Results 1 to 8 of 8

Thread: More Suprapubic Questions

  1. #1

    More Suprapubic Questions

    To all responders and SCI Nurse, thank you for the responses. I do have a few more questions though.

    In the article "suprapubic cystostomy vs. urethral catheterization", it is written, "Despite the high incidence of bladder stones, bladder cancer was not more higher in patients who use suprapubic catheters compared to those who use intermittent urethral catheterization, i.e. 0.07% in patients managed with either suprapubic or intermittent urethral catheterization, compared to 0.17% in those managed with indwelling uretheral catheters (West, et al, 1998)."

    From what I was previously taught, and the way that I read your post, it seems to contradict the article. Am I understanding you correctly that there is a greater chance of bladder cancer with a SC?

    The article also states that: in people with spinal cord injury, suprapubic catheterization is associated with significantly lower incidence of urinary tract infection than intermittent catheterization, i.e. 12% vs. 26% (Mitsui, et al, 2000). I have always heard just the opposite, that those with SC have more infections.

    Also, how easily can a SC be inadvertently dislodged? I would have to say that I am more of an active individual, compared to others with my level of injury, doing a regular exercise routine and outdoor activities. Could this pose a problem if I chose to go with a SC?

    I have sensation below my level of injury. It has always been referred to as impaired, being that I do not feel light touch. I am very aware of the catheters location when I currently intermittent cath though. Is the constant sensation of a suprapubic catheter troublesome to those with sensation?

    If I do choose to go with a SC, can it be easily reversed so that I can return to intermitent catheterization?


    I appreciate the information, Josh

  2. #2
    I will try to answer your questions:

    1. The incidence of bladder cancer is very small - and is probably not statistically significant, which is why the statement that they made.

    2. While all indwelling catheters can lead to a greater incidence of infections, there are many people whom I know that once they had a SP tube placed, the incidence for them did go down. It is probably related to the decrease in stones that we see in people with SP tubes.

    3. While it is not impossible to dislodge a SP tube, it is very difficult. Your active lifestyle should not be a "con" in figuring out whether this is an option for you.

    4. As far as the sensation, I am not sure what to tell you. Every person is different.

    5. You can reverse the SP so that should not be an issue if you choose to go with it.

    ckf

  3. #3
    Thank you for answering my specific questions.

    I visited my urologist today. I explained my reasons for wanting a suprapubic catheter; uninterrupted sleep, convenience, more dependence, and so on. They suggested that I first try using a Foley catheter for times when intermittent catheterization is disruptive, such as when I'm sleeping at night and on outings when catheterization is more difficult.

    In the 10 years that I have been injured, no one has previously suggested this. Are there other individuals that routinely do this?

  4. #4
    I've read about a number of people on Care Cure Community using indwelling urethral foley catheters at night and when it is inconvenient to intermittent cath (personally, I always found it inconvenient to intermittent cath). That said, it can be expensive and your insurance or medicare may not pay for both intermittent and foley catheters.

    While I was using intermittent catheterization, I would occasionally use indwelling urethral foley catheters, usually for 2 to 3 weeks on vacation or a business trip. If my memory is correct, it seems to me that invariably when I returned home, I'd end up with a urinary tract infection. I never really understood why. I have had very few urinary tract infections with my supra pubic catheter (SPC). I do instill HydroCleanse or MicrocynAH daily to help reduce colonization and prevent urinary tract infections.

    Just a comment about the reversibility of a SPC. In theory, and in the typical community medical setting where supra pubic catheters are used for a short term, a couple of weeks, a month, the procedure is reversible. But, when you use a SPC for long term, the bladder shrinks to almost nothing and can hold very little urine. Stretching a bladder back to a reasonable size to hold enough urine so that you can cath every 4-6 hours is not an easy thing to do, if it can be done at all.

  5. #5
    You are absolutely right about the time factor in reversing the SP. Thanks for including that.


    ckf

  6. #6
    Senior Member wheeliegirl's Avatar
    Join Date
    Nov 2002
    Location
    2 blocks away from the Real Housewives of Orange County
    Posts
    388
    I just had my SP catheter put in, in November. For the most part I am happier with it than a urethral catheter. It is less bothersome (as a female), gets clogged less (not sure why, I had augmentation almost 20 years ago), and it seems easier to change (I don't do this myself, have only had doctors change it. Next month will be a home nurse).

    What I don't like about it, is having to wear a dressing. I'm squeamish and HATE changing it, hate looking at where the catheter comes out. It bleeds and/or drains often (not a lot anymore, but still its enough to gross me out. Doctors and nurses have told me it's normal). I change the dressing every other day. The good thing is that the dressings and tape aren't too expensive and are obtainable via Amazon.

    Sometimes underwear can cut off the flow, due to where it comes out under/through the leg opening of my underwear, but I've managed to fix this issue. For guys, they have it easier (as always) because they have the opening in the underwear.

  7. #7
    Thank you for the responses, It's helping me come to a decision.

  8. #8
    To answer your questions:

    - Any indwelling catheter can increase the risk of UTIs. But then again so can restricting fluid intake as you're currently doing or the urethral Foleys they are suggesting you try. There's all kinds of tricks to reduce UTIs, keeping fluids up, flushing etc. Everyone has different tricks.

    - It is very hard to dislodge an SP cath. I once went an entire month with the balloon deflated and the thing never came out, even after pulling on it accidentally. I suppose it depends on how much muscle tone you have in the area but I hardly see the muscles around the SP allowing a balloon with 10 or 30mL to pass through very easily.

