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Thread: indwelling catheter vs suprapubic catheter (female)

  1. #1

    indwelling catheter vs suprapubic catheter (female)

    I am a fairly new member to this site. I dont have a SCI, but i do use a wheelchair and have severe incontinence requiring a catheter (since october 2011). This is all fairly new to me so forgive my ignorance. I want to know the pros and cons of indwelling vs suprapubic catheters?

    When pads and incontience pants did not control my urinary incontinence and also it was super embarrasing when i leaked everywhere all the time and also for physical disability reasons cos i am unable to transfer to ANY public toilet including "accessible, disabled" whatever you want to call them toilets my urologist suggested trialling a catheter (indwelling) she said that i was totally in control of the trial and that i could cease it at any stage. However There have been many pros to the catheters as well as many cons (including 3 visits all in the middle of the night, once via ambulance to the emergency dept of my local hospital. Ive also had a nasty and rather ongoing UTI as well which kinda sucks, GP has treated this with antibiotics and also now on a prophylactic.

    I go back to my specialist urologist dr on 19th january so i am wanting info on this so i feel more like i have a clue about the differences. She said in october at my last apmt (she put all of the catheter management training and care into the hands of the RDNS (royal district nursing service who come out to my house and have apmts and change the catheter etc etc) so she hasn't seen me since last year, that if i like the catheter and its useful ie i dont have to transfer to toilet for wee and therefore its only once a day much more unlikely to be when im out etc etc, then she would consider the procedure (of which i know nothing about) to have a supra pubic catheter put in. Apparently the leg/night bag and also the valve (im using the bard flip flo valve which im having some difficulties with as well) is all the same its just the placement of it that changes.

    I am married so i am guessing it may help in the intamacy area esp given we would like to have kids one day soon.

    But other than that i dont know anything at all.

    Unfortunately part of my disability is undiagnosed which is why ive waited so long before having children (and have been wheelchair user/had disabilities for 31/2 years). It is possible that i have a genetic condition called mitochondrial disease a type of muscular dystrophy. the geneticist is waiting for tests for this from the US (I am in australia).
    the reason i say this is because many people with this have problems with anesthetics and in the past ive had multiple probs with medications and such. Also had a extrmely difficult time getting a diagnosis.

    I also have diagnosed dystonia and i am aware that there are definately anethetics that should not be used with this condition.

    So what type of anesthetic is usually used or does it depend on the patient. Is it really painful??? and what are the pros and cons between the two catheter types.

    Has anyone here used the bard flip flo valve? it goes between the catheter and the leg bag and basically if you can feel when you need to go you open it and then shut it off again thus retaining some bladder function. thats my understanding. the issue i have is that i open it and then i close it about 10 mins later i need to open it again either that or i forget (due to cognitive issues) that the darn thing is closed and it bursts out around the catheter NOT GOOD!!!!! once that ended me up in the ED!!!! So ive been leaving it open for a much longer time like 1 or 2 hours at a time then closing it because otherwise i would not get anything done. According to the nurses ive had they believe i have bladder spams and im guessing they are the cause of the actual incontinence. the pain and weird feeling ive been getting and the way i need to go so soon after closing and opening the valve is EXACTLY what happened prior to having the catheter so even though its been one long tough journey ive certainly learnt a thing or two!

    hope someone has some advice, sorry this is so long!
    from erin

  2. #2
    Moderator jody's Avatar
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    I have had an indwelling and I IC now. the only reason I have not gotten the sp is because I have hangy belly where the stoma would be. if you are younger, and not yet through menopause, a indwelling is probably a good choice, so you can do either indwelling or intermittent cathing.

    If my tubing got crimped and could not empty into the bag, I got very very sick very suddenly. I used a belly or night bag.

    I have been reading a lot about sp catheter and another procedure called mitrofanoff.
    the sp procedure is fast, and is easily reversed by just removing the catheter and letting the hole close, which it will do in only a few minutes. The mitrofanoff is a major abdominal surgury, not reversable and the stoma can come out the belly button or just above the pubic bone as the sp does, but the mitrofanoff does not need to be always connected to a bag.

    I still don't know what is best for me at this time, but I think the mitro because of the stoma placement, and the no bag option. If I could get a tummy tuck, I would choose the sp though, because if there is a cure, the supra pubic is easily removed.


    I have two close friends who got the supra pubic, and both had a lot of leaking at first. one is because of a tiny pelvic area, and apparently it is hard to place the catheter correctly for her so she leaks, the other did not leak for long after the surgery. Both are very happy now with the supra pubic procedure.

  3. #3
    I have a neverending love/hate relationship with the Belly bag. I think it is the greatest and most comfortable and convenient idea, but the valve to empty has injured me, sometimes it gets clogged and does not fill until I leak around the foley and just recently the white plastic in the back gets this nasty smell (not urine) that can be felt by anyone around me, even on new units a couple of days after initial use. I love it, but it gives me problems consistently. But I donĀ“t see too many complaints about it.
    T6 complete (or so I think), SCI since September 21, 2003

  4. #4
    Moderator jody's Avatar
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    paramoto do you rinse your bags with bleach and water solution? you have to let it dry completely after the bleach too.

