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Super Pubic Tube
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Super Pubic Tube

I am a C4 C5 Quadriplegic. I've been paralyzed since 1983. For 2 years now I have been wearing a indwelling Foley catheter because I'm not emptying my bladder enough when I void. I started getting one bladder infection after another sometimes so bad I would get septic.

My Urologist wants to insert a super Pubic Tube.
1. Can anything be done to my bladder surgically or other to train my bladder to void properly again?

2. what are the advantages and disadvantages of having a super pubic tube?

3. Is surgically placing a super pubic tube reversable?

4. What about infections versus a foley?

Thanks,
Tony Alexander
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Hi Tony,

I was diagnosed as having a neurogenic bladder in 1996. I had been using intermittant catheterization once a day to ensure that my bladder was emptied properly. Than in 2000 after having had a major kidney infection and a staph infection in my left testicle which was removed in emergency, I started to self cath several times a day. This cut down the infection rate.

In 2008 I came down with another major kidney infection as well as pneumonia all at the same time. During this time I had inserted an indwelling Foley to ensure that the bladder was draining. While staying in hospital for about a week being on IV antibiotics I noticed that I was passing gas through the penis and catheter. After I was discharged I had an appointment with the urologist to have a cystoscopy which confirmed that I have a fistula between my prostate and rectum. The Urologist thinks that I caused this during self catheterization. I myself think that it was the result of a TURP and bladderneck resection at the age of 30. I'm 46 now. I feel that the are was weakened due to the surgery.

The urologist decided to insert a Foley through the penile urethra in the hope that the fistula would close spontaneously. I had the Foley in for about a year when another urologist ( reconstructive) decided to try a suprapubic catheter in the hope that the fistula would close since there now was no movement of the Foley inside the prostatic urethra. I was told that the infection rate with a suprapubic Foley is far less than one in the penile urethra.

Some advantages are that there is no more trauma to the penile urethra and urinary meatus (opening at the glans (glands)). The movent of the catheter inside the uinary meatus causes trauma from chaving. I have had the suprapubic catheter for about a year and a half now and just recently started to have more problems with 2 kidney infections since the last 6 months. I might have had a third which I reated with on hand antibiotics Cipro.
I do not believe that this is due to the suprapubic Foley, but it is the result of an abnormal communication between the prostatic urethra and rectum as the result of the fistula.

A disadvantage of the suprapubic catheter is the location between the belly button and penis right around the waiste area. Movement of the waist band in pants can cause bladder spasms due to movement of the catheter. I have this problem when I do a lot of walking. I also use a wheelchair at times due to having ballance problems due to a neurological condition which has caused weaknes in my left foot and knee, and also caused ballance problems. When I use the wheelchair there is no discomfort because there is no movement of the waist band of my pants.

The stoma created at the time of the suprapubic catheter placement can be reversed most of the times. This is done when near normal urination can be restored. They most likely will use a foley catheter for this any how, so just the location of the catheter has been changed. Having the catheter located in that region facilitates for a cleaner environment. The catheter now is further away from the rectum than what the penis would be and therfore less likely to result into infections.

I'm not sure as to what your urologist means by training the bladder to drain properly. Having a Foley in through the penile urethra would not be much different in proper drainage as far as I can see. One advantage for those with sensation in the prostate region is the fact that the suprapubic does not go through the prostate. In this case the catheter does not irritate the prostate. With the catheter in the penile urethra I have experienced severe pain in the prostate and rectal region, causing me not to be able to sleep. One drawback that I have is that at times I do leak urine out of the penis during bladder spasms. I therfore also use a condom catheter to catch the urnine that normaly would be spilled.

On September 8, I will have another cystoscopy to determine the state of the fistula. Haing had the 3 infections in the last 6 months most likely indicate that corrective surgery is needed. In order to do this I might need a colostomy to divert the bowel for a period while the area recovers after the corrective surgery. From my understanding the suprapubic catheter and colostomy can be reversed if the surgery is successful and the procedure has healed sufficiently. Currently I get my Foley catheter changed through home care every 2 months. I sure prefer to have the suprapubic changed over the catheter in the penis. The procedure is fast and has no problems and very little discomfort is felt

I hope that I have addressed some of your concerns and that things are little more clear for you. I also hope that a doctor on this site will address your concerns as well.

I sincerly hope that things will work out well for you.

God bless,

Ronald
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