC-Q (68.31 ± 16.87 vs. 54.04 ± 16.95, mean difference 14.27, 95 % CI 9.15 - 19.39). There was no difference in quality of life by the CIQOL. After regression analysis, women with suprapubic bladder drainage were more satisfied with their catheter-specific needs despite longer duration of catheter use, more concurrent continence surgery, and higher trait anxiety. CONCLUSIONS: Differences in catheter-specific quality of life and patient satisfaction scores favoring suprapubic bladder drainage support its continued use in appropriately selected women for treatment of temporary postoperative urinary retention after reconstructive pelvic surgery.

Quality of Life of Intermittent Urinary Catheterization Users and Their Caregivers: A Scoping Review.

AIMS: This study aimed to examine and map the scientific evidences regarding quality of life in neurogenic bladder patients and consequently their caregivers by means of a scoping review. DESIGN: This is a scoping review proposal of the Joanna Briggs Institute. METHODS: It was conducted to examine and map the scientific evidences about quality of life (QoL) in neurogenic bladder patients and their caregivers, to identify the meanings attributed to QoL and its relation with intermittent urinary catheterization. The following guiding question was: "What scientific evidence has been produced on the QoL of neurogenic bladder patients using intermittent urinary catheterization and their caregivers?" A total of 2945 research studies were identified using The Cochrane Library, CINAHL, LILACS, Academic Search Premier (via EBSCO platform), PubMed, SCOPUS, the platforms Web of Science, the b-on and Gray Literature. The keywords established were patient, intermittent urinary catheterization, neurogenic urinary bladder, quality of life and caregiver. RESULTS: From 2,945 studies, 13 studies were selected. Most of the selected studies that analyzed variables related to the patients' QoL were regarding the urinary catheterization technique, assessment of urinary incontinence, individual perceptions of the procedure and experiences with urinary catheter in childhood and adult life. The meanings attributed to QoL, when compared to adult and child individuals with normal bladder functioning, presented lower QoL scores. Concerning caregivers, the QoL of caregivers of children using intermittent urinary catheterization demonstrated low scores. LINKING EVIDENCE TO ACTION: The QoL of patient's who use intermittent urinary catheterization can be determined by improvement of urinary symptoms and self-confidence. Research related to QoL of patients who use urinary catheter indicates the importance of adequate professional support and appropriate health public policies.

Development and psychometric evaluation of the ICIQ-LTCqol: A self-report quality of life questionnaire for long-term indwelling catheter users.

AIMS: Long-term indwelling catheterisation may affect health related quality of life, but clinical assessment and monitoring of people with indwelling catheters is poorly recorded because there are no validated measures to capture these criteria. In this paper, we describe the development of the ICIQ-Long Term Catheter quality of life (ICIQ-LTCqol), one of the modules of the ICIQ series, an international project to standardise assessment of lower pelvic dysfunction: www.iciq.net. METHODS: In-depth interviews were conducted with 27 catheter-users and 4 informal carers and cognitive debriefing with a further 31 catheter-users and clinical experts to evaluate clarity and comprehensiveness. The draft 44 item questionnaire was then sent by post to 893 long-term catheter-users; the 370 completed questionnaires were used to test content validity, test re-test reliability and internal consistency (Cronbach α coefficient). Factor analysis alongside expert opinion was used to formulate the final questionnaire of 16 items. This was then sent by post to another 438 long-term catheter-users to evaluate domain scores. RESULTS: The final questionnaire consists of two scored domains: catheter function and concern (9 items) and lifestyle impact (3 items) and four standalone items, relating to pads, pain, sexual activity and bladder spasm. Levels of missing data are good (mean 3.6%) with moderate to good agreement and acceptable internal consistency (Cronbach's alpha 0.76 and 0.74 for each domain respectively), suggesting acceptability and stability of the questionnaire. CONCLUSION: The ICIQ-LTCqol is a psychometrically robust self-report questionnaire for the clinical assessment and evaluation of health related quality of life for long-term catheter users.

Patients' experience with intermittent catheterisation in everyday life.

