Stuck suprapubic catheter

[Dannyjenkins1981]

32 year old male with suprapubic catheter due to hypotonic neurogenic bladder  following cauda equina sundrome , size 18ch all silicone with flip flow valve .

Catheter stuck in bladder for four months ( three months overdue for change ) .
Cystostomy site red swollen and foul smelling discharge
Overflowing from penis regularly.
Urine dipstick nitrite +++ blood +++ protein+++ specific gravity >1.050
Frank haematuria
Severe abdominal pain
Penile pain
Swollen lymph nodes
Bladder spasms
.
Relevant medical history

Severe antiphospholipid syndrome on warfarin INR 4.1
Previous bladder stone formed on catheter requiring cystoscopic removal
Inappropriate sinus tachycardia on bisoprolol
Suprapubic catheter was done seven years ago have been having trouble for a year changing the catheter due to scarring of the cystostomy and urologist will be resign g catheter in near future .

Scared to go to hospital as any movement of the catheter is excruciating dont want to have people just pulling it trying to get it out . I have tried using instiligel local anaesthesia I am very scared as it is so painful and due to the thought of someone just pulling at the catheter is why I have not been to hospital .
What would be the likely management of my condition be in your opinion

Thank you for your help

Danny

[wezzy1976]

My husband has this problem everytime the SPC needs changing, tried regular 4 week changes and still stuck.  Now has GA every 12 weeks to change the catheter along with botox and prostate massage.  Around the 10 week mark he too finds it so painful to touch the tubing etc.  Has had SPC two years.  Next change Monday and urologist cannot explain why it sticks so badly.

[wezzy1976]

My husband has this problem everytime the SPC needs changing, tried regular 4 week changes and still stuck.  Now has GA every 12 weeks to change the catheter along with botox and prostate massage.  Around the 10 week mark he too finds it so painful to touch the tubing etc.  Has had SPC two years.  Next change Monday and urologist cannot explain why it sticks so badly.

[Dannyjenkins1981]

Hi thanks for the reply

I am currently seeing  a haematologist weekly due to my antiphospholipid syndrome as I am suffering TIA's recurrent thrombosis hence the high INR

The main problem is the stuck suprapubic catheter at the moment I was really wondering how that would be managed clinically

Thanks danny

[S. Kaul, MD]

Hey Danny!

Well, without knowing the relevant clinical details or a detailed clinical evaluation it would be difficult to comment specifically on the situation of suggest a management plan. Cystostomy/ suprapubic catheterisation is an effective management for uncontrolled bladder. If there is overflowing penile urine flow, obstruction to the suprapubic catheter may be suspected and if unobstructed, penile catheterisation may be considered. The urine tests are suggestive of a UTI, while the blood cells are likely to be due to the high INR. At this time I would recommend seeing a urologist and a haematologist regarding the urinary tract infection/ symptomatic management and the increased INR respectively.  
Hope this is helpful.

Take care!