ICIQ Structure Short Form

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Module Title


Full Name of Module

ICIQ-Long Term Catheter Quality of Life

Purpose of module The ICIQ-LTCqol provides a brief and robust measure to assess the impact of long term catheterisation (three months or longer) on quality of life and outcome of treatment. This questionnaire is of use to district nurses, general practitioners and clinicians in both primary and secondary care institutions to obtain a brief yet comprehensive summary of the impact of living with a long term catheter and to facilitate patient-clinician discussions, in addition to research purposes.
Derivation of module New Instrument
Intended Population Adult males and females with long term catheter in-situ (three months or longer). Urethral or supra-pubic catheter users.
Number of items 17
Question items

Catheter type
Equipment confidence
Catheter leakage on mind
Catheter blockage on mind
Catheter problems
Urinary tract infections
Adapted to catheter
Overall effect of catheter
Travel ability
Social activities
Ability to go out of the house
Pad use
Pain or discomfort
Bladder spasm
Sexual activity

Lanuage versions available


Associated publications Cotterill N, Fowler S, Avery M, Cottenden A, Wilde M, Long A, Fader M. Development and psychometric evaluation of the ICIQ-LTCqol: a self-report quality of life questionnaire for long-term indwelling catheter users. Neurourology and Urodynamics 2016. 35 (3): 423-428.
Level of validation according to ICI grades of recommendation Not yet graded.
Scoring system

0-42 Catheter function and concern 3-15 Lifestyle impact

Suggested modules to use in conjuction


completion time Less than ten minutes

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