Bladder Maintenance Question

[TD]

Just how many different bladder maintenance techniques are there? I have only been introduced to catheterization which is time-consuming and does not seem to be helping keep me continent. If you would, please briefly explain each technique and the pros and cons of each.

"And so it begins."

[SCI-Nurse]

There are several bladder management techniques. The management technique depends on the type of bladder you have. You know about intermittent catheterization. This has obviously been seen as the best technique for you to use. Some men are able to use a condom (external) catheter and drain their bladder into a leg bag. This can be done with an intentional void or by "triggering" the bladder. Triggering may involve any number of techniques, with tapping on the bladder probably being the most common. Pushing on the bladder to empty it (crede) can be used if the bladder is large and floppy to help it empty. It is no longer a common practice as the risk to the upper tracts is a factor when this technique is used. It is also difficult to empty the bladder completely using this technique. An indwelling catheter can be used and can enter the bladder either through the urethra or by a surgical suprapubic route. Are you on any medications for your bladder? Have you had a recent urodynamic study? With an intermittent catheterization program the goal is to remain dry between cathings. If that is not happening for you, it is time to ask some questions of your SCI doctor or urologist. (EMK)

[TD]

I was placed on intermittent catheterization with a condom when I first came home from rehab six years ago!! I have changed a lot since I came home including having a Intrathecal baclofen pump implanted.

On occasion I can trigger a bladder spasm in my neurogenic bladder but a spasm is usually triggered by itself when my bladder reaches a certain amount (between 400 and 600 cc). During these spasms I can, if I concentrate on my bladder, force a lot of pee out. The usual residual after this is between 200 and 300 cc. I only crede when I am cathing.

An indwelling catheter is definitely out because I am fairly active and do not want to take the chance of pulling on it. I am trying to reduce the number of UTIs I am getting and I understand an indwelling causes them. I am considering a SP as well as a stent because they are not permanent. I just may live long enough to see a cure although I will be a very old man!! http://sci.rutgers.edu/forum/images/smilies/biggrin.gif

My last urodynamics study showed I have good compliance up to 450 cc before my pressure starts to go up. I am having a video urodynamics study done at the end of November. In the meantime I have an appointment with my urologist next month.

My goal is not to stay dry but to reduce or eliminate the need to cath. With all my other problems, I would like to put this behind me. http://sci.rutgers.edu/forum/images/smilies/smile.gif

"And so it begins."

[Jeff]

There is a new catheter called Bioderm that allows easy cathing while wearing it. It is also much better for your skin as only a small portion of the penis is exposed to urine. It's a little hard to get on, though, and won't stand up to a lot of urine flow. Definitely not a "real beer drinker's catheter." That was a term coined by Dr. Young in one of his posts and I still laugh at it. Anyway, the Bioderm excels at keeping you dry in between intermittent catheterizations... something a lot of people need.

[anniemes]

The most popular option for your bladder is intermittant catheterization. If you are "reflexing" (peeing) in between caths, you probably have a reflexive bladder and should be wearing a condom cath. aka external catheter. There are many different types and sizes for everyone. They are covered by insurance and that company, UroMed will send you some free samples to experiment with until you find what you like. They also bill your insurance, and ship for free. The girl there is Anne M. that does this and her number is 800-841-1233. Their website is www.umed.com.Give (http://www.umed.com.Give) her a call and at least get some samples so you can see if this would be an option to go along with your intermittant catheterization. WHatever you do, stay away from the foley's as there UTI's waiting to happen.Good Luck

[Ken]

My urologist suggested the surgical suprapubic route a couple of months after my injury. I have a flacid bladder, but I leaked continually and was never dry. The concept was that the SP cat would present the least path of resistance and the urine would go through the cat into a leg bag - for some reason, 95% goes that route, but I still have 5% that drips out. I can unplug the bag (zero resistance), let as much urine drain out as possible, then flex my stomach (crede) and get 10-15 cc of urine out of my penis. Anyone have any idea what the problem is? The good news with the SP cat is I can hook up to a foley bag at night and not worry about over filling my bladder at night. Down side is I have a minor infection every other week.

[SCI-Nurse]

I have often seen patients with s/p's who have urine dribbling from their penis too. It may be related to the placement of the s/p in your bladder or positioning. For example, lying down would cause less leakage than sitting. Some patients would wear a birthcontrol condom on the penis just to catch the dribbling while up in the chair (if the amount is minimal). This requires good skin care in the area at the end of the day.
Is your output of urine large quantities? I am wondering if urine is leaking thru the penis as an overflow type response. (SAH)