Other less common complications of long-term catheterization include urethral fistulae, epididymitis, scrotal abscess, prostatitis, and prostatic abscess. ALTERNATIVES TO LONG-TERM CATHETERIZATION
As has been previously mentioned, one alternative to long-term catheterization is intermittent catheterization. Another option is the placement of a suprapubic catheter. This type of bladder decompression reduces the incidence of certain complications associated with urethral catheterization. Because the suprapubic catheter does not exert pressure on the urethra or external genitalia, erosion and necrosis of these structures are eliminated. Damage to the urethra during insertion is similarly reduced, although injuries from suprapubic catheter insertion can include perforation of intraabdominal structures, as well as urinoma or abscess formation. Rates of bacteriuria from suprapubic catheters are lower as a result of the lower density of organisms at the catheter's abdominal insertion site. 4
External urinary drainage devices (condom catheters) are also used for the long-term management of incontinence in men. By virtue of the noninvasive nature of these devices, urethral damage is minimized and introduction of external pathogens is greatly reduced. These devices do not, however, decompress the bladder and are therefore most useful in patients with either a hyperreflexic neurogenic bladder or with incontinence not due to neurogenic causes. Use of the condom catheter is also limited by the ability of the catheter to fit securely to the penis. Complications from these devices most commonly result from pressure necrosis at the area of the roller ring of the condom. These complications can range from nonhealing ulcers to distal penile necrosis.
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