AIMS AND OBJECTIVES: This study reports about the experiences of 11 patients in the Netherlands who use intermittent self-catheterisation to manage their symptoms. The aim of the study was to get insight in underlying barriers and facilitators for patients dealing with intermittent catheterisation in everyday life. BACKGROUND: Studies show that intermittent catheterisation has an impact on everyday life. A positive effect does not guarantee that patients maintain catheterisation over a longer period of time. After the implementation of a guideline, a quantitative study was performed to determine successful intermittent catheterisation. The patients of this study had previously taken part in this quantitative study. DESIGN: This is a qualitative multicentre study using semistructured in-depth interviews with 11 patients between March-May 2013. METHODS: Inclusion criteria included patients of a quantitative study (n = 124) with a variety of diagnoses referred to the outpatient clinic. Those who received instruction from the researcher and who at start of the study performed catheterisation ≤3 months were excluded. Of the total number that met the inclusion criteria, every fourth patient was invited to participate in an interview. Patients were asked about the introducing of intermittent catheterisation, the incorporation into everyday life, the progress after the instruction and guidance perceived, the cause of the bladder problem and the motivation to start intermittent catheterisation. RESULTS: Eleven interviews were performed (six males/five females). All patients described the instruction and follow-up care as positive. Barriers were the preparation before the handling, which is more difficult than the catheterisation itself, and the fact that patients felt constrained by the need to plan convenient times to catheterise themselves. CONCLUSION: This study shows that patients who perform catheterisation are satisfied about the instruction and follow-up care. Important barriers in everyday life are the preparation and the need to plan convenient times. RELEVANCE TO CLINICAL PRACTICE: Interviewing patients gave important additional information about dealing with intermittent catheterisation in everyday life. Prescribers and teachers of intermittent catheterisation must realise that they often have to high expectations of patients when it comes to being flexible in frequency of catheterisation. It is important to realise that patients experience barriers of which healthcare workers are not always aware of, such as the preparation before the handling and feeling constrained by the need to plan convenient times to catheterise. The outcome of this study can be used to improve the content of patient information brochures and guidelines for intermittent catheterisation.

Drawing on Accounts of Long-Term Urinary Catheter Use: Design for the "Seemingly Mundane".

The design of the Foley catheter has not changed since 1937. Scientists interested in medical technology tend to focus on state-of-the-art designs for newsworthy specialties rather than the more mundane technologies of daily life. We interviewed 36 people living with a long-term urinary catheter in the United Kingdom, who described limitations of the current catheter design, including infections and complications and consequences for social life and relationships, and their perceptions of whose responsibility it was to improve the design. All took steps to hide the urine bag, but the need to use a catheter and urine bag had, for some, a very detrimental effect on social life and relationships. People living with long-term catheters are relatively isolated at home and dealing with many different underlying health problems, undermining opportunities to speak with a collective patient voice. Qualitative health researchers could act as a conduit to help stimulate new designs.

Comparing transurethral and suprapubic catheterization for long-term bladder drainage: a qualitative study of the patients' perspective.

PURPOSE: To explore why men and women decide to have a suprapubic catheter, how the decision is made, and to compare people's experiences of suprapubic and transurethral catheterization for long-term bladder drainage. DESIGN: Narrative interviews followed by thematic analysis. SUBJECTS AND SETTING: Thirty-six long-term catheter users living in England, Wales, or Scotland were interviewed. The sample included men and women from various socioeconomic backgrounds, with a wide range of conditions. They were aged 22 to 96 years (M = 57 years). METHODS: Interviews lasted between 1 and 3 hours; they were audiotaped and fully transcribed for analysis. A qualitative interpretive approach was taken, combining thematic analysis with constant comparison. RESULTS: Some respondents were satisfied with or preferred a urethral catheter; others preferred a suprapubic catheter because they perceived that suprapubic catheters led to fewer infections, were more hygienic, more comfortable, improved self-image, allowed a sense of control, and were better suited for sexual relations. Participants also mentioned the decision-making process, including how the decision was made to have a suprapubic catheter and where to insert the catheter at a particular point in the abdomen. Even with a suprapubic catheter, some worried about sex or were put off sexual intimacy because of the catheter. CONCLUSION: Our findings suggest that patients should be better informed before a suprapubic catheter is inserted and that issues such as sex should be raised in consultations when appropriate.

Emergency Department Placement and Management of Indwelling Urinary Catheters in Older Adults: Knowledge, Attitudes, and Practice.

UNLABELLED: Indwelling urinary catheters (IUCs) are placed frequently in older adults in the emergency department (ED). Though often a critical intervention, IUCs carry significant risks. Our objective was to examine current knowledge, attitudes, and practice of emergency nurses and other providers regarding IUC placement and management in older adults. METHODS: We surveyed ED providers at a large, urban, academic medical center. We developed questionnaires using items from previously validated instruments and questions created for this study. We also assessed providers' management of 25 unique clinical scenarios, each representing an established appropriate or inappropriate indication for IUC placement. RESULTS: 129 ED providers participated: 43 nurses and 86 other providers. Ninety-one percent of nurses and 87% of other providers reported comfort with appropriate indications for IUC placement. Despite this, on the clinical vignettes, nurses correctly identified the appropriate approach for IUC placement in only 40% of cases and other providers in only 37%. Practice varied widely between individual providers, with the nurse participants reporting appropriate practice in 16%-64% of clinical scenarios and other providers in 8%-68%. Few nurses or other providers reported reassessing their patients for IUC removal at transfer to the hospital (28% of nurses and 7% of other providers), admission (24% and 14%), or shift change (14% and 8%). DISCUSSION: Although emergency nurses and other providers report comfort with appropriate indications for IUC placement, reported practice patterns showed inconsistencies with established guidelines. Wide practice variation exists between individual providers. Moreover, nurses and other providers infrequently consider IUC removal after placement.

