DEAR MAYO CLINIC: I am 80 years old and had prostate cancer treatment several years ago. I later had several urine blockages requiring catheters, and doctors finally decided on a suprapubic catheter, which has functioned as expected for three years. Would it be possible for me to have the catheter removed and return to a normal manner of urinating? I am otherwise in good health and am wondering what complications may arise with such a procedure.
ANSWER: When a suprapubic catheter is needed long-term, returning to normal urination usually isn’t feasible. In some cases, however, it may be possible. Working with your urologist, you can see if it might be an option in your situation. If not, and if you would still like to get rid of the catheter tube, other alternatives are available.
A urinary catheter is a small plastic tube that drains urine from the bladder. A suprapubic catheter is a type of urinary catheter placed into the bladder through a small hole in the abdomen. The tube carries the urine outside of the body and is connected to a drainage bag that collects the urine.
The need for a suprapubic catheter is relatively uncommon. Generally, they are used only when the passage that carries urine from the bladder to the outside of the body, the urethra, becomes severely blocked and cannot be effectively opened again. That can happen as a result of scar tissue buildup after radiation therapy for prostate cancer.
When you’ve used a suprapubic catheter for several years, the likelihood that you will be able to switch back to normal urination is low. If you’re interested in trying, though, talk to your doctor about capping the catheter. When that’s done, the urine will accumulate inside your bladder. If there is a path for the urine to get through the urethra, it will do so. If it does, then you could get rid of the catheter.
If the urine doesn’t have a path out of the bladder, and you need to return to the suprapubic catheter, you have several alternatives. First, you could ask your doctor about surgical procedures to open the urethra. For most people who have a suprapubic catheter, however, those techniques were attempted before the catheter was placed. If you went through such a procedure already and it failed, then trying it again would not be recommended.
Second, the catheter could be replaced with a urinary diversion. It involves surgery that uses a piece of your intestine to create a tube that runs from your kidneys to your abdominal wall. The urine then drains out a hole in your abdomen. You would still need to wear a bag to collect the urine.
There are several benefits to transitioning from a suprapubic catheter to a urinary diversion. With urinary diversion, you no longer need to deal with changing the catheter on a regular basis. You also eliminate the possibility of developing complications that can accompany long-term suprapubic catheter use, including chronic urinary tract infections and increased risk of a type of bladder cancer called squamous cell cancer.
Creating a urinary diversion does involve a complex surgery. In some older adults, particularly those who have other health concerns, such a procedure may pose more risks than benefits. If you are in good physical health, though, it may be a reasonable option.
Talk to your doctor about your interest in moving away from suprapubic catheter use. For most people, there’s no harm in capping the catheter to see if urination through the urethra is possible. If that doesn’t work, then discuss your other options with your urologist to see what may be best for you. — Paul Young, M.D., Urology, Mayo Clinic, Jacksonville, Fla.