Living with a urinary catheter
The catheter of the future: what catheter users say they'd like
The Foley catheter is still one of the most commonly used devices for managing urinary incontinence, although it is only recommended for that purpose as a last resort. Since its introduction in 1937, its design as an indwelling catheter has not fundamentally changed. Device manufacturers have tried many modifications to lessen the risk of trauma and infection associated with these catheters. Improvements in materials have been made from the original latex rubber to silicone, and a variety of coatings such as Teflon and hydrogel have been used. The size and shape of the drainage eyes have been modified to enhance urine flow and reduce clogging. Antiseptic and antibiotic coatings on catheters have also been applied to combat the bacteria introduced into the bladder by the catheter. However, the results of these changes have been inconclusive and the Foley catheter design is believed to be a major cause for many of the complications, including urinary tract infections (UTIs), bladder spasms, cystitis, and possibly an increased risk of bladder cancer. Many health professionals and catheter users would welcome a new urinary drainage system that can reduce infection and morbidity.
A consultant describes what he feels a newly designed catheter should be able to do.
A consultant describes what he feels a newly designed catheter should be able to do.
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We are interested in looking at what we call the 21st Century catheter. When one considers what has happened in the last twenty, thirty years in the field of surgical implants, we’ve seen an amazing revolution. When I was a student, one couldn’t replace hip joints or knee joints, but this is now a regular feature and so many people are living with new hip and knee joints. We have people being given new heart valves. And we have people whose cataract is removed and you have implant lenses put into the eye. It’s a remarkable transition from what was available in the past.
But we are still using a urinary catheter that was developed in the 1930s at a time when medicine was very empirical. It wasn’t based on scientific evidence. I tried to explain to you that the bladder has a remarkable anti-bacterial defence mechanism and this relies on its ability to fill and empty completely, and also on the preservation of that lining of the bladder, preventing bacteria from attaching to the cells on that surface.
Now the Foley catheter, as I’ve explained, does prevent complete emptying of the bladder. Bacteria get into the bladder and they multiply very rapidly in urine. It’s a very good culture medium for bacteria. They rapidly multiply and the tip of the catheter will damage the surface, that mucin surface that lines the bladder, and also ulcerate the surface. So then the bacteria can get into the wall of the bladder and, once they are in the wall of the bladder, they can reach the blood stream. So serious infections can follow in certain circumstances.
I think we need a new design of catheter which supports those anti-bacterial defence mechanisms, that we store the urine in the bladder, not in a bag on the leg. The bladder in most cases can store the urine perfectly well but we need some mechanism to allow the bladder to be drained. We want to make sure that no damage is done to the lining of the bladder.
Modern technology is advancing so rapidly we should have a catheter valve that could be controlled by remote control for those people who have poor manual dexterity or even on an automatic timed mechanism for those who don’t have the cognitive ability to be able to drain their own bladder.
Unfortunately, there are too many people who have to rely on catheter drainage of the bladder because of their condition and I think that we, our technology today should be addressing these problems more actively.
Peter Y helped set up the 21st Century Catheter Project which aims to improve the design of the...
Peter Y helped set up the 21st Century Catheter Project which aims to improve the design of the...
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The 21st Century Catheter Project started a year ago now, which is the middle of 2010. But we got up and running and got a full website up at the beginning of this year. And we really, the focus is to improve the design of the catheter, of the Foley catheter, to improve that design.
But we knew if we put the website up, we would get a lot of people saying, “Help me with what I’ve got.” And so there’s a forum there. There’s all the science of problems with catheters, in terms of proteus mirabilis infection, how it occurs. There’s some graphic pictures which, unless you’re a, if you’re a member of the general public we should probably put an x-rating on it.
But, apart from that, it’s a website to help current users. And it’s also a website trying to promote a new design and actually to get people to accept that professionals in the industry and in the medical profession, to accept how limited the existing catheter is. It’s rather, it’s one of those things which, if brought forward now as a new invention, would simply not be approved in its current state. And the only reason it’s being used, it seems to me, is because no one can be bothered to get anything better. And I think part of the problem, the other thing we wanted to raise was, or to demonstrate, was that existing users are not happy with what they’ve got, but there’s no alternative.
What would the ideal new catheter do?
An ideal solution would interfere with the bladder as little as possible, in other words we’d want to retain its elasticity, so that it empties and fills in the normal way. But the bladder must empty completely or so completely that there’s, again the normal level of residue left. And so of course the magic one would interfere very little with the body. But I appreciate there’s got to be some mechanism of dealing with the problem. I mean I’m assuming that the problem is that the sphincter is not working properly and there are other reasons for catheterisation. But the problem with this catheter is that it damages the lining, the wall lining of the bladder and so that an infection can get into what is effectively an open wound. That has been videoed and shown to be true.
And also it’s impossible for the bladder to empty properly with a circular balloon as a retention mechanism. To get rid of the tip of the catheter and alter the shape of the balloon or use a retaining mechanism which doesn’t keep the bladder full of 100ml or so of urine, would help a lot. But that’s easy for me to say.
