Q: I’m 34 years old and I’ve been a T9 complete para for 14 years. Right after my injury I had trouble with bladder spasms, high bladder pressures and leaking. I tried managing my bladder by balancing a condom catheter and intermittent internal catheterization. That wasn’t working so I had a sphincterotomy. For about two years following the sphincterotomy, things seemed to be fine. I felt healthy, was going to college and playing sports. But a routine ultrasound on my kidneys showed there were problems. A urodynamic test confirmed I had high bladder pressures and kidney reflux.

In 2000 I decided to have a bladder augmentation. Since I didn’t want to deal with taking a condom catheter off each time I needed to cath intermittently, I also decided to have a stoma added to drain the urine from my bladder.

I never understood why my sphincterotomy didn’t work. Now I’m getting tired of having my condom catheter blow off. I’m looking at options to stay dry. Any suggestions?

A: Josh, your story points out the importance of regular urology follow-up to keep your system healthy. A PubMed search on sphincterotomies suggests that although the surgery is generally effective, problems like scarring can restrict urine flow and require a repeat of the procedure.

As far as options, the first and easiest option is look for an external catheter that stays on. There is a relatively new external catheter on the market called the Liberty manufactured by BioDerm. The Liberty is unique in that it attaches to the head of the penis only, which makes it more discrete, and more importantly it won’t roll or peel off like condom catheters can. In addition, it has a short, relatively stiff neck (the area that the drainage tube fits into) which eliminates the possibility of the neck “kinking” and resulting in “blow-out.” The neck is also short and stiff enough to clean the inside with an antiseptic wipe and insert an internal catheter, eliminating the need to remove the external catheter to do an intermittent cathing procedure. Anecdotally, I use an external catheter for stress incontinence, but still need to cath intermittently four to six times a day. I tried the Liberty system two months ago and haven’t had a single leak or blow-out.

If your goal is to get rid of an external catheter all together, here are a couple of options you may want to run by your urologist. One option is pretty straightforward: You can ask your urologist about having your bladder neck sewn shut. Another option is to inquire about a male sling system. You can check this out online at American Medical Systems, www.americanmedicalsystems.com. The system consists of a “sling” made of synthetic mesh that is surgically placed so the sling puts pressure on the urethra and reduces the possibility of urine leakage. Results of a 2003