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Is Suprapubic A Better Option Than CIC For Multiple System Atrophy With Urine Retention Problem?

Posted on Sat, 28 Dec 2013

Question: My father is suffering from Multiple System Atropy (MSA) and for the last one month have not been able to urinate on his own as there has been disease related retention. He was initially on Urethral Catheter but his Neurosurgon docs advised to remove this as there is heightened risk of catching UTI. We now administer him CIC every 3-4 hours or as and when he feels the urge. But I'm being told by a family doctor that SPC (suprapubic) is a better option. The questions that I have are: first, how much time it will take the SPC hole to heal-up completely; and second, is it a better option than CIC with reduced UTI or stone risks. Please advise urgently.

Answered by Dr. Dr. P. T. Patil (2 hours later)

Brief Answer: SPC is the best option. Detailed Answer: Hello Thanks for your query,based on the facts that you have posted it appears that your father has what is called as Neurogenic bladder and on per urethral catheter now to drain his bladder. However there is high risk of getting UTI and stricture formation with er urethral catheter. Same is the XXXXXXX with CSIC Hence I would advise to put supra- pubic catheter.It is very simple procedure done under local anaesthesia. The advantage of SPC is that it is painless ,offers efficient drainage of bladder and comfortable to patient also.and does not involve the risk of injury to urethra that is associated with CSIC. More over if Silicon catheter is used it can be kept for six months and catheter can be changed at home after six months.. SPC hole gets closed within 2-3 days after removal of catheter. . Hope I have answered your query ,please feel free to ask if you have more questions ,I shall be happy to help you Thanks and Regards. Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (34 minutes later)

Dear Dr XXXXXXX Thanks for your reply; really appreciate it. I have been told that even SPC carries a risk of UTI and even stone formation in the bladder or kideny. Can you please help clarify how serious these risks are when compared with CSIC? Also, how is the risk of injury to urethra associated with CSIC - I thought it was a relatively simple procedure and the only risk that it carries is of UTI if the attendent doesn't take proper hygine care. And one last question, won't keeping silicon catheter for six months in the case of SPS increases the chances of risks associted? Please advise. Thanks, XXXX

Answered by Dr. Dr. P. T. Patil (19 minutes later)

Brief Answer: There is little risk of UTI with SPC. Detailed Answer: Hello Thanks for follow up. There is little risk with SPC as the bladder drainage is complete without any residual urine in bladder. One can not drain the bladder repeatedly with CSIC for multiple times in a day. Even with utmost care there is always risk of delicate urethra being injured on attempting to do catheterisation repeatedly . Silicon is inert material and does not have tissue reaction even keeping it for a long time. I always prefer my patients of neurogenic bladder to be on SPC and is following this for over last 40 years of my practice with satisfactory outcome both for patient and his family. Thanks and Regards. Dr.Patil.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar