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Urology (Expert Forum)
supra pbic and ureathal catheters
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
supra pbic and ureathal catheters
by peter__0__0, Jul 25, 1998 12:00AM
my wife,42. suffers from m.s. she had bladder retention with some leaking when laughing or coughing. she used self catheters for a while but had to stop because of left sided dysfunction. she had a ureathal catheter fitted but was very uncomfortable when sitting. eventually she had supra pubic catheter fitted, at the same time cystosopy done and scope inserted again as target for site. after this op she was totally incontinate from ureatha. she expelled the supra pubic catheter with ballon inflated out through the ureatha with the balloon and tube between her legs on several occassions. the balloon had to be cut off and the catheter drawn back through the ureatha and supra pubic site to fit a fresh one. because of this she had to wear two catheters, ureathal and supra pubic until a bladder/ureathal closure was done over 1 year later.
can you comment on the possible cause of these bladder problems. the doctors here in england say that the sudden incontinance was caused by m.s. during the operation and if not, my wife is pychriatrically ill.
please can you offer any other reason for this outcome
regards
peter andresen
=============================================
Dear Peter,
MS is one of the most common neurologic diseases causing voiding dysfunction. The disease is caused by impairment of the conduction nerves involved in the function of the bladder. 50-88% of patients with this disease complain of some type of urinary tract dysfunction at some time during their disease process. Bladder involvement is part of the presenting symptoms in approximately 10% of patients. The primary urologic findings include, an overactive bladder which squeezes when it is not supposed to, a nonfunctioning (atonic) bladder that cannot squeeze at all, and a bladder that can squeeze but the sphincter or valve to empty the bladder won’t open properly.
In regards to your wife, the incontinence experience during coughing and laughing may be a entirely separate issue from the neurological consequences from the MS. It sounds like your wife had some stress urinary incontinence before her diagnosis and then had an overactive bladder which would squeeze and empty when it was not supposed to. Therefore she was started on intermittent or straight catheterization to keep her bladder volumes low to prevent leakage or incontinence. She was then unable to continue with straight catheterization due to her left sided weakness and a foley or urinary urethral catheter was placed. Due to the fact that patients with an indwelling foley catheters have frequent urinary tract infections and the discomfort experienced by your wife while sitting she had a suprapubic tube placed. Also an indwelling foley catheter may cause urethral necrosis and dilation requiring larger and larger foley catheter. Even if the bladder is successfully decompressed and the leakage is managed, the bladder may still contract secondary to the catheter irritating the lining of the bladder or the balloon of the catheter giving the bladder a sensation of fullness. This is probable what happened when the balloon was expelled through the urethra. The doctors then placed a foley in the urethra leaving the suprapubic tube. This was acceptable until a decision was made to close the bladder outlet and drain the bladder by the suprapubic tube.
I have one idea on how to manage this problem however this idea hinges on the fact your wife is a relatively healthy patient. This idea would involve a large operation but may be the best thing for her in the long run. It is generally not a good idea to leave an indwelling foley catheter in a patient that is not terminal. There is an increased risk of bladder cancer after the foley has been in place for ten years. In younger individuals, such as your wife, some patients may benefit from an ilealvesicostomy or a segment of bowel that would drain the urine to a bag on the skin. This procedure would eliminate the indwelling tube as well as decrease the bladder pressures, potentially decreasing the risk of upper urinary tract disease(renal failure or infection )which is common in these patients.
I don’t think your wife is psychiatrically compromised ,however I have not had a chance to speak to her. All of her problems can be explained by the MS, although it is unfortunate that this has occurred. It is important to maintain her kidney function, but how the urine is drains is more of a personal decision.
This information is provided is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword:Multiple Sclerosis
can you comment on the possible cause of these bladder problems. the doctors here in england say that the sudden incontinance was caused by m.s. during the operation and if not, my wife is pychriatrically ill.
please can you offer any other reason for this outcome
regards
peter andresen
=============================================
Dear Peter,
MS is one of the most common neurologic diseases causing voiding dysfunction. The disease is caused by impairment of the conduction nerves involved in the function of the bladder. 50-88% of patients with this disease complain of some type of urinary tract dysfunction at some time during their disease process. Bladder involvement is part of the presenting symptoms in approximately 10% of patients. The primary urologic findings include, an overactive bladder which squeezes when it is not supposed to, a nonfunctioning (atonic) bladder that cannot squeeze at all, and a bladder that can squeeze but the sphincter or valve to empty the bladder won’t open properly.
In regards to your wife, the incontinence experience during coughing and laughing may be a entirely separate issue from the neurological consequences from the MS. It sounds like your wife had some stress urinary incontinence before her diagnosis and then had an overactive bladder which would squeeze and empty when it was not supposed to. Therefore she was started on intermittent or straight catheterization to keep her bladder volumes low to prevent leakage or incontinence. She was then unable to continue with straight catheterization due to her left sided weakness and a foley or urinary urethral catheter was placed. Due to the fact that patients with an indwelling foley catheters have frequent urinary tract infections and the discomfort experienced by your wife while sitting she had a suprapubic tube placed. Also an indwelling foley catheter may cause urethral necrosis and dilation requiring larger and larger foley catheter. Even if the bladder is successfully decompressed and the leakage is managed, the bladder may still contract secondary to the catheter irritating the lining of the bladder or the balloon of the catheter giving the bladder a sensation of fullness. This is probable what happened when the balloon was expelled through the urethra. The doctors then placed a foley in the urethra leaving the suprapubic tube. This was acceptable until a decision was made to close the bladder outlet and drain the bladder by the suprapubic tube.
I have one idea on how to manage this problem however this idea hinges on the fact your wife is a relatively healthy patient. This idea would involve a large operation but may be the best thing for her in the long run. It is generally not a good idea to leave an indwelling foley catheter in a patient that is not terminal. There is an increased risk of bladder cancer after the foley has been in place for ten years. In younger individuals, such as your wife, some patients may benefit from an ilealvesicostomy or a segment of bowel that would drain the urine to a bag on the skin. This procedure would eliminate the indwelling tube as well as decrease the bladder pressures, potentially decreasing the risk of upper urinary tract disease(renal failure or infection )which is common in these patients.
I don’t think your wife is psychiatrically compromised ,however I have not had a chance to speak to her. All of her problems can be explained by the MS, although it is unfortunate that this has occurred. It is important to maintain her kidney function, but how the urine is drains is more of a personal decision.
This information is provided is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword:Multiple Sclerosis
