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URINARY CATHETER ISSUES RELATED PATIENT QUESTIONS
1) My husband has had a long term catheter coming out of his penis for 4 years. I have noted in the last 6 months his penis at the tip is splitting and there is regular discharge which we have been dressing and cleaning with the advice of the district nurse. He has a lot of discomfort at times when his catheter moves while he is pulling his pants up or when he is walking around. Is there any solution for this?
Mr.Varadaraj - When a catheter is left in for a long period in the water passage (urethra), due to downward pressure of the indwelling "urethral catheter" (UC), the urethra is injured and starts to split on the ventral aspect (under suface) of the penis in men and into anterior vaginal wall in women. Over a period of years this spilt will go right through the penis as if the penis has been split into two halves. In women it may split through the short urethra and into the bladder neck through the urinary sphincter.
The urethra below the lowest part of the bladder (the bladder neck) is encircled by a muscle (the urinary sphincter) that remains contracted to close off the water passage and prevent urine leaking. This splitting can damage the urinary sphincter causing leaking of urine through the water passage and around the catheter. The balloon of the catheter can also erode through the bladder neck at times due to pressure over time. making the bladder neck wide open and incompetent. Once the sphincter and bladder neck is damaged (especially in females due to a short urethra of approximately 4cm compared to 20 cm in men) urinary incontinence sets in as urine freely leaks by the side of the catheter and it becomes difficult to manage the incontinence with a catheter or any other drainage appliance.
The possible solution in your husband's case is to consider a "Suprapubic Catheter" (SPC). Some of the advantages of SPC are: 1) majority of patients find SPC more comfortable than UC, 2) Urinary tract infections related to indwelling catheter is lesser with SPC compared to UC, 3) if there are problems with the UC getting blocked with debris the SPC catheter size can be increased in size gradually upto size 20 unlike the preferred restriction on lower sizes (12-16) for UC. The SPC will stop the urethral splitting and hopefully stop the urethral/ penile pain. Your husband can discuss this option of SPC with his Urologist (after referral from your GP). Depending on the medical, surgical details and bladder capacity a decision can be taken about the insertion of the SPC with the mediplus SPC system under Local anaesthesia or under General anaesthesia, if he is suitable for SPC option.
2) Is Suprapubic catheter an option in women with a long term catheter? I have progressive multiple sclerosis and bladder contraction failure due to my neurological condition and have had a urethral catheter for 3 years now.
Mr.Varadaraj - Suprapubic Catheter (SPC) is a better option than urethral catheter for long term catheter in both women and men, if the option of Intermittent Self Catheterisation is ruled out due to any reason. If you read the answer in question 1 above you will understand why women are at a higher risk of urinary incontinence with long term urethral catheter. You can discuss the option of SPC with your Urologist. Depending on the medical, surgical details and bladder capacity a decision can be taken about the insertion of the SPC with the new mediplus SPC system under Local anaesthesia or under General anaesthesia, if you are suitable for the SPC option.
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