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Thread: Suprapubic after sphincterotomy

  1. #1

    Suprapubic after sphincterotomy

    KLD,
    it's time for me to find a way to stop using condom catheters.
    I am having a lot of skin breakdowns on my penis along with retractions that require me to tape the condom very tightly.
    I am using a Urocare Uro-cath condom with Ostobond latex adhesive. I use Elastoplast tape around the condom catheter.
    I have tried Bioderm catheters with very poor results.
    It seems that the superpubic catheter would be my best alternative.
    I have had a number of sphincterotomies through my 37 years being a quadriplegic.
    Will I still be able to have the superpubic?
    Can the sphincterotomy be reversed surgically?
    Are there any other solutions?
    Thank you,
    Wayne

  2. #2
    I would avoid using a latex catheter or latex skin bond like this if you have problems with your skin. Latex allergy can be easy to get with a SCI, and very difficult to manage.

    Try using a self-adhesive silicone external condom catheter. I can recommend either the Ultraflex or Wide Band by Rochester. Mentor also makes an Active-Cath that is latex free. With these you don't need to use Skin bond, but it is strongly recommended that you use a protective skin wipe such as Shield Skin or 3M No Sting Protective Barrier Swabs.

    If you have had multiple sphincterotomies, unfortunately is is very common to leak from the urethra if you have a SP catheter. You can discuss Contigen (collegen) urethral injections to try to tighten up the sphincter with your urologist, but not everyone is a candidate, and they don't work for all. They also may have to be repeated every 6-12 months.

    A urethral catheter may work better, but you can still leak around the catheter due to the previous sphincterotomies.

    (KLD)

  3. #3
    Senior Member
    Join Date
    Apr 2006
    Location
    Massachusetts
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    kld
    I have many of the same problems, and I use the Rochester catheters you refer to. Many times I have a retracting problem, causing the catheter to leak. Can those injections you speak of work to prevent such retracting issues?
    Thank you
    Shamrock

  4. #4
    Senior Member
    Join Date
    Aug 2001
    Location
    Melbourne, FL USA
    Posts
    1,673
    This may be a silly question because you're obviously an SCI vet but are you using enough "dry time". I used mentor freedom external catheters until one or two years ago when they sold that company to another one. Their quality control went downhill fast and I started using the Rochester brand catheters.

    Have you considered getting a smaller size? When I switched from freedom catheters to Rochester I went from a large to 32 mm.

    KLD I was wondering what the most likely course of bladder management I will need if I am no longer able to use external catheters. I have had no surgeries and only one urinary tract infection in the last few years (no stress, no UTIs) and I know intermittent catheterization will be beyond my capabilities.

    Is it possible to "tap and crede" forever or do problems inevitably occur? As long as I am still able to use this method I will but as HOS has had sphincterectomy and this impacts his options later in life, where is my biggest risk and what do I need to avoid that leaves me with the most options down the road.

    The same question as it applies to aging and my bowel management program. Currently I use a bicuspid suppository every other day using a suppository inserter. Sometimes I need digital stimulation but that is usually only 1% of the time. Sometimes I will use MiraLax when I noticed my stool is too hard but for the most part I rarely use laxatives and when I do it's usually half a bottle of citrate of magnesium.

    As long as I eat correctly and keep up my rhythm I do not have any problems with my bowels (except for the fact SCI already has messed things up) and I wonder how do you know if you need to get a colostomy. In 25 years I've only been "impacted" once and that was because narcotics got in the way.

    I also know that my right elbow is going to be giving me trouble from my transfers. 80% of my transfers are to the left subsequently stretching my right arm out. What do I need to watch out for so I do not hurt this any further? It is basically "tennis elbow" and have had cortisone shots that have not helped any and am really only bothered by it when the weather changes. When the barometric pressure changes it will causes significant discomfort by the third sip of coffee in the morning.

    The bottom line is where is most of my risk of losing independence going to come from as I get older

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