Should My Grandmother Keep Her Catheter? A Urology Dilemma

Q: Should My Grandmother Keep Her Catheter? A Urology Dilemma

Hello： If the patient is able to urinate properly, it is often due to self-catheterization or long-term indwelling catheters. <br>In cases of dementia, it depends on whether the family members can perform the catheterization procedure correctly. <br>If they cannot, then a long-te

What is the best approach?

Before my grandmother had a stroke, she had been self-catheterizing due to bladder issues.
She often had a full bladder, but it seemed she wasn't placing the catheter correctly, which led to urine retention.
During several check-ups at her long-term care hospital, it was discovered that her bladder was completely full of urine.
The physician temporarily placed a urinary bag for her to drain the urine.
However, after her stroke, she was admitted to a hospital in Taipei and continued to use a catheter with a urinary bag.

While in the Taipei hospital, there was a discussion with the resident physician about whether to remove the catheter.
The resident suggested that since my grandmother was self-catheterizing, it was more convenient for her.
However, at least 2-3 family members needed to learn how to catheterize her.
Each month, someone would come to the house to help her change the catheter.
A friend with a nursing background visited and advised against removing the catheter, as it would reduce the risk of infection since it would not be inserted and removed frequently.
The decision at the Taipei hospital was to keep the catheter in place.
Now that she has been transferred to a rehabilitation ward in a hospital in Taoyuan, the staff there mentioned that having a catheter could lead to bacterial infections.
I would like to know whether it is better to continue using the catheter or to discontinue its use.
P.S.
My grandmother has dementia.

Xie, 20~29 year old female. Ask Date: 2018/09/17

Dr. Du Shixi reply Urology

Hello: If the patient is able to urinate properly, it is often due to self-catheterization or long-term indwelling catheters.
In cases of dementia, it depends on whether the family members can perform the catheterization procedure correctly.
If they cannot, then a long-term indwelling catheter may be necessary, with regular changes.
As for the potential drawbacks, they are quite similar; improper catheterization can lead to infections, and long-term indwelling catheters may also pose problems due to inadequate hydration or poor maintenance of the catheter's drainage function.
This should be discussed between the family and the physician, taking into account any underlying medical conditions and the patient's ability to manage the procedure independently.
There is no definitive approach that is universally best.
Wishing you good health.

Reply Date: 2018/09/17

More Info

When considering whether your grandmother should keep her catheter, several factors must be taken into account, particularly given her medical history and current condition. The decision to maintain or remove a catheter is not straightforward and involves weighing the benefits against the potential risks.

Understanding Catheter Use
Catheters are often used in patients who have difficulty urinating due to various medical conditions, including neurological disorders like stroke, which your grandmother has experienced. In her case, the catheter has been a means to manage her urinary retention effectively. However, long-term catheterization can lead to complications, including urinary tract infections (UTIs), bladder spasms, and other issues.

Risks of Keeping the Catheter
1. Infection: One of the most significant risks associated with long-term catheter use is the increased likelihood of urinary tract infections. Bacteria can enter the urinary tract through the catheter, leading to infections that can complicate her overall health, especially given her age and existing health conditions.

2. Bladder Health: Prolonged catheter use can affect bladder function. The bladder may become less responsive over time, potentially leading to further complications when the catheter is eventually removed.

3. Comfort and Quality of Life: Depending on how well your grandmother tolerates the catheter, it may affect her comfort and overall quality of life. If she experiences discomfort or pain, this could be a significant factor in deciding whether to keep it.

Benefits of Keeping the Catheter
1. Convenience: For patients who are unable to void independently, a catheter can provide a convenient way to manage urinary retention and prevent overflow incontinence. This can be particularly important for patients with mobility issues or cognitive impairments, such as dementia.

2. Reduced Risk of Urinary Retention: If your grandmother has a history of incomplete bladder emptying, keeping the catheter may help prevent complications associated with urinary retention, such as bladder distension or kidney damage.

Recommendations
1. Consult with Healthcare Providers: It's essential to have a thorough discussion with her healthcare team, including urologists and rehabilitation specialists. They can provide insights based on her current health status, the risks associated with catheter use, and her overall prognosis.

2. Consider a Trial Without Catheter: If feasible, a trial period without the catheter could be beneficial. This would allow you to assess her ability to void independently and monitor for any complications. If she can manage without the catheter, it may improve her quality of life.

3. Educate Family Members: If the decision is made to keep the catheter, ensure that family members are adequately trained in catheter care and management. This includes how to change the catheter, recognize signs of infection, and maintain hygiene to minimize risks.

4. Monitor for Symptoms: Keep an eye on any signs of infection or discomfort. Symptoms such as fever, chills, increased urgency, or pain during urination should prompt immediate medical attention.

5. Evaluate Regularly: Regular follow-ups with her healthcare provider are crucial to reassess her condition and the necessity of the catheter. As her health evolves, the decision regarding catheter use may need to be revisited.

Conclusion
Ultimately, the decision to keep or remove your grandmother's catheter should be made collaboratively with her healthcare team, considering her unique medical history, current health status, and personal preferences. Balancing the risks and benefits is key to ensuring her comfort and well-being. Regular monitoring and open communication with her caregivers will be essential in managing her urinary health effectively.

Similar Q&A

Understanding Catheter Removal: Considerations for Elderly Patients

Hello, Director. My elderly family member is quite advanced in age and has been managing benign prostatic hyperplasia well with medication for many years. However, recently he suddenly experienced urinary retention and, after multiple tests, was unable to urinate on his own, nece...

Dr. Du Shixi reply Urology
Hello: In elderly patients, the most common issue is that after catheter removal, they often need to be reinserted shortly afterward (within a few times for short-term, or 1-2 weeks for long-term). If this happens twice, I personally recommend against further removal (of course, ...

Managing Urinary Catheter Issues and Constipation in Elderly Patients

Last Thursday, my grandmother, born in 1931, underwent urodynamic testing, which indicated that her bladder was not contracting. She has had a urinary catheter in place for a month. As a result, she experienced severe urethral pain and went to the emergency department yesterday. ...

Dr. Du Shixi reply Urology
Hello: Please ensure that the catheter remains patent. If there is residual urine, it may leak out and cause discomfort. If you observe that the stool is indeed hard and dry, you may need to use a stool softener. If not, it may just be the sensation of having a catheter in place....

Surgical Options for Dementia Patients with Prostate Issues: A Family's Dilemma

My grandfather is 74 years old and has dementia (he does not exhibit violent tendencies but has difficulty with verbal expression). He recently underwent hernia surgery and currently has benign prostatic hyperplasia, for which he has a urinary catheter in place. He has been expre...

Dr. Tu Xiuhong reply Urology
Difficulties in urination and urinary retention are not necessarily caused by benign prostatic hyperplasia; elderly individuals may experience urination difficulties due to brain lesions as well. It is advisable to seek examination at a major hospital. Dr. Tu Hsiu-Hung.

Managing Kidney Inflammation in Elderly Patients: Treatment Options Explained

My grandmother is 70 years old and recently experienced symptoms such as hematuria and abdominal pain. After seeking medical attention, the doctor diagnosed her with inflammation in one of her kidneys. Her other kidney already has a catheter inserted. The doctor mentioned two opt...

Dr. Liu Jianting reply Urology
Your grandmother's situation is indeed quite complex, and how to address it must be very troubling for you. One kidney has undergone nephrostomy with a catheter, while the other kidney has recently shown signs of inflammation, hematuria, and abdominal pain. In this case, we ...