    - I have sensation and the presence of the SP doesn't really bother me at all. But that's me. Depends if you're hypersensitive in that area, or how your body reacts. At first I felt it there all the time, and I felt the leg bag too but when it's always there I guess your body learns to tune that, kind of like you notice glasses at first when you've never worn them before? Sure if I wear pants that are too tight it might get irritated after a few hours, or if it gets pulled around too much. But I secure the tube with a stat-lock on my leg, and a piece of 3M blue silicone tape (leaves no sticky stuff behind and can be repositioned) and nothing moves. If it really hurts (as in it's not because I pulled on it accidentally), then it means there's some sort of issue - either a UTI or I had an abscess along the tract once. This stuff is pretty rare though. Bonus that you have sensation, you'd notice these things and you want to notice them.

    - I don't see how an SP cath could be a problem with being active? If anything it has allowed me to be MORE active! I don't have to worry about finding washrooms, or accidents. I don't have to worry about being far from washrooms or lack of privacy like when I was intermittent cathing. I've gone camping, kayaking, swimming, cottaging, and using my racing chair without ever thinking about the SP cath. I shovel snow in the Winter, I play with my rowdy 120 lbs dog without worries. I can't think of very many activities you wouldn't be able to do with an SP cath? Just make sure everything is taped down and good to go. Maybe not swimming in a very dirty lake (and if I had to, I'd find a way to seal off the stoma).

    Quote Originally Posted by wheeliegirl View Post
    What I don't like about it, is having to wear a dressing. I'm squeamish and HATE changing it, hate looking at where the catheter comes out. It bleeds and/or drains often (not a lot anymore, but still its enough to gross me out. Doctors and nurses have told me it's normal). I change the dressing every other day. The good thing is that the dressings and tape aren't too expensive and are obtainable via Amazon.
    Maybe I'm just weird but I haven't used a dressing since a month after the surgery. It doesn't leak at all and only oozes a bit if I have an infection...

    Quote Originally Posted by gjnl View Post
    Just a comment about the reversibility of a SPC. In theory, and in the typical community medical setting where supra pubic catheters are used for a short term, a couple of weeks, a month, the procedure is reversible. But, when you use a SPC for long term, the bladder shrinks to almost nothing and can hold very little urine. Stretching a bladder back to a reasonable size to hold enough urine so that you can cath every 4-6 hours is not an easy thing to do, if it can be done at all.
    Unless you use a valve to close off the SP. My bladder has shrunk very little in the 3 years I've had my SP cath. Keeping my bladder capacity was a happy side-effect, though I didn't have a large capacity to start with. I started using the Flip-Flo valves was because it wouldn't drain properly otherwise after trying every catheter out there and I would actually get more frequent UTIs if I left it free-flowing because uh, it wasn't free-flowing at all haha. But then again you need some level of sensation to know when your bladder is full for this to work (which I have) and/or this may not work for everyone but it works for me and my urologists are on board with it. I also use a button feeding tube in my SP because I found it works better than regular catheters so I have a weird set-up, not sure it's comparable to most SPs.

    Point is, if the standard way of doing things doesn't work for you, you can tweak things I guess? I'm a really weird case of pelvic dysfunction/spasms on top of a neurogenic bladder and being the size of a 12 yrs old so regular catheters weren't working for me, so please don't let this put you off an SP lol. I wasn't sure about mine at first but I had no other conservative options, I made it work and I don't regret it. I suppose you could try it and see if it works for you. Like they said it may not be fully reversible after having one long term but giving it a few weeks to a few months should be feasible if you're really set on the idea to try this, I mean, if your quality of life could really benefit? Though I'm no medical professional, might be worth asking your doc what they think about how reversible it would be after x time for you. I'm sure there's people that hate theirs but I happen to be quite content with mine. Everyone's different.

    Either way, I love my SP. It's caused some issues (like more infections, but I've learnt my warning signs and what to do about it) but I got it because I could no longer do intermittent caths and the alternatives to it were invasive surgery. Gave me my life back too - don't have to worry about accidents anymore, or being up several times a night, or having to severely restrict my fluid intake. I drink as much as I want, I can travel now, do a lot more activities without having to worry and I sleep through the night!

    Edit: Having no tubes down there is a plus, and I no longer have to wait forever for that one accessible stall. Just pull into a regular stall and empty the leg bag even if you can't close the stall door behind you...who cares because you don't have to drop your pants. I mean privacy is nice but if you're stuck. You can also empty the bag in an empty bottle if you're stuck in rush hour traffic, or elsewhere in a remote grassy corner if there's really no washrooms (camping!). Also, I don't know how spazzy you are but I had a hard time balancing to cath and bending over. SP solved that!
    Last edited by twistties; 10-22-2017 at 11:12 PM.

Similar Threads

  1. Suprapubic Questions
    By TomRL in forum Care
    Replies: 0
    Last Post: 06-03-2009, 01:29 PM
  2. Suprapubic Catheter Questions
    By Violet in forum Care
    Replies: 6
    Last Post: 09-26-2008, 03:10 PM
  3. New suprapubic catheter - questions
    By zillazangel in forum Care
    Replies: 3
    Last Post: 02-11-2008, 08:28 PM
  4. suprapubic questions
    By Jimi5 in forum Care
    Replies: 4
    Last Post: 11-17-2006, 02:17 PM
  5. New suprapubic catheter questions?
    By C5_Since_1983 in forum Care
    Replies: 11
    Last Post: 02-16-2004, 04:54 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •