Foley Woes

Pete Health Guide
  • (I should have titled this post "Catheter Woes" but I think "Foley Woes" is a more memorable title!)


    Although it has been almost four weeks since my Botox procedure and "Foley" left about two weeks ago, my bladder has not fully recovered so I still have to self-catheterize to empty. "Foley" left some scar tissue at my urinary opening which makes self-cathing somewhat of a challenge. Also, there must be some friable tissue just inside because there is some occasional bleeding as well. It's not bad, just a little un-nerving!


    I have written many times about catheters and catheterization, but one point I don't think I've covered is the variability in catheters. I don't mean variable in types of catheters, although there are many, but variability within a given type.

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    Catheters are molded from various types of plastics, and because of this, they very slightly depending on a number of factors. While this is usually not important, for me it is because of past surgery. Because of changes to my internal anatomy, if I try two different catheters of the same brand and type, one might work and the other might not. This is due to minor differences in the curve (I use coude catheters) and the tip.


    This means I might have to try several before I find one that works. Once I have found one I tend to re-use more than I should. The re-use limit, as specified by my doctor, is about a week, but I have one that I have kept almost a year now. I call it "the old standby" because it always works. Sometimes I wait longer than I should and become very uncomfortable. In these cases I don't care which I use, as long as it works!


    The reason for using them only a week or so is sometimes a biofilm may develop that cannot be washed off. It is also very difficult to clean the inside, as the drainage channel is very narrow. Even though catheters are plastic, sometimes there may be miniscule cracks that trap foreign matter and bacteria. Biofilm development is more of a problem for indwelling catheters, but any catheter can trap bacteria, causing infection.


    There can be significant discomfort (even outright pain) during catheterization. The discomfort is worse for men than women because of the length and sensitivity of our urethras.


    Lidocaine gel can be used to numb the urethra and reduce the discomfort, but I learned the hard way that applying to catheter does not work, because it takes several minutes for it to "do its job."


    The numbing gel must be administered directly into the urethra and then allow to sit for about 5 minutes or more. This can be difficult depending on type of container the gel is in. Sometimes the gel will be in a tube, similar to a small toothpaste tube, with an applicator on the end. Lidocaine gel also comes in a pre-packaged container which includes a syringe type device pre-loaded with the gel.


    The gel I use is packaged in a small plastic bottle, also with an applicator. However, this bottle is difficult to use because, once you squeeze the bottle to "inject" the gel, you have to keep applying pressure to the applicator so the gel does not run back out. Continuous pressure must be applied to the bottle as well so it will not "suck" the gel back out!


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    An econmical solution that most urologists use is a 5 or 10 ml luer-slip syringe. This type of syringe has a small tip that accepts a hypodermic needle, but no threads that lock the needle to the syringe. They will fill the syringe with the appropriate amount, insert the tip and then slowly push the syringe plunger in to inject the gel, giving the urethra time to accommodate to it.


    I don't have one of these syringes and did not want my pharmacy to buy a box of 25 when I only needed one. One of the pharmacists came up with an ingenious solution: An oral medicine syringe! The one she gave me also has a little adaptor that just fits the bottle. The other end of the adapter is for the syringe. The syringe end of the adapter has a little cover, so it can be left on the bottle, keeping the gel from drying out. The syringe has a small luer-slip type end which actually "fits" me better than a real syringe.


    This allows me to hold the syringe in place and slowly inject the gel. Once I have the proper amount in, it's easy to squeeze the end and then remove the syringe, holding the gel in place. For me, it works very well.


    What's that expression? Necessity is the mother of invention? In this case it's true!


Published On: February 17, 2009