Poor quality of life in patients with urethral stricture treated with intermittent self-dilation.

PURPOSE: We assessed patient perceptions of regular intermittent self-dilation in men with urethral stricture. MATERIALS AND METHODS: We constructed and distributed a visual analog questionnaire to evaluate intermittent self-dilation via catheterization by men referred for urethral stricture management at a total of 4 institutions. Items assessed included patient duration, frequency, difficulty and pain associated with intermittent self-dilation as well as interference of intermittent self-dilation with daily activity. The primary outcome was patient perceived quality of life. Multivariate analysis was performed to assess factors that affected this outcome. RESULTS: Included in the study were 85 patients with a median age of 68 years, a median of 3.0 years on intermittent self-dilation and a median frequency of 1 dilation per day. On a 1 to 10 scale the median intermittent self-dilation difficulty was 5.0 ± 2.7, the median pain score was 3.0 ± 2.7 and median interference with daily life was 2.0 ± 1.3. Overall quality of life in patients with stricture was poor (median score 7.0 ± 2.6 with poor quality of life defined as 7 or greater). On univariate analysis younger age (p <0.01), interference (p = 0.03), pain (p <0.01) and difficulty performing intermittent self-dilation (p = 0.03) correlated with poor quality of life in a statistically significant manner. On multivariate analysis only difficulty catheterizing (p <0.01) and younger age (p = 0.05) were statistically significant predictors. Patients with stricture involving the posterior urethra had a statistically significant increase in difficulty and decrease in quality of life (each p = 0.04). CONCLUSIONS: Most patients with urethral stricture who are on intermittent self-dilation rate difficulty and pain as moderate, and inconvenience as low but report poor quality of life.

Micturition problems after bladder distension during hospitalization in Sweden: "I'm not ill, just damaged for the rest of my life".

BACKGROUND: Urinary retention is a common complication following hospital care, which can result in overdistension of the bladder and, at worst, chronic bladder damage and persistent micturition difficulties. OBJECTIVES: The purpose of this study was to explore patients' experiences of micturition problems after bladder distension and their effects on the patients' everyday lives. METHODS: The Swedish Patient Insurance LÖF was used to identify patients from January 2007 to June 2010 who have reported micturition problems after hospital care and have had their injuries classified as avoidable bladder damage due to overdistension. Narrative interviews were conducted with 20 volunteers and analyzed by qualitative content analysis. RESULTS: The micturition problems affected everyday life through constraints (dependence on disposables and access to toilets, clothing restrictions, limitations on social life and career), suffering (pain, infections, impaired sex life, leakage), and concerns for the future (fear of worsening symptoms and fear of losing control with age). Aspects related to having been harmed by the healthcare system were the harm could have been avoided (lack of knowledge, insufficient routines, mistrust), obstacles to overcome when reporting an injury (difficulties in obtaining knowledge about the possibility of reporting an injury, ambivalence toward reporting their healthcare providers), and a wish to improve care (raise awareness, prevent harm to others). DISCUSSION: Bladder distension is a healthcare-related injury that can cause suffering and practical, emotional, and psychosocial problems with a great impact on the life of the person affected and anxiety for the future. The healthcare system must, therefore, raise awareness and improve preventive routines.

Does nurse self-testing affect catheter choice?

BACKGROUND: Involving patients in decision making about their care requires expert knowledge and understanding of patients' perspectives. Knowledge comes from several sources and experience; however, the self-testing of products by health professionals who teach clean intermittent self-catheterisation (CISC) has not been investigated. AIM: This study aimed to assess the impact of self-testing on catheter evaluation by continence nurses. METHODS: Sixteen continence nurses self-tested two catheters and completed a questionnaire on their opinions about the catheter, routine self-testing and whether the study would make them change their usual practice. RESULTS: Almost half of the participants found self-testing intermittent catheters a useful experience and some of those who did not routinely self-test said they would do so in future. CONCLUSION: Self-testing intermittent catheters can provide useful knowledge to those who teach CISC.

Adolescents' experience with scoliosis surgery: a qualitative study.

