| I | Where do you work? (Check only one) |
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| Teaching hospital center of Fann /_ / | Aristide Le Dantec General Hospital /_ / |
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| II. | What is your specialty? (Check only one) |
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| Neurology /_ / | Neurosurgery /_ / | Urology /_ / | Endocrinology /_ / | Pediatrics /_ / |
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| III. | What is your level in training? (Check only one) |
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| First year /_ / | Year 2 /_ / | Year 3 /_ / | Year 4 /_ / | Year 5 /_ / | University Diploma 1 (6th year) /_ / | University Diploma 2 (7th year) /_ / |
| IV. | What is the definition of clean intermittent catheterization? (Check only one) | ||||||
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| In-house catheterization /_ / | Non-sterile intermittent catheterization /_ / | Sterile Intermittent Catheterization /_ / | No response /_ / |
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| V. | What are the indications for clean intermittent catheterization? (Check one or more answers) | ||||||
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| Urinary retention /_ / | Overflowing urination /_ / | Urgency incontinence /_ / | Stress incontinence /_ / | Dysuria /_ / | No response /_ / |
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| VI. | What are the goals of the clean intermittent catheterization? (Check one or more answers) | ||||||
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| Protection of the urinary tract /_ / | Complete emptying /_ / | Fighting Urinary Tract Infection /_ / | Improving quality of life /_ / | Restoring Continence/_ / | No response /_ / |
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| VII. | What should be used for perineal and hand washing before the practice of clean intermittent self-catheterization? (Check one or more answers) | ||||||
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| Soap and water /_ / |
| Antiseptic /_ / |
| Sterile gloves /_ / |
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| VIII. | How often does the poll take per day? (Check one) | ||||||
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| 1 to 2 times /_ / | 2 to 4 times /_ / | 4 to 6 times /_ / | No response /_ / |
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| IX. | When to request a Cytobacteriological Examination of the urine? (Check one) | ||||||
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| Symptoms of Urinary Tract Infection /_ / | Any infectious symptoms /_ / | Systematic /_ / |
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| X. | What would you do when faced with a symptomatic urinary tract infection in a patient on clean intermittent catheterization? (Check one or more answers) | ||||||
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| Increase survey frequency /_ / | Antibiotic /_ / | Diuresis cure /_ / | Stop Intermittent Catheterization /_ / | No response /_ / |
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| XI. | How long does antibiotic therapy last? (Check only one) | ||||||
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| 1 Day /_ / | 5 Days /_ / | 10 Days /_ / | 15 Days /_ / | No response /_ / |
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| XII. | Are you worried about intermittent catheterization? (Check one) | ||||||
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| Yes /_ / | No /_ / |
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| XIII. | What are the complications of clean intermittent catheterization? (Check one or more answers) | ||||||
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| Urinary tract infection /_ / | Haematuria /_ / | Stenosis /_ / | Perforation /_ / |
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| XIV. | Would you like training on clean intermittent catheterization? (Check only one) | ||||||
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| Yes /_ / | No /_ / |
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| XV. | Have you ever heard of the clean intermittent catheterization? (Check one) | ||||||
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| Yes /_ / | No /_ / |
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| XVI. | Have you ever followed a patient using clean intermittent self-catheterization? (Check one) | ||||||
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| Yes /_ / | No /_ / |
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