Q. My indwelling urethral catheter leaks all the time — and it is bumming out my sex life! I am an active quad (C5-6) so I have been considering a suprapubic catheter. What do you know about this?
Q. What is a “chemical sphincterotomy”? A guy on my wheelchair basketball team said he was going to have one before spending a year in Mexico, and I didn’t understand what he was talking about. He said quads could do it, too.
First, the suprapubic catheter. Suprapubic surgery bypasses the urethra and creates an opening in the abdomen just above the pubic bone, through which urine is drained. Once healed, the surgical site becomes the point of entry for a short-term indwelling cath that empties into a legbag. Advantages include drier nether regions than with a urethral catheter and, of course, less interference during sex. But it’s not a perfect system. Read on.
The surgery — officially called suprapubic cystostomy — is simple and short (about 10 minutes). After making an incision, the surgeon inserts a Foley catheter through the cystostomy site (stoma) and into the bladder. The balloon at the end of the Foley is filled with 30cc’s of sterile saline and retracted so the balloon pulls the bladder up against the stoma. There are no stitches required, the Foley catheter stays in place, and the hole in the bladder scars and heals to the hole in the skin (usually taking about a month) in what looks like a “bladder piercing.”
If you’ve had previous bladder surgery, the procedure is usually performed with the aid of a cystoscope, which is inserted through the urethra to shine light against the bladder wall. The cystoscope is adjusted until the light is visible through the skin just above the pubic bone — like putting a penlight in your mouth to see it shine through your cheek. That’s where the incision is made.
The convenience factor for women boils down to access; the surgeon-made stoma is much easier to see and work with than the plumbing you were born with. And suprapubics keep you drier — indwelling urethral catheters generally result in more leakage, because they stretch the urethra, and more pressure sores because of the wetness.
That’s not to say the system is care-free. The catheter must be changed every two to four weeks, and your doc may want you to clean the skin around the stoma every day. If you have a spastic bladder, you will still need to take anti-cholinergic medications like oxybutinin (Ditropan) to prevent permanent damage to upper urinary tract when excess pressure forces urine to back into the kidneys.
Other risks should be considered. Journal studies vary in their results but show 36 percent to 65 percent of people using suprapubics develop bladder stones within 10 years. Dr. Mark Fredrickson, a phys