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Urology/permanent catheter alternatives

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Question
My father is 67 was diagnosed with brittle diabetes and heart disease when he was 47. His heart has gotten so weak and his diabetes has gotten so bad that his kidneys are failing. Last week he was diagnosed terminal. Unfortunately we won't have that long with him about six months to a year hopefully ( figures crossed ). Two weeks ago he had a procedure by his urologist to stretch the open in his penis in order to be able to relieve himself. My father has scar tissue very close to his bladder due to a surgery he had at infancy. The blockage made it so he could hardly urinate and when he did his his bladder wouldn't empty fully. Surgery would be the only option to fully fix the obstruction but there's no way he'd survive with his heart condition to put him to sleep is just not an option at this point. That is what all the doctors in including all of our section opinions say and it's understandable in his condition. So now he has a permanent catheter / foley in order to relieve himself but ever since he's had it he's been miserable. He's constantly uncomfortable walking around with a bag strapped to his leg, having to empty the bag every hour, he's had numerous accidents as well as different size bags and a number of hospice nurses trying to prevent the leaking which has been nothing more than a temporary fix until the next time he wakes up wet.My question is, is there another alternative to this permanent foley and if so what would it be? It's one thing to deal with his diagnosis and another to see him in constant discomfort. This is the only thing that's taking a toll on him and if we can find a way to make this time he has with us as close to normal as we can that's what we'll do. Any advice would be greatly appreciated thank you.

Answer
Jane:

This is a difficult situation.  We have scar tissue both near the bladder and near the opening in the penis, either meatal stenosis or a phimosis (foreskin scarring).  Without a surgery, options are:

1. Intermittent Self Dilation or Catheterization to gently stretch the scar tissue open several times a day.  However, he may not be physically able to do this himself and might need help from others which can be burdensome.

2. Place a suprapubic tube.  Still needs a bag and a small anesthetic, but it's a simple surgery.  The tube is placed directly into the bladder from the lower stomach so it drains the bladder well and avoids the sensitive areas of the prostate and penis. But there is still some anesthetic risk as well.

3.  Live with the Foley.  Chances are you will have to pick from one of these.  

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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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