A viable option for bladder management in males is condom catheterization. As noted above, condom catheterization is associated with relatively fewer complications than indwelling methods but more complications than intermittent catheterization (Ord et al. 2003; Hackler 1982). However, complications may still arise, as described by Newman and Price (1985). Of greatest concern is incomplete drainage, which may lead to persistently high bladder pressures, recurrent UTI and the likelihood of renal complications including glomerular filtration rate deterioration described below. Sometimes this situation necessitates adjuvant daily or twice daily catheterization, medications, or sphincterotomy. Medications to improve drainage, such as alpha blockers can improve emptying by reducing outlet resistance, and sometimes by reducing pressures. Newman and Price (1985) raise practical issues such as cleanliness and proper use of appliances. Application difficulties with condom catheterization are likely problematic in the event of impaired hand function. Slippage of the condom can result in leaks. Perkash et al. (1992) describe the use of penile implants, in part as a means to circumvent this issue with condom application.
Total Sample Size
|Newman & Price 1985
|Population: SCI individuals with external catheters: Gender: males=60; Level of injury: paraplegia=25, tetraplegia=35; Severity of injury: complete=47, incomplete=13. 17 had sphincterotomies, either before or after switching to condom drainage
Intervention: Individuals went through a renal function evaluation which included: roentgenographic studies, and glomerular filtration rates. Urine cultures, antibody coated bacteria determinations were done. Individuals were interviewed about their bladder emptying habits. Mean time external catheter was used was 48 mo.
Outcome Measures: Urine infections, (a positive culture was defined as any organisms growing), mean time of external catheter use, renal and bladder abnormalities, glomerular filtration rate.
|1. 32 individuals had positive urine cultures.
2. Tetraplegic individuals were more likely to have positive cultures than paraplegics (61% versus 44%).
3. Complete lesions individuals were more likely than incomplete lesions individuals to have positive urine cultures (60% versus 31%).
4. 27 of 34 individuals that were previously free of morphologic abnormalities developed changes including positive urine cultures, reflux (4), bladder diverticula (14) and trabeculation (26), urethral diverticula, and urethral dilatation.
5. 5 of 26 individuals who initially had morphologic defects became free of abnormalities.
6. No change in glomerular filtration rate was seen in 46 individuals, while 2 improved and 12 deteriorated.
|Perkash et al. 1992
|Population: SCI: Mean age: 41.9 yr; Level of injury: paraplegia=37, tetraplegia=38; cauda equina=4; Severity of injury: complete=61, incomplete=18; Mean time post-injury=8.24 yr.
Intervention: Follow-up of individuals implanted with a penile implant allowing improved condom placement or sexual penetration.
Outcome Measures: Failures, complications, Quality of Life Satisfaction survey.
|1. Penile implants in place for a mean of 7.08 yr.
2. Overall failure rate was 8% with an infection complication rate of<2%. 3. Prior to implant, 61 people lost condoms and had accidents with urine leakage >2/week, while only 15 reported condom loss 1-2/week after the implant.
4. Prior to implant, 14 people had indwelling catheters, while none had indwelling catheters after.
5. 54 individuals expressed satisfaction with sexual intercourse.
6. All felt it was easier to keep themselves clean and dry.
Bladder management through condom drainage is often chosen to overcome persistent incontinence that may occur with other methods of bladder management. However, periodic monitoring for bladder “residuals” and complete emptying may be necessarily, as emphasized by Newman and Price (1985) following a review of 60 SCI patients with external catheters. Elevated residuals should raise suspicion of the possibility of excessive bladder pressure resulting from incomplete emptying from a spastic sphincter or areflexic bladder. This is a situation that can easily be assessed by urodynamic studies. Though Newman and Price (1985) indicated a high prevalence of bladder trabeculation, and implied that this occurred secondary to high pressure, no corroborating urodynamic data was provided. Sphincterotomy is a surgical procedure that eliminates outlet resistance and one that almost 30% of the study group in Newman and Price (1985) had undergone. Another problem commonly described with condom drainage is infection. It is difficult to make conclusions in this area based on the rather generalized description of a positive culture (“any organism growing”) as presented by Newman and Price (1985).
Some patients prefer condom drainage for convenience, as there is usually no need or reduced need to catheterize, compared to regimes that involve sole use of clean IC. However, this convenience can be offset by accidental leaks, and skin problems at the site of condom attachment. Perkash et al. (1992) conducted a retrospective analysis of 79 male patients with penile implants in place over a mean time of 7.1 years. A primary reason for obtaining a penile implant in these patients, among others, was to provide a stable penile shaft to hold a condom for external urinary drainage. In addition, penile implantation allowed some to switch to a more effective and safer bladder management method (i.e. 18% no longer required an indwelling catheter). All patients reported improved continence as reflected in the general observation that it was easier to keep themselves clean and dry.
There is level 4 evidence (from one case series: Newman & Price 1985) that condom drainage may be associated with urinary tract infection and upper tract deterioration.
There is level 4 evidence (from one case series: Perkash et al. 1992) that penile implants may allow easier use of condom catheters, thereby reducing incontinence and improving sexual function.