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Urology/Alternatives to Cathertirisation

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Question
Hello, I am 31 and I suffer with M.S. I have a suprapubic catheter, as a penile catheter is not viable and I cant ISC due to problems with grip, due to MS and damaage down below.

I have had a SPC for 15 years and dispite resiting, it is extremely painful to change. Due to this, I have to be put out for it to be changed, as it is so painful, morphine or dihidromorphone wont even touch the pain, plus it is extremely distressing to have it changed due to this.

There have to be other options for me, as I cannot urinate normally, due to the MS. Doctors dont seem to listen to me and I am not sure how much more my body can take.

Any advice would be greatly received.

Answer
Aaron:

There are no good alternatives, but here are a few.  

External sphincterotomy.  This would make you permanently incontinent which can be managed with an external condom catheter.  This would be permanent and no way to restore the system to its current state.

Use local Anesthetic.  It is rarely necessary to take patients for a general anesthetic for something that is typically painless.

Neurology evaluation.  See if they can identify why you are so tender.

Urinary diversion.  The ureters can be attached to a piece of bowel that is brought out of the body through an ostomy.  But this creates new problems.

Your case may need to be referred to a tertiary care teaching or university center.  Good luck.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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