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Thread: urethral damage

  1. #1
    Junior Member
    Join Date
    Jan 2005
    Location
    Henderson, Nevada, USA
    Posts
    20

    urethral damage

    I'm an incomplete quadriplegic. For the past five years I have been on a program of intermittent catheterization. My wife usually performs the catheterization, but at times it is done by another caregiver. For the past several months we have occasionally experienced resistance to the catheter approximately half way into the urethra. We also occasionally experience resistance at the sphincter, and sometimes resistance occurs at both places. Our usual response is to insert a Foley catheter for about a week as a means of "soft dilation". Following that procedure intermittent catheterization usually goes smoothly, without feeling unusual resistance.

    Last Wednesday evening (January 5) at about 10:30 p.m., my wife felt resistance about halfway through the urethra. She withdrew the catheter and I immediately began spilling blood out of the meatus. We completely soaked about six facial tissues, one paper towel and left a large blood stain on my undergarments on which I was sitting. The rapid bleeding stopped, and upon the advice of my urologist we inserted a Foley catheter. I will see my urologist in his office in about three weeks, however meanwhile I continue to be anxious about the cause, the appropriate response, and the prognosis. Is this kind of event common, has anyone had similar experiences, does it mean I should consider discontinuing intermittent catheterization, what symptoms should I be on the watch for, how long should I wear the Foley before attempting intermittent catheterization again, etc.??

    Thanks for any insight into the problem you can provide.
    Jim Deacon

  2. #2
    Jim,
    I can't help you, but wrote to bump this to the top.
    Cathy

  3. #3
    Forcing a catheter against resistance is a perfect way to get false passages. The proper way to catheterize when you run into a tight sphincter is to maintain firm but gentle pressure (no poking or jabbing) for 1-2 minutes until the sphincter fatigues and allows the catheter to pass.

    If you have a false passage, it is very easy to get the catheter into that passage. Jabbing or forcing the catheter then can result in opening the passage into the interior of the penis or even into the corpus cavernosus (the blood filled area responsible for erections). This can result in a large amount of bleeding. This should send you to the ER.

    False passages should be diagnosed with a urethrogram, and if found, usually an indwelling catheter is left in place for 2-4 weeks until the passage has closed up (which it usually does). Once intermittent catheterization is started again, it is important to use a soft catheter (like the Rochester Personal) and not a stiff plastic catheter that can cause the same damage again, and also to use the technique described above.

    (KLD)

  4. #4
    Jim,

    In my 7 years as a para, I have had bleeding a half dozen times. Generally, it has been when I have been forcing the catheter in and not realizing it. What seems to happen to me is that the catheter doubles over itself. So I end up with a big ball of catheter stuck inside. Doing this for 5 times a day for 7 years, sometimes I don't pay attention.

    I have had my urologist check things out a couple of times and, fortunately, I have not done any major damage. Also, I have not had to use a foley. What I have been doing is switching to the hydrophilic catheters for several days. They definitely go in a lot easier than any catheter and k-y that I have experienced. I then restart my "normal" routine.

    If you have not already done so, you should check out the hydrophilic catheters (I don't have one in front of me so my spelling may be off).

  5. #5
    Senior Member
    Join Date
    Aug 2001
    Location
    Montreal, Canada
    Posts
    1,268
    Originally posted by HC:

    Jim,

    In my 7 years as a para, I have had bleeding a half dozen times. Generally, it has been when I have been forcing the catheter in and not realizing it. What seems to happen to me is that the catheter doubles over itself. So I end up with a big ball of catheter stuck inside. Doing this for 5 times a day for 7 years, sometimes I don't pay attention.

    I have had my urologist check things out a couple of times and, fortunately, I have not done any major damage. Also, I have not had to use a foley. What I have been doing is switching to the hydrophilic catheters for several days. They definitely go in a lot easier than any catheter and k-y that I have experienced. I then restart my "normal" routine.

    If you have not already done so, you should check out the hydrophilic catheters (I don't have one in front of me so my spelling may be off).
    I agree with HC here, use hydrophilic in the future.

    C5-C6 pharmacist

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