Suprapubic Catheter management and bladder retention

[dancerkendo]

Hi
I am paraplegic. As a result I lost function of bowel and bladder.

In hospital I was told I had flaccid bladder yet had very limited retention and when trying to train bladder for time intervals for self intermittent- catheterisation was basically leaking all the time! Even 15 mins after catheterising despite scanning bladder straight away cath’d showing zero left.

As a result I was fitted with a suprapubic catheter...
Many people use spc and a flip-flow valve so allowing bladder to fill but then release into leg bag. However I am still in same situation, limited/unpredictable retention so was told to go on full drainage freeflow.

Last year though, on my urology tests they said my bladder is very small and need to start using flip/flow valve again. I receive no advice though how to manage this and soiled so often as unable to tell transit time from drinking to bladder as seems to vary wildly, how much retention I do have if any, and judge releasing appropriately resulting in permanently changing and washing which has degraded skin unfortunately under sit-bones giving something else to manage..OK now and gone to freeflow again.

I have heard though that bladder can continue to reduce to more eventually requiring surgery.

Any comments or ideas welcome.

[Elaine Hazell]

Good afternoon.
The problem with having a permenant catheter in situ on free drainage is the bladder never fills so it becomes very small. I agree that recycling the bladder by using a flip flow valve is a good idea. However like you say it doesnt stop the leaking as it takes a long time to increase capacity i.e months. . We usually advise that you build up the time in trying to increase the bladder capacity , starting with emptying 1/2 houlry & trying to stretch the time between opening the valve.
Have you tried an anticholenergic medication such as solifenacin ?. this may increase capacity . Maybe botox injections would increse the capacity. Its worth discussing this with your urologist.I think surgery would be a last resort.
You could also use a penile sheath to drain any leakage which would help with your skin breaking down. Again your urology nurse should be able to provide them. Please go back to them & explain the problems youre having.