What is the cause of urinary leakage from the penis in a patient with a suprapubic (SP) catheter?

From the Guidelines

Leakage of urine from the penis in a patient with a suprapubic catheter is most likely due to bladder outlet obstruction or high intravesical pressure not fully alleviated by the suprapubic catheter, as suggested by the principles outlined in the management of urinary catheters 1.

Causes of Urinary Leakage

The causes of this leakage can be multifactorial, including:

• Catheter blockage from sediment, blood clots, or kinking of the tube
• Inadequate catheter size for the patient's urine output
• Persistent bladder spasms pushing urine around the catheter
• Infection or other conditions leading to increased urine production or bladder irritability

Management Strategies

Management of urinary leakage in patients with a suprapubic catheter involves:

• Checking for and clearing any catheter obstruction
• Ensuring proper catheter positioning
• Considering a larger catheter size if output is high
• Possibly using anticholinergic medications like oxybutynin to reduce bladder spasms, as guided by the latest recommendations on overactive bladder management 1
• If infection is suspected, urine culture and appropriate antibiotics are necessary
• Regular catheter maintenance and scheduled changes (typically every 4-12 weeks depending on the type) are essential to prevent this complication

Considerations for Patient Care

It's crucial to consider the patient's overall condition, the reason for the suprapubic catheter, and any potential contraindications or ineffective treatments for overactive bladder before deciding on chronic indwelling catheterization, as emphasized in recent guidelines 1. The decision should always be made in the context of shared decision-making, weighing the risks and benefits of different management strategies.

From the Research

Causes of Urinary Leakage

• Urinary leakage from the penis in a patient with a suprapubic (SP) catheter can be caused by various factors, including:
  • Malposition of the catheter, which may cause damage to the bowel, bladder, or urethra 2
  • Bladder spasms, partial blockage of the catheter, constipation, and urine infection 3
  • Catheter migration, which can lead to obstruction of the ureter 4
  • Design flaws in the catheter, which can cause leakage between the catheter shaft and the urethra mucosa or from around the catheter when inserted suprapubically 5

Possible Complications

• Urinary leakage around a suprapubic catheter can lead to serious complications, such as:
  • Maceration of neuropathic skin and pressure sore 3
  • Sepsis and septic shock, as seen in the case of a malpositioned suprapubic catheter that perforated the penile urethra 2
  • Ureteric obstruction, which can occur due to catheter migration 4

Management and Prevention

• Management of urinary leakage around a suprapubic catheter should include:
  • Changing the catheter 3
  • Prescribing anticholinergic drugs to control bladder spasm 3
  • Treating constipation and urine infection when present 3
  • Imaging studies or flexible cystoscopy to look for vesical calculus 3
• Proper placement and functionality of the suprapubic catheter should be ensured by the provider to prevent complications 2, 6