What type of cath?

[grbrown]

I am a C-3 - 6 tetrapalegic, 2 1/2 years post. My Urologist and I are having some discussion on intermittent cath versus external cath. No one thinks I can learn to cath myself, so I prefer the external cath. Also, I read the SCI Nurse's article about less invasive equals less UTI's. So, what differences have you found between external cathing and intermittent cathing? Especially UTI's and accidents.

Thanks

[SCI-Nurse]

What is your actual neurologic level? The C3-6 sounds like your fractures, which is different. Do you have only biceps and deltoids? Do you have tenodesis? If so, you can undoubtably cath yourself if you are male...difficult if you are female.

To use an external, you may have to have a sphincterotomy. This is a "burn your bridges" procedure which may have to be repeated every few years, and means that you will always dribble urine (have to always wear an external and bag), may have loss of reflex erections (depending on the procedure used) and will probably have only retrograde ejaculation even with assisted ejaculation. If you do not drain completely and carry any significant residual you may still have to cath several times daily. If your bladder does not drain just right, if your sphincter is tight or your bladder has higher pressures (which can occur over time) your upper tracts (kidneys) are more at risk; sometimes with even more risks than an indwelling catheter for UTIs and kidney damage.

(KLD)

[handibob]

have been using external cath, condum, for almost 3 yrs now. no uti's since, i don't dribble and i drink lots of water. for me, this has been the best, i'm c5-6 inc no surgical procedures for cathing and i have had a urodynamics test, aka pressure of the bladder test. hope this helps, bob

[grbrown]

The C3-6 is incomplete. I have use of my biceps and deltoids in my left hand only (I was right handed). I have been tested for bladder pressure and I have high pressure before voiding. If I go external the Urologist suggested that I choose between a sphincterotomoy and a Urethral Stint (I am leaning toward the stint). If you still think I can cath myself I would be greatly encouraged.

Thanks,
Brownie

[crags]

Every type of bladder mgmt has pluses and minuses. I'm 15 yrs post and had a sphincterotomy after about 6 yrs, then 6 yrs later a stent, then 1.5 yrs later stent removal, then 6 mos later a second sphincterotomy, then 6 mos later bladder augmentation. After the 1st sphincterotomy, it was trying to save a sinking ship. Externals can really suck in many regards, but other options have difficulties as well. My only advice is that as you age, consider whether your current bladder mgmt is still "working" (lifestyle, work, health, etc) for you (not just your doc) and don't wait year after year suffering. Be informed and then make your decision.

Lastly, having an external in no way protects you from UTI. In can, and is in many persons, worse than intermittent. What's key is pressures, residual, reflux, body response (dysreflexia), skin condition, etc.

Good luck.

[SCI-Nurse]

Brownie, if you do not have tenodesis (at least one one side) it is very difficult to self cath. You may want to consider the stent, as this is a non-permanant change that can be removed if you do not like it or it does not work for you. Sphincterotomy is more permanant and cannot be undone.

(KLD)