cathing with false passage

[Distrbd]

I dont post as you can see, i usually read through old posts to get answers. I am a t-12 complete para 10 yrs post. I always IC with no problem until recently, i just found out i have a false passage right after my sphicter in my urethra. I had a foley cath in for the last 3 1/2 months to try & heal this all for not. My urologist told me to switch to coude caths which with the curved tip would get by false passage easier, not so sure about that 1 anyway but i cant get them for a week or so. Using my regular 1's are turning out to be a pain in the ass, i have no sensation which i think is good as far as cathing goes but i cant distinguish between getting in the false passage or getting by a spasming sphicter until i check to see if there is blood in cath, they both kind of feel the same as far as resistance & depth. When i see the blood i know its getting in the false passage which isnt making it smaller, he already said it was the biggest 1 he ever seen, so thats great(j/k). He first said that it was fixable with some kind of rotor-routing my prostate, now he says it cant be, because of the location of it, to close to some duct, yeah whatever. I guess this means i have to live with this, wouldnt even mind if it wasnt such a pain to cath. Using the foley for that long created more problems. Other then giving me a psudamonous infection that i couldnt get anyone to treat, but thats another story. It also shrunk my bladder so now it holds only around 300ml or so before i start leaking, which i never had that problem unless my bladder was overfull, over 1000ml. So now i have to cath every couple hrs & that is to many caths, i had to fight with Medicare to get the # i get. They are those Rusch/MMG cath kits, they are totally enclosed & are sterile. Had high incidence of uti's until i switched. How do i stretch my bladder back out without the use of Detrol or Ditropan or other dry mouth inducing meds? Sorry for the novel & thanks for any thoughts on my situation, PEACE...

[SCI-Nurse]

The usual treatment for a false passage is to put in a foley urethral catheter and let it heal. It is unusual for it to not heal after 3 months of having the catheter in place. Using Ditropan or Detrol while using the indwelling catheter can reduce the amount of bladder shrinkage. 450 cc. is about the maximum safe bladder capacity. 1000cc can actually cause damage to the bladder, increase the risk of reflux, and increase your risks for UTI by decreasing circulation to the bladder wall.

Have you considered intravesicular instillations of Ditropan? This is a good way to give this drug that decreases the risks for side effects. There have been many posts about this on this site in the past.

I don't know about MMG, but I know you can get Coude tipped catheters in the Bard Touchless cath kit. Coude catheters must be used properly though, or they can actually cause more urethral damage.

You may want to get a second opinion from an experienced SCI urologist if your false passage fails to close with the use of the indwelling catheter. Surgical reconstruction in the area you describe is very difficult, and rarely done for that reason.

(KLD)

[rye1945]

I cannot really offer you any advice on this situation since it has never happened to me. I was wondering if you and/or the SCI nurse could explain this false passage. What is it? How did it develop? Anything else you could add? I perform intermittant catheterization and would like to know about this potential problem that I have never heard of previously. Thanks.

[hank70]

I had the same problem a couple of years ago and switched to the coude tipped caths. I have not had any problems since, but they are more expensive than regular caths. Just make sure the blue guide line on the cath stays straight up.

[Distrbd]

Thank you KLD for your input. MMG do have coude in their kits to, those are the ones i am waiting for i hope. I say hope because i have to rely on my VNA to get these & i just have a feeling they wont get them. The reason i have to rely on them is they are seeing me do to a pressure sore on my ischial tuberosity. They got a foley cath for me to replace the old 1 & now Medicare wont pay 2 providers, even though VNA only come to check on sore, & have nothing to do with my cathing. Because i only have Medicare & no secondary insurance things like this seem to always happen to me. The small cracks i seem to slip through are looking more & more like deep canyons.

HC, a false passage is just what it sounds like, it is a passage way that forms in your urethra, it usually happens to us SCI people who have to cath frequently. It is empty passage way that can be more susceptible to infection.

I read Dr. Wise's post about placing a nitinol prostatic stent in the false passage of people that refused indwelling catheter. This seems like the only option i am left with but not sure if my urologist is aware of such a procedure, i dont even know if he is familiar with SCI.

This incontinence is really starting to get to me, i hate having to tailor my liquid intake due to this. I was wondering if there is anyway i can stretch my bladder back the way it was, without anticholinergics (Detrol, Ditropan). I would rather not deal with the side effects, if infusing it in the bladder takes away side effects i would maybe consider that route, but would rather not for the fact that it would cost me $. Not that i am cheap but i have been gathering some costly medical expenses as of late. Just had a rotator skin flap on my ischial that didnt take & now have to have another. This time he is going to do a skin & muscle flap, dont know where the muscle is coming from. Dont have much padding in the rear. I hope this time is the charm, been on almost a whole year of bedrest, no fun at all. Thanks for the input, i welcome all thoughts & ideas on this situation. PEACE...

[This message was edited by Sean on 07-14-03 at 03:23 PM.]