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Thread: Indwelling Foley Catheter Problems

  1. #1

    Indwelling Foley Catheter Problems

    I am a T8 incomplete spinal cord injury. For the past three and a half years, I had an indwelling foley catheter. It worked fine for the first two years and then I started having problems with leakage so they increased the size of the catheter from a 14 french to a 16 french which helped for a little while. It has leaked off and on ever since which is quite miserable. And I don't why? But yesterday I started having major problems. Every time I put the catheter in it would come right back out with the balloon intact. It had done this in the hospital and the urologist said to increase the size of the balloon which didn't work then, but I was desperate and willing to try anything. So I gradully increased the size of the balloon from 15cc to 30 cc (I have a 16 french 30 cc catheter). But each time I put the catheter in, it would come right back out with the balloon intact. Does anyone have any ideas of why it is doing this? I had to miss a friends party because of this problem and I finally gave up and left the indwelling foley out. I had tried switching to a new catheter too. Does anyone have any ideas of what I can do? This has never happened to me before and I have run out of ideas. I have an appointment with a neuro urologist on Monday (the soonest they can give me and they won't give advice over the phone). Anyone please help! I am going insane!

  2. #2
    I assume you are female. How much Ditropan or other anticholenergic meds are you taking? These are the right way to manage leakage with an indwelling urethral catheter, not by increasing the size of the catheter or the balloon. Doing the latter just further irritates the bladder, causing more bladder spasm and more leakage. A larger size also stretches out your urethra. We never recommend larger than a 16 Fr. with a 5 cc. balloon (filled to no more than 10 cc.) for urethral indwelling catheters. Most people with SCI with indwellings do much better taking an anticholenergic medication to prevent leakage, bladder skrinkage and reflux.

    How old are you? Development of a patulous urethra in women with SCI usually takes a number of years (more than 3 1/2 usually) and is made worse by menopause.

    Wondering why you are using an indwelling catheter at your level of injury? Did you not try or were you unsuccessful with intermittent cath? Have you considered a Mitrofanoff? After 3 1/2 years of an indwelling catheter, you probably have a very small bladder capacity, so to do that you might have to have an augmentation too in order to go that route. Do you have a urologist who is expert in neurologic urology?

    (KLD)

  3. #3
    Thank you so much for responding. Yes I am a female and am 25 years old.
    I was injured at the age of 19. I am currently not taking any ditropan or similar drugs because I was told that I didn't need them when they gave me the indwelling foley catheters. I initially did try intermittent catherization, but had numerous problems with it. I would leak every hour, so on the advice of my neuro urologist at the time, I started cathing every hour, but the bladder still leaked. So he increased the ditropan, but that didn't help either. So then he finally just wrote a script for an indwelling foley catheter. He didn't explain to me any of the problems that I could/would have with an indwelling foley (such as increased urinary tract infections.) He also didn't mention a suprapubic tube which I have been told would have been a better option. After he wrote the script for the indwelling foley catheters, he said that I should schedule a urodynamics test in six months. He rescheduled that procedure 12 times in a row. On the 13th time, I had been admitted to Johns Hopkins with a low blood count, fever, and pneumonia so I called and told him that I would have to reschedule which didn't make him happy. So after that, I didn't feel comfortable returning to him. So since I am in the hospital a lot (4 surgeries in five years, plus numerous illnesses and transfusions), I relied on the urologists there. However I received many different answers to the same questions (some urologists would treat urinary tract infections, others would only treat them if I was symptomatic.) None of them felt qualified to handle my case.
    You stated that patulous urethra would take a long time. However when I was in the hospital a doctor stated that the leakage was caused by stretching of the urethra and I should continue to increase the balloon size and go up to an 18 french catheter eventually. He said it would only be a temporary fix. He had also suggested a drastic surgery in which the bladder was removed, but he did not perform surgery so he suggested I see another doctor but did not know of a urologist that performed surgery. So based on his advice, I have gradually increased the balloon size and put about 15cc in it now. Should I decrease the balloon size? Or is it possible that my urethra is so far stretched that I have to keep the balloon size at 15cc and keep gradually increasing it.
    I have an appointment with a urologist who has experience with neurogenic bladders on Monday. To my knowledge, Chesapeake urology is the only place in the Baltimore/Washington area that has neuro urologists. Do you happen to know of any other doctors within forty miles of the Baltimore area? I really prefer a female urologist.
    My spinal cord injury is incomplete and complicated and I spoke to my neurosurgeon about the procedure that involved removal of the bladder and he did not want me to undergo any drastic operations because he believes that I will probably get return of bladder function once I am walking again which will occur with intensive therapy. I have shown drastic improvements in standing and movement of my legs in therapy prior to this past surgery. Thank you so much for answering. If you have any other suggestions, please let me know.

  4. #4
    You definitely should have been put onto anticholenergic medications when you had the indwelling catheter put in.

    I would agree you need a new urologist. Going from a urethral foley catheter to a bladder diversion is a big drastic step without considering many interium steps that are less drastic (and don't burn your bridges like this).

