[Gary Anderson]

Ok Guys/Gals

Here is Monday's question.

One of my best mates was shot in a robbery and tuis has resulted in him being left partly paraplegic due to nerve damage. Because one of the bullets hit his bladder, he was fitted with an SPC. Prior to release from hospital he was shown how to perform intermittent self cathertisation. However, although he tried he could not bring himself to do it. He was told in hospital that this was the best method to use to avoid problems, etc. However, my mate found it hard because unlike most paraplegics he still has sensation/feeling in his genitals.

So, the question is, should you ISC? As far as I am aware he was shown 2 ways to empty the SPC (1) was free drainage into a bag the second was emptying the valve either into a bag or toilet.

Possibly I should mention here that my mate is overcontinent and not incontinent. He can tell when his bladder requires to be emptied.

Any assistance would be appreciated. I told him I would try asking on the boards (here and on Moose's) as he would get better advice than he would from any hospital.

I know you wont let me down folks.

Gary

[kanga2433]

Gary,

I take it your friendhas the sensation of a full bladder but also has retention so cannot actually pass urine. Is that correct? If so, that I can quite see why ISC would be suggested. Now I have tried ISC myself though without sensation so I don't know if it is painful or not, though I would have thought that with modern lubricated catheters it would not be too bad.

The other thing IO noticed when doing ISC was that the bladder got used ot the idea and started to leak in between ISC so I have to empty more often. This is possibly not relevant here if his bladder does not empty by itself, although constantly passing a catheter might reduce the sphingter pressures and allow some leaks which would not be a good thing.

The SPC, however, is quite a good idea as long as it is not uncomfortable to have in place. Again I have one but with no sensation. I would have thought that he would be quite safe from infections used an SPC as long as he follows the rules; keeping the area clean etc. If he knows when he needs to go and doesn't leak, draining via the SPC would work well for him as it would be quicker and easier than inserting a catheter. Overnight, a drainage bag ould be used to get a better night's sleep too.

I reckon the SPC is a pretty good idea, but I am not sure if I answered the right question.

[Gary Anderson]

Quote

take it your friendhas the sensation of a full bladder but also has retention so cannot actually pass urine. Is that correct

Hi Kanga

Yep! that is correct. He can sense the need to "pee" but cannot in the conventional way. He copes very well with the SPC and drainage into the loo/bag. However, was a bit concerned as his medics keep asking him if he is performing "ISC." They tell him that this is the method "all paraplegics" use.

I am not the best person to ask as my bladder/bowel work well due to mine being a nerve injury. HOwever, from what he tells me the fact that he has sensation "down there" means that inserting a catheter he feels every move. Despite being told that he will feel the resistence of the valve and he should "keep on pushing" he says he just cannot bring himself to do it - even now he cant.

Thanks for your help.

[kanga2433]

Well, Gary, I can tell you that not all paraplegics use an SPC; I use one. I think others on this site do too. ISC does work for some but, as I found, it only lasts for a while as the bladder starts to release earlier and earlier until wetness is not acceptable. Of course, where the bladder never releases it can work well and I have come across a number of people who have been successful, but to prescribe the same treatment for everyone is to treat people like tins of beans.

Basically, if your friend gets on well with the SPC, doesn't get any infections and drains properly I'd say job done, successfully! Medical suggestions aren't always right (except for the anaesthetic department of course!)

[dom]

hi Gary
i have the same problems as your friend , at first i was dead set against doing isc but persevered,i hated the sensation dragging in and out of the urethra but got used o it and eventually it desensitised by itself[ i assume the skin inside was hardened slightly and also i made sure i used good caths at the right size [12.0]
i have what is known as a flaccid bladder and it is overcontinent even after 5 years of cath usage
it has on one occasion become overfull when i was in a traffic jam, i felt when i got out of the car a leakage in my jeans needless to say i quickly cathetered
i have feeling when i need to 'go' but after tests in urogenics was informed technically that 'my plumbing was knackered
i hava'nt found any difference in my sphincter and never feel a resistance if i smoothly,slowly apply hand pressure to the cath but whaever works for your friend is best,tell him we all felt squeamish at the beginning but can and do get used to it

[Simon]

Maybe they want him to learn to isc then they will take out the spc? Otherwise, it makes no sense. Any cath is an infection risk, isc is lowest, then spc, then urethral. We were isc-ing recently after discovered my left kidney was damaged through rflux so need to reduce my bladder residual (measured at about 400mls on ultrasound)actually found my sitting residual was 600mls. We saw the urologist again on Monday last and we decided 600mls was just crazy, so he put an spc in.
His reasoning for doing isc originally was that it was the lesser of 3 evils infection wise. I know there's no way he would now suggest I do isc too because it increases the risk of infection which is already higher from the spc.