External Catheter System

1. Concept

  • Collecting urine into a device to prevent urinary leakage

2. History

  • Please refer to this

3. Terminology

4. Purpose of the Procedure

  • To prevent spilling of the urine
  • To have better hygienic control
  • To better control of unpleasant odor
  • To have a better quality of life
  • When combined with a procedure to reduce outlet resistance to assure safe low pressure controlled urination

5. Indication

  • Usually available for men
  • May be indicated in male SCI patients with urinary incontinence having no penile lesion if intravesical pressures during storage and voiding are urodynamically safe
  • Preferred by patients who have used condom catheters for a long time

6. Contraindication

  • No absolute contra-indications
  • High pressure voiding
  • Constriction of the urethra by the condom catheter that increases outlet resistance

7. Procedure

  • The catheter fits over the penile shaft towards the peno-scrotal junction and is fastened to the penis to prevent slipping with an adhesive band, strip or self-adhesive, or some combination of these.
  • The distal open tip connects to a tube of a urinary collecting bag that is strapped to the patient’s leg.
  • Catheters with a circumferential band should not be too restricting to the shaft of the penis as this may increase outlet resistance. This is done to prevent slippage and loss of the seal of the condom catheter.

8. Catheter Product

9. Clinical Outcomes

Author (Year)

Methods

Results

Comments

Esclarin De Ruz A, Garcia Leoni E, Herruzo Cabrera R. [J Urol. 2000 ]

Prospectively followed 128 SCI patients for 38 months

Incidence of urinary tract infection was 0.68, while for male indwelling, clean intermittent, condom and female suprapubic catheterization, and normal voiding the rate was 2.72, 0.41, 0.36, 0.34 and 0.06, respectively

Low incidence rates support condom catheterization methods is reasonable drainage means of managing neurogenic bladder dysfunction in SCI.

Golji H. [Paraplegia. 1981]

Retrospective review of cases during previous 3 years

  1. Irritative skin reactions
  2. Penile gangrene necessitating amputation
  3. Urethral dilatation with reflux
  4. Urethral diverticulum

Improper application of a condom in more than 15 per cent of these patients has caused a variety of penile or urethral complications, some of them very serious.

  • Serious complications
    • Penile erosion [Bycroft 2003]
    • Gangrene and partial amputation of the penis [Steinhardt 1980].
  • Penile skin breakdown
    • Secondary to mechanical damage to the skin from an excessively tight condom worn for a prolonged time
    • Preventive measures: not to continue the use of the condom during night
  • Allergy to the condom material (usually latex) [Harmon 1995]
    • Well documented in patients with long-term use of latex products
    • Best prevention is to use a latex-free (vinyl, silicone, etc) condom catheter

10. Advantages

  • Not invasive
  • More comfortable than indwelling catheter
  • Obviates some complications related to indwelling catheters
  • Probably at low cost although there is no study on the cost-effectiveness.
  • Advantageous in terms of the quality of life:
    • At discharge from the hospital, 33% of patients used CIC, the percentage of men using CCs increased with advancing time post-injury while the percentage using IC decreased [Sekar 1997].

11. Disadvantages

  • Risk of introducing the colonizing bacteria to the bladder from perineum, rectum, urethra, or penis
  • Draining bag may have a harmful role as a bacterial reservoir.
  • Not an option for managing female patients since condom catheter is not available
  • May not guarantee proper urine drainage since condom catheter itself may provide a cause of obstruction.   
  • Chance of penile skin breakdown
  • Chance of allergy to the condom material

12. Current Significance

Summary

Effectiveness

Condom catheter is an effective method for controlling urinary incontinence in selected male SCI patients.

Safety

Excessive compression around the penile shaft and allergic reaction can cause significant complications.
Long-term use may cause bacteriuria but it does not increase the risk of clinically significant UTI compared to other bladder drainage methods.

Ease of application

Sometimes problematic, and may fall off leading to stronger efforts to secure it in place and outlet obstruction or penile necrosis

Patient Comfort

Successful condom catheter used is defined circumstances does improve patient quality of life

Cost

No data available

13. Other Comments

  • If condoms and urethral catheters are used for bladder management additional care is required to avoid potentially serious pitfalls. These complications are inevitably worsened by decreased sensation in SCI patients.
  • Complications may be less if the condom is applied properly with good hygiene, and changed frequenctly.
  • Most important is the determination that with the condom catheter “on”, the detrusor leak point pressure is acceptable.
  • A CC should be changed at daily.

Key Points of This Section

  • Collection devices for women do exist but have never been satisfactory in application.
  • A condom catheter, in selected male patients can be associated with fewer problems than a Foley catheter, but chronic bacteriuira is universal, and thus storage and leak point pressures, with the condom catheter “on”, must be determined to be normal.
  • A cystometrogram and detrusor leak point pressures should be done through the opening in the condom catheter to prove that the situation is safe.

References

  • Bycroft J, Hamid R, Shah PJ. Penile erosion in spinal cord injury--an important lesson. Spinal Cord. 2003 Nov;41(11):643-4.
  • Esclarin De Ruz A, Garcia Leoni E, Herruzo Cabrera R. Epidemiology and risk factors for urinary tract infection in patients with spinal cord injury. J Urol. 2000 Oct;164(4):1285-9. 
  • Golji H. Complications of external condom drainage. Paraplegia. 1981;19(3):189-97.
  • Harmon CB, Connolly SM, Iarson TR. Condom related allergic contact dermatitis. J Urol 1995; 153: 1227-1228
  • Sekar P, Wallace DD, Waites KB, DeVivo MJ, Lloyd LK, Stover SL, Dubovsky EV. Comparison of long-term renal function after spinal cord injury using different urinary management methods. Arch Phys Med Rehabil. 1997 Sep;78(9):992-7.
  • Steinhardt G, McRoberts JW. Total distal penile necrosis caused by condom catheter. JAMA 1980; 244: 1238.

 

 

 

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