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Thread: Para Advice- Nurse- Wise

  1. #1

    Para Advice- Nurse- Wise

    I was wondering what is the best bladder management method for a
    t12-L1 incomplete para with low bladder capacity? I have cathed myself for 22 years. In those years, Ive always had leakage issues as my capcity is low around 200-250cc. I am currently on a foley as Im having bladder stones removed (im having my last procedure next week). The last time he removed the foley, I had urine gushing out. He said it was due to the stone and infection and placed the foley back in. The foley stays in until the final stone removal next week. Im wondering when the stones and infection are gone and the foley comes out, should I and will I able to go back to cathing. What is the accepted standard for someone with my level and bladder capacity? Do paras at my level actually use foleys,suprapubics etc. long term? Would something other than IC be better? Again, the leakage is always an issue. I just want to be clean, dry, infection free and be able to have sex when I want. I am able to achieve erection, orgasm and ejaculate.

  2. #2
    Leakage can usually be controlled with IC by the use of anticholenergic medications, but if your bladder has a small capacity due to shrinkage, not bladder spasm, they may not help enough. The same is true of Botox injections.

    Augmentation (surgery) is a possible option for you, but a big step because it is a big surgery. It would give you lower (safer) pressures and higher capacity though.

    IC still is the gold standard for bladder management. While many people with SCI do use an indwelling catheter, they put you at higher risk for stones, and since you just are getting rid of one that probably would not be the best idea. There is also research supporting more kidney deterioration with long term indwelling vs. intermittent, and after 10 years or so your risks for bladder cancer go up significantly. I am reminded of this with the diagnosis of bladder cancer for another one of my patients again this week, and unfortunately it is so advanced it is not operable or treatable with chemo, and has spread to his liver already.

    A SP indwelling would not interfere with sexual activity as much as an indwelling, but you still would have to wear a bag all the time, and that can be a turn-off for some.

    (KLD)

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