  5. #5
    The whole idea of the flip flo valve is to make the bag not run all the time. That way the valve controls the flow of the urine just like if you didn't have a catheter. I am not paralysed but i am incontinent (probably due to a type of muscular dystrophy and i have movement disorder, called dystonia). This is the way the nurse set it up when she inserted the catheter. The bag already has a valve closure at the bottom of it. The idea is suposed to be so that you dont lose bladder function from having a catheter all the time. thats the way my urologist described it. I will definately ask her when i see her. When i went to her last time (about 4 months ago) and told her that my incontinence was worse and what could we do cause i was sick of getting wet all the time because the pants think incontinence pants were not working. thats when she suggested a catheter and a trial. She said that it was up to me how long i did the trial for and i could stop it at any point and then she described the flo valve as a cork and said it basically plugs it up so no urine comes out then when you feel you need to go you open it and it drains into the bag. Some people prefer not to have a day bag at all but i chose to have one because i thought it would be rather difficult say if in long pants to get the flo valve out of pants and squirt into toilet!!!!! And the thing is once the bag is attached it must be changed every 2 weeks maximum. the day bag is not cleaned but the night bag is washed out every day and dried fully before using again. I was told to use dishwashing detergent and water and then vinegar and water. Thats what the home nurses taught me. Hoping to gain more info about the SP i was told it only requires a local anesthetic by one person and to be honest that put me off cause i dont like the idea of needles down there and someone doing a procedure while i am awake!!!! Sounds ghastly if nothing else i would say the dystonia would freak and i would have a hell of a time trying to control it enough to stay still!!! Dystonia is a movement disorder and it sets off at a drop of a hat!!!
    I dont think that I am physically able to intermittently cath i think i wouldn't be able to stay still enough and because the wee comes so damn fast and so often i think that i would just end up way more incontinent and wet like it used to be. This has been no picnic mind you but in some ways definately better than what it used to be like.
    thanks for your replies. I hope some other people reply before my appointment on wednesday.

  6. #6
    In the UK and Australia I have seen urologists recommending clamping indwelling catheters and draining intermittently. This is not considered safe by urologists in the USA, as it can lead to reflux of colonized urine to the kidneys, causing serious kidney infections, and can cause back-pressure (i.e., high pressures) in the bladder, which can damage both the bladder and kidneys. No studies have been done that show this is safe.

    The Bard Flip-Flo valve is designed (and safety and FDA tested) to be used ONLY at the drainage end of the leg bag, to make it easier to empty the bag (into which urine is constantly draining). It does NOT belong, nor was it designed to be used, between the indwelling catheter and the bag. If your providers are using it this way, they are definitely using it in a way that I would consider unsafe. They would have to jerry-rig the bag to use it this way.

    (KLD)

  7. #7
    I was wondering why clamping a catheter would be a problem? When you intermittently cath., your bladder is holding urine. Why would that be different?

  8. #8
    Quote Originally Posted by tinern View Post
    I was wondering why clamping a catheter would be a problem? When you intermittently cath., your bladder is holding urine. Why would that be different?
    When I was first injured, my bladder didn't open, no matter what kind of pressure was built up. I didn't feel it, so...

  9. #9
    Just a clarification. Both a urethral indwelling catheter and a suprapubic indwelling catheter are indwelling catheters. One is inserted through your urethra, and one is inserted through a surgically created stoma just above the pubic bone.

    Clamping of indwelling catheters is not recommended in people with SCI who have neurogenic bladders. This is because of several issues including 1) common to have high bladder pressures in those with SCI, which increases the risk of reflux of colonized urine (a given with an indwelling catheter) up the ureters to the kidneys. Both the back water pressure is dangerous to the kidney tissue, and the risks for causing kidney infections, 2) because this can lead to autonomic dysreflexia in those at risk (injury at T7 or above), and 3) significant increased risk of UTI when the bladder is over-distended (beyond about 425 ml.), esp. if you forget to to drain.

    Having a foreign body in your bladder creates an environment that makes you more vulnerable to bladder cancer, bladder stones, and bladder infections/colonization compared to an able bodied person with a normal bladder.

    Women can have special problems related to the use of indwelling urethral catheters over time. One is the risk for development of a "patulous" (stretched out) urethra, which can lead to leakage around the catheter and even dislodgement of the inflated catheter balloon through the urethra. This is likely to get worse after menopause, when the urethral (like the vagina) looses much of its elasticity and the tissues thin (esp. those that make mucous). This makes it more difficult for your body to seal around the catheter and prevent leakage. Use of a SP catheter can prevent these problems, and be a means for management of these problems if they have already occured.

    (KLD)

  10. #10
    I hesitated to get an SPC for a long time because I have a belly overlap. I also have very sensitive skin, prone to breakdown. I was forced to do it because I started to have problems retaining the balloon from a foley.

    If you have that area, you are probably used to the clean and dry routine, SPC adds very little to that

    It it was placed directly in the crease where the flap folds over. I take blood thinners, so it continues to ooze a small amount of blood tinged ..mucus? Dunno exactly. I clean the stuff off with a diaper wipe in the morning, clean the raw bits with saline and a bit of gauze. I take a gauze 4x4 and twist it a bit around the catheter where it comes out. This keeps it clean and catches any drainage. At night, I once again clean it fairly casually, wrap another 4x4 around it for the night.

    none of the issues I worried about happened. No skin breakdown, the tube has not irritated my skin..nada. If I wasn't living in a nursing home I would be apt to use a soapy wash rag to clean it am and pm. When I shower, I let the water run on it for a bit, I feel like it washes extra debris away. The urologists nurse says mine is a bit messier than if I hadn't been on blood thinners, but it's quite manageable. I am telling all, because I wish I had done it years earlier.

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