Urinary Bypassing - Diane Newman
June 26, 2020
Diane K. Newman, DNP, ANP-BC, FAAN, Adjunct Professor of Urology in Surgery, Perelman School of Medicine, University of Pennsylvania and Co-Director of the Penn Center for Continence and Pelvic Health. She is the author of several books. The most recent is as lead editor of the 1st edition of the SUNA Core Curriculum for Urologic Nursing and of Clinical Application of Urologic Catheters, Devices and Products.
Download: Urinary Bypassing
Diane Newman: Welcome. I'm Diane Newman. I'm a nurse practitioner. I'm also a continence nurse specialist and a pelvic floor specialist. I've been practicing in this area for the past 35 years, primarily in urology practice. As part of patients that I see, I see patients with urinary incontinence with bladder dysfunction who require catheterization. I'm proud to say that I am the Editor of the Bladder Health Resource Center on UroToday, and I suggest you review that center because I have added information and some resources on catheterization, such as indwelling urinary catheter, intermittent catheterization, as well as external catheters.
This presentation is about one of the common problems that we see in patients with either a transurethral indwelling catheter, called a Foley catheter, or a suprapubic catheter, and it's called urinary bypassing. This means urine leaks around the catheter. This is really a common problem seen by many nurses in longterm catheter patients, so we don't see this as much in the hospital unless there was a clot retention in a postop patient. But where you're going to see this is in home care patients, where that nurse is going out and changing catheters, or you'll see it maybe in nursing home patients. Or maybe in your urology office, because you have a population of patients who come in for catheter changes, and they may complain of this.
But what does this mean? This means that urine is leaking around the catheter. I want to share with you what the problem and maybe what the action can be. First, the bypassing may be caused by the catheter being blocked. I want you to look at the presentation I've done on the catheter that is not draining. The urine's not draining from that catheter into the bag and through the tubing, because I have actually the problem and action for that also. So I want you to review that, because I review the fact of why it may be blocked, the eyelets might be blocked. There may be encrustations or crystals that do develop minerals around the eyelets so they're blocked.
Is the catheter the correct size? We really don't recommend over a 14 French size. But for some individuals who may have a 16 French in, that might be irritating the bladder, causing bladder spasms, and that'll push the urine around the balloon outside. Actually, they really will have leakage around the catheter.
This is also a sign for urinary tract infection, so you want to check for signs and symptoms of systemic infection and treat as indicated. They should have some other signs such as fever. Perhaps they have some low back pain and that you really think they may have that infection that could be causing the bladder to be very irritated and bypassing.
It could be just really bladder overactivity. We used to call them bladder spasms, but basically the bladder's reacting to a foreign object in place. It doesn't like it, so it tries to get rid of it by spasming around that balloon in the catheter, and that is pushing urine out.
Concentrated urine can promote bladder spasms, so increasing fluid intake is very important. You want to check also, it could be the spasm is due to calculi stones in the bladder, and this can be confirmed by a renal ultrasound. You may need to refer them to urology.
Many patients with a suprapubic catheter, they may leak through the urethra, and they may need to go back in to see that urologist to have surgical closure of the bladder neck and the urethra. That should have been done at the time that the suprapubic catheter was placed, but maybe it was not done or it's not been effective.
Then finally, I would consider medications such as anticholinergic or beta-3 agonist medication, which really we treat for overactivity of the bladder in ambulatory patients without catheters. Actually, these can be very successful in this population. So I would consider possibly getting a prescription for one of those medications.
This is a problem that is very frustrating for nurses who change these catheters and also family members and the patient. We do see an increase the longer time that the patient has an indwelling catheter. I think that we really want to consider options on this.
Another sign, it also could be possibly a latex allergy. These are acquired allergies, so I suggest that you change that catheter material to all silicone.
So good luck with this. It's a problem that we see quite a bit, and it can be a very, very frustrating problem for all. Thank you.