Some people we interviewed said they’d like a catheter that would allow them more independence including, for example, a device that would allow those with limited use of their hands to empty the drainage bag themselves, and a catheter they could change themselves. Hayley said she’d like to be able to open her own catheter valve without relying on her carer to do it.
Peter Z would like a catheter that has a valve on his stomach to let out urine.
Peter Z would like a catheter that has a valve on his stomach to let out urine.
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If men could do their own, I think there is a female catheter, but I’m not sure how men would do it to be honest. But I would, I think if it was possible to have a little valve, if you just screwed it in or something here, I’m sure it would be possible when they first operate to put in a valve on your tummy. And that would be great.
And then that would…
Chained up like a hose pipe. It would be rather nice and you could change your own, just make sure everything is sort of hygienic and keep it clean. I mean I’m not sure it’s possible. I’m not in the design area, wish I were ‘cos I really think it could be a brilliant idea if I knew someone that wanted to develop that a bit, a little valve on there.
A little valve and then you could just empty?
You could change it yourself, that’s the thing. Yes. I’m surprised that, to be honest they haven’t reached that stage because medicine seems to be years before in everything else in this country and yet that particular one seems to have been missed.
Alok said a newly designed catheter could have a microchip that monitors urine output and fluid...
Alok said a newly designed catheter could have a microchip that monitors urine output and fluid...
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This catheter has been designed in 1935 but still nothing has changed since then. I don’t know but in my layman understanding, I can say, ‘come on man, we just need to find out a way of emptying a tank, a tank which is filling up and which needs to be emptying.’ It can be a small motor, which can suck the urine, whatever is available, and throw it out whenever someone needs to. And that motor can be automatic, can be made automatic, it can be made by manual, it can be controlled manually or automatically. I don’t think it’s a very complex thing to design. It’s very, very simple.
People who are in the designing industry, I think if they start thinking about it, it’s going to be a very simple solution, which can be done. The only complexity comes in terms of what material should we use? And about how to get rid of the sediments which come out and which are the main cause of blocking it, and UTI’s.
But for those also, you can, once you know how to evacuate the bladder completely, after that you can start thinking about what other things we can pass into the bladder so that there won’t be any sediments. The sediments won’t form. We can even pass some medicines at a regular interval so that it will keep it clean and keep it away from the UTI’s.
If you look at the catheter, it’s nothing but a tube going into your water tank. Whenever water is there, it just comes out. There is no regulator in there, like when it should come out, when it should not come out. And there is no monitoring of how much is coming out.
Nowadays this technology has become third world, everything can be programmed in a chip in which it gets recorded automatically. We don’t need to have any record of how much we have drunk and how much has come out. It can be recorded on a chip and the chip can automatically monitor your, monitor and take care of how much you are drinking because, if you are drinking and if you are getting less output, you should automatically get a reminder by something attached to your catheter that ‘oh you are drinking less’. You need to check something is going on and you have to talk about it to the doctor or something.
There are so many things you can programme in that, and those are the things which I wish and I feel that those are not difficult. It’s just a matter of asking and gathering together the relevant people who can put all these things in one small product, which can be used along with this simple tube.
Some people felt strongly about ‘having a bag of urine strapped to the leg’ and wanted a newly designed catheter that would be more discreet. Ian would prefer a less intrusive catheter than a suprapubic one and Dave would prefer something smaller and less visible.
Vicky would like a newly designed catheter to empty completely and store urine internally. She’d...
Vicky would like a newly designed catheter to empty completely and store urine internally. She’d...
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The main thing is, as lovely as it would be for somebody to come up with a better solution, there is always this feeling that it’s a precarious balance of life. If things do work and you aren’t leaking and you don’t get blockages, okay there’s still the infections but they are manageable, there is always this feeling that you shouldn’t really rock the boat or try anything too new or outrageous because you just don’t want to damage that fragile balance that you’ve got with this crude system that at least means that there’s some dignity.
The idea of having to leave a room of people who could be friends or might even be strangers, and having to leave a room because you’ve leaked urethrally is just so horribly humiliating that, even though this system does seem very crude, at least it does work. It’s certainly not perfect in any way but I think there’s always a slight fear of trying anything too new because of exactly that, not wanting to make anything worse really.
In the ideal world, a new catheter, a new design, what would you like it to do?
I think it has to be very much more discrete. It would be nice if the urine was stored inside the body, rather like an ordinary healthy bladder would work, expanding and then emptying, rather than having something that’s external that attaches to you to store urine in. That for me, you know it’s a very crude solution. So really I guess mimicking the ordinary healthy human body in the way the bladder fills and empties.
If something could be more inside the body and not so noticeable, that would be a huge positive. If I could manage it myself as well, that would be a huge positive. And if we can do away with all these things that continually cause problems, like the blockages and the infections, if there was a way of getting rid of all of those complications, and not having to take so many antibiotics and not having to go to the toilet and apologise to the PA who is emptying your leg bag, “I’m so sorry it smells so bad but I’ve got an infection.”
It’s just all those things that make you feel very self-conscious. The fact that somebody might notