Will a catheter improve Dad's quality of life?
My 81 year old father has been working with a urologist to address his overactive bladder. He has other health issues, including a history of strokes, seizures and a colostomy. None of the drugs tried (Sanctura, gelnique, oxytrol patches, vesicare, etc) have improved his quality of life. He still needs to urinate multiple times at night (about every 2 hours) and can't necessarily control his bladder during the day. This lack of control has made him house bound and exhausted. His urologist recommends installing a suprapubic catheter. I'm concerned about the initial procedure (particularly the anesthesia) and then the daily upkeep of the catheter. Will this improve his quality of life? Is this just trading one problem - incontinence - for another - UTI's?
Reading your letter, I agree with you. Having him go through an invasive surgery to have a suprapubic cathether is not a easy solution to his incontinence problems. With his seizure disorder, surgery is especially risky. Also, catheters can have their own set of problems, like urinary tract infections, bleeding, and daily maintenance.
Many people with a history of strokes have a neurogenic bladder (not overactive bladder), and bladder medications do not always help this type of incontinence. You did not mention if your father has any prostate issues that could be contributing to his bladder urgency, but he should be checked to make sure that is not a problem. He also needs to be checked to make sure he empties his bladder fully.
What I would recommend is to take him to another urologist for a second opinion. He needs to see if surgery is the only option for his incontinence.
We have been dealing with this problem for 6 years, as a result of scaring from the cure for prostate cancer a decade ago, and the progression of Parkinson's. For us it wasn't so much overactive bladder, as failure to void completely. None of the drugs helped. I agree, you should get another opinion from another urologist. We resorted to intermittent catheterization, at bedtime ( a huge help), first thing in the morning and once or twice during the day as needed and always before we went out. If your dad is physically stable in the bathroom, he can learn to do this for himself--it doesn't hurt. Clean-up is simple, warm water and soap. By the way, I did this for my husband, but it got to be wearing because I was tied to his needs--caretakers need lives, too.
We used a foley for 8 months, but it is uncomfortable, all though bag emptying and changing from a night drainage bag to a leg bag during the day, really wasn't a problem. Maintenance is pretty easy. I even trained our housekeeper to change the bags.
Now he is using a superpubic which was inserted as an out patient procedure using dilaudan (that took about 24 hours to leave his system). The bag change and maintenance is the same as the foley, with the cath changed by the doctor ever month.
Infection is a potential problem in all of the procedures, but it is a risk if the bladder doesn't empty, too. Discuss all with your doctor.
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