Bob VogelQ. I’m 28, in my fourth year as a C5-6 quad and have had a suprapubic catheter since rehab. It works well, so I thought it enabled me to dodge taking anticholinergic drugs like Ditropan that control bladder spasms. At a recent SCI support meeting, I heard that long term use of an indwelling catheter causes permanent bladder shrinkage and that bladder spasms makes this worse. The discussion also brought up two equipment options, a “dual-balloon” Foley called the Duette, and a catheter valve called the BioFlo that can help reduce bladder shrinkage. What can you tell me about these two products?
— Nancy

A. According to Paralyzed Veterans of America’s Bladder Management Guidelines for Adults with Spinal Cord Injury, long term bladder management with indwelling catheters — urethral or suprapubic — tends to cause decreased bladder compliance (elasticity and size), which is irreversible and can cause other problems, including formation of stones, reflux and an increase in UTIs