This article reports a study of adolescents' narrated experiences of undergoing scoliosis surgery. Six adolescents were interviewed. Open and semistructured questions were asked, and a qualitative content analysis of the text was performed. The results are presented in three main categories followed by subcategories. The three main categories of experience were emotional, physical, and social. The emotional aspects that emerged were fear, nightmares, nervousness, and helplessness. These had a great impact on adolescents' well-being before, during, and after the hospital visit. The physical aspects were mobilization, scars, different hip levels, pain, nausea, appetite, and urinary catheter. These aspects caused much discomfort, mostly during the hospital visit. The social aspects were friends, power, coaching and comfort, and sports. Some of the social aspects had a strong negative impact on the adolescents' well-being mostly after the hospital visit. This study suggests that both before and long after the surgery adolescents have strong emotions that they should be better prepared and helped to manage. To optimize perioperative care an interdisciplinary, a holistic approach must be taken that incorporates the complexity and whole of the adolescent's experiences. The findings of this study suggest that perioperative care of adolescents during scoliosis surgery needs to be optimized. To improve patients' psychologic preparation before surgery pediatric nurses should learn more about the individual patient and make care plans from a holistic perspective. Follow-up after discharge should address emotional, social, and physical aspects of the adolescent's health.

Effects of urinary catheter education for patients undergoing prostatectomy.

In a nonrandomized prospective study, significant decreases in patient anxiety with home urinary catheter management and in length of stay were reported when patients attended the preoperative prostatectomy class with standard postoperative education versus standard postoperative education.

Living with an indwelling urinary catheter.

Despite 450,000 people in the U.K. using long-term catheters, there is very little information available about the experience. This study aimed to gain an understanding of patients' perspectives of living with an indwelling urinary catheter.

[The anxiety and types of problems encountered by homecare patients during an intermittent self-catheterization].

The aim of this study was to clarify why a homecare patient had an anxiety and the type of difficulties while having an intermittent self-catheterization at home. We used a questionnaire survey to conduct an oral interview for 25 homecare patients, who regularly had an intermittent self-catheterization. The survey results were codified into single phrase units of meaning, and then separated into categories. The results revealed that 70 to 80% of patients who had an intermittent self catheterization in their own homes experienced an anxiety and encountered difficulties during the process. The findings emphasized the importance of providing a sort of support for homecare patients when they have an intermittent self-catheterization for the first time, as well as the importance of providing continued support until the patients are comfortable with the procedure. For a future support, these patients' anxiety need to be reduced and difficulties related to an intermittent self catheterization resolved during an outpatient visit.

A new urinary catheter-related quality of life instrument for adults.

AIMS: To develop and assess the measurement properties of a catheter-related quality of life (C-IQoL) instrument designed to support research with persons using long-term urinary catheter users who use indwelling urethral or suprapubic catheters permanently. METHODS: Testing was conducted in two small studies for psychometric qualities of reliability (internal consistency and test-retest) and factor analysis. The initial instrument, which was modified after each study, was based on an International Continence Society (ICS) validated generic incontinence quality of life tool. ICS guidelines were used to develop content, including using descriptive and qualitative literature as well as and subjective/objective measures. Literature included content areas related to sexuality, embarrassment, and everyday catheter management. RESULTS: A three-factor solution of subscales (management, interpersonal, and psychosocial) was created. The final instrument contains 22 items. Reliabilities were all satisfactory. CONCLUSIONS: Quality of life continence instruments need to be device-specific to address appropriate and critical issues in randomized trials. For further development of a valid and reliable measure, continued collaboration is needed among researchers working with this population.

Clean intermittent self-catheterization: a burden for the patient?

AIM: To assess patients' perception of clean intermittent self-catheterization (CISC) for voiding dysfunction. PATIENTS AND METHODS: A total of 101 patients performing CISC because of voiding dysfunction were invited to participate in this questionnaire survey. The response rate was 91% (92/101). RESULTS: The mean time over which CISC was performed was 5 years (standard deviation (SD) +/- 6.3) and the mean frequency of CISC per day was three times (SD +/- 2). Almost 80% (72/92) of the patients perceived CISC as easy or very easy and CISC did not interfere at all or interfered a little bit with work or other regular daily activities in more than 80% (76/92). Almost 90% (80/92) reported no or minimal pain while performing CISC. This did not interfere at all or interfered a little bit with work or other regular daily activities in almost 90% (80/92). Quality of life improved considerably due to CISC in more than 60% (56/92) and 12% (11/92) complained of a deterioration. In multivariable analysis, severe pain performing CISC (odds ratio 20.9, 95% confidence interval 1.7-259.9, P = 0.018) was the only factor that predicted poor quality of life. CONCLUSIONS: The majority of patients considered CISC to be an easy and painless procedure which did not interfere with daily activities. Consequently, quality of life improved in more than 60% of the patients. Therefore, CISC does not appear to be a burden for the patient and, from a patient's perspective, can be recommended.