    Options would include:

    -SP catheter. Problems with this may be urethral leakage since you have such a patulous urethra already. A bladder "sling" procedure might help with urethral leakage if that was a problem. Of course this is still an indwelling catheter, with the accompanying problems of more risks for UTIs, stones, kidney damage and (long term) bladder cancer. This is a reversable procedure.

    -Mitrofanoff. This is a conduit from your bladder to your abdomen (to your belly button, or close by), usually made with your appendix. You then do intermittent cath through this, which is easy since you do it on your abdomen. Your bladder is left in place, and you can also have a urethral indwelling catheter for short term if needed short term (such as when in the hospital). There is still some risk of urethral leakage, but again, a sling might help with this. Pediatric urologists are usually the best resource for this surgery. This procedure is potentially reversable.

    -Indiana pouch. This is a urinary diversion, but it is continent, so you catheterize through it (through your abdomen again). The bladder is usually not removed unless it is cancerous. This is the biggest surgery of these 3, and should not be undertaken unless other options have failed. Not reversable.

    -An ileal conduit. The bladder can be left in place or removed (generally only done if your have bladder cancer). You must wear an appliance glued to your abdomen and drain into a bag all the time. Strictures and stones are pretty common. Cosmetically this is the least desirable of all the options above. Not reversable.

    Personally, I think it is way too early for drastic action. See another urologist (or two, or three) before you make up your might, and if you have to travel to find the right one, take the time and effort to do so.

    (KLD)

  5. #5

    Thumbs up

    Quote Originally Posted by SCI-Nurse
    A larger size also stretches out your urethra. We never recommend larger than a 16 Fr. with a 5 cc. balloon (filled to no more than 10 cc.) for urethral indwelling catheters. Most people with SCI with indwellings do much better taking an anticholenergic medication to prevent leakage, bladder skrinkage and reflux.
    (KLD)
    Really? I know this is going to sound shocking and I used to 24Fr with a 5 cc balloon. I had problems with the 16 cc catheters getting stopped up from mucus. I drink about eight glasses of water a day, the cranmagic pills, cranberry juice. Really never had a problem with bladder infections until I had to go to rehab last year. Since then I've had two infections and currently have one right now. One of those required IV antibiotics.
    It seems like ever since my flap surgery my immunity system shot.

  6. #6
    You have a 24 Fr. urethral catheter??? You are really risking some significant urethral damage with this. Clogging is best managed by drinking plenty, Renicidin instillations if needed, and more frequent changes, not by using a larger catheter. You can still have reflux and even hydronephrosis with an indwelling catheter, which is another reason to keep pressures down with an indwelling (aside from the leakage problems common to both men and women with indwelling catheters).

    (KLD)

  7. #7
    I saw the urologist, but he was not a neuro urologist so he reccomended I see a different doctor in the same practice who deals with spinal cord injuries. However I don't have an appointment with him for another few weeks. This doctor put me on detrol 4mg once a day to start. For a week it worked great. The catheter stayed in and there was no leakage. However, the catheter started leaking again. So he said I could take it every 12 hours if the original dose didn't work. So I started doing that and it seemed to work really well. But now I am having a terrible problem with the catheter leaking. Should I add more fluid to the balloon or do you have any other suggestions for at least a temporary fix until I see the urologist. I go to sleep and wake up completely soaked in urine and I would really like it to stop. Also sometimes the catheter will work fine for a few hours and not leak and then it will start leaking. At first I thought that it was the change in position when I was sleeping so I started sleeping sitting up, but that didn't help at all. i will take any suggestions you can offer. Also, did I do something wrong the reason I developed this problem with the urethra so early? And besides the surgery and sling procedure which the urologist also mentioned but said that i should speak to the other doctor about it, is there anything I can do to make the indwelling foley work correctly in the meantime? Thanks,

  8. #8
    Are you (and have you) secured the catheter to your thigh? If you have a patulous urethra the catheter can move so that the balloon slips partially down into the urethra, and it will not drain if this occurs. I would not recommend more water in the balloon, as this is just likely to cause more bladder spasm. Call the urologist back and see if they want to do anything else. Meanwhile, use padding and a protective skin product so that you don't get skin breakdown from the urine leakage.

    (KLD)

  9. #9
    Thank you for your response. I have secured it to my thigh and my leg. I have also tried placing it at different points on my leg to see if one way helps it drain or another way does. I hate removing the catheter and putting a new one in because I worry that it just irritates the urethra and the bladder. The urologist is unfortunately off this week for passover. My appointment with the other urologist who specializes in spinal cord injuries is next week. I know that it is too late to reverse this, but is there something I could have done to prevent development of a patulous urethra? You had said that it normally takes longer than 3 1/2 years, so I was just wondering if their was something I should have done differently with regards to the indwelling catheter. I initially had no problems with a 14french inflated to a 10cc balloon. Would switching to an 18 french catheter make things worse or is it too late to prevent my urethra from getting more stretched? Thanks,

  10. #10
    Oh there were two other things that i thought of after posting the response above... one is that some uring flows through the catheter and some leaks out. And it will go through periods where it does not leak for about 8 or 9 hours and then it will start leaking which seems odd to me. Sometimes it starts leaking after doing the bowel program which is digital stimulation. Also how do you know that the catheter is in the bladder not the urethra?

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