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Thread: Cathater selection

  1. #1
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    Cathater selection

    Hi all I have a friend who is 42 and is a c6 level quad 25 years post injury. For most of the time in the last 25 years he was on condom catheter not using intermittent catheter along as most doctors recommend for complete emptying of bladder. Recently he did tests of kidneys and bladder and luckily there was no problem. Since last one year he has been on indwelling catheter. He tried external catheter last week but the urine outflow was too frequent indicating decrease in his bladder capacity. He is also getting married next month. please give suggestions that which catheter should he choose now. Should he start taking taivor tablets for increasing his bladder capacity and come back again on external catheter, or should he go for superapubic catheter? What will be your suggestions? Thanks

  2. #2
    I am not sure that taivor tablets will work and increase his bladder capacity. It is no longer the recommendation to use just condom drainage since it can cause a lot of complications. That would mean, depending on the results of his bladder tests, either intermittent cath or a suprapubic. There are also other options such as a mitraoff valve, but they are involve rather significant surgery. I would encourage you and him to look at the Neurogenic Bladder Guidelines posted at the top of the Care Forum page for ideas on how to manage a neurogenic bladder. You also need to speak with his physician and see what the recommendations are given his test results.
    CKF

  3. #3
    I an 31 years post injury, about the same level of injury as your friend. My bladder management techniques have followed pretty much what your friend has experienced. I started out in rehab with a spontaneous bladder and wore a condom catheter for a long time, until I had to start intermittent catheterization (CIC). I used CIC for many years until I began getting frequent and recurring urinary tract infections and I was having to cath about every two hours (always on Oxybutynin and I tried Botox). My quality of life was about a 0 on a scale from 1-10. I wore an indwelling urethral catheter for a short time while I was trying to decide what to do. My options were suprapubic catheter and a couple other procedures that (as SCI nurse CKF indicates above) are major surgeries with weeks of recovery time. I consulted with a urologist who specializes in the care of the neurogenic bladder, my regular urologist and my primary care physician. In the end, I opted for the suprapubic catheter. I reasoned that I would take a "baby steps" approach to this problem, start with the most simple options and if that didn't work out, I would still have other options.

    I had the suprapubic catheter placed about 3-1/2 years ago, and my only regret is that I didn't have it done sooner. I was not comfortable long term with the indwelling urethral catheter. I had read about meatal and urethral erosion and didn't want to have to deal with the possibility of that. Sex is easier with a suprapubic than with an indwelling urethral catheter. I use Vetericyn to help prevent colonization and urinary tract infections and I have had very few infections since the placement of the suprapubic.

    If your friend has more questions, please ask them here or feel free to send me a PM. Better yet, try to get your friend to post here and take advantage of discussions about many spinal cord injury issues.

    All the best,
    GJ

  4. #4
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    Thanks CKF and GJ. Physiatrist here also forbid using external catheter alone. But I have seen dozens of cases using this option only for decades with out any complications. Being a c6 quad I also used this option for 8years. But was detected with 5mm kidney stone last year. Don't know whether it was because of using external catheter. My friend is seriously thinking about coming on superapubic catheter . But he has some questions. First is that option reversible? Mean can one come again to external catheter from superapubic catheter? With superapubic catheter is there chances of urine leakage through urethra?

  5. #5
    Yes, a suprapubicis reversible. Most people I know who have had it done, are like GJ- wish they had had it done earlier. Once it is established, there is very little chance of leakage. Water(or in this case, urine) takes the easiest path it can and the catheter is it. I would strongly suggest that an external catheter alone is not a safe option over the long term. Yes, I know many people who managed (and continue to manage) their bladder this way. The evidence today more than suggests that this is not the safest way to go. When we did that management program in the past, we didn't know better. Now we do - Please feel free to continue to ask questions- it's the best way to find things out. CKF

  6. #6
    The suprapubic is reversible with a caveat. While on any kind of indwelling catheter either suprapubic or urethral, the bladder will shrink. A small bladder will not be able to hold urine between 4-6 hour normal intermittent catheterization cycles. It is doubtful that your friend could go back to a condom catheter, because the conditions that drove him to use an indwelling urethral catheter still exist which are probably high bladder pressure and urine retention when he is trying to use a condom catheter. You said your friend had some tests and the bladder and kidneys were fine. Did he have urodynamics testing?

    All the best,
    GJ

  7. #7
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    He did ultrasound and some other tests. Do urodynamic test show any other problem also along with bladder pressure and capacity!?

  8. #8
    Quote Originally Posted by asif
    He did ultrasound and some other tests. Do urodynamic test show any other problem also along with bladder pressure and capacity!?
    Here are some excerpts from information provided by the National Kidney and Urologic Disaeses Information Clearinghouse about urodynamics testing. You can read more detail at: http://kidney.niddk.nih.gov/kudiseas...ic/#urodynamic

    Urodynamic testing looks at how well the bladder, sphincters, and urethra are storing and releasing urine. Most urodynamic tests focus on the bladder’s ability to hold urine and empty steadily and completely. Urodynamic tests can also show whether the bladder is having involuntary contractions that cause urine leakage. Imaging equipment takes pictures of the bladder filling and emptying, pressure monitors record the pressures inside the bladder, and sensors record muscle and nerve activity. Urodynamic tests include uroflowmetry ,postvoid residual measurement, cystometric test, leak point pressure measurement, pressure flow study ,electromyography, video urodynamic tests.

    These tests help a urologist recommend an appropriate bladder management technique.

    All the best,
    GJ

  9. #9
    Nothing more to add to GJ's post CKF

  10. #10
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    Thanks a lot. This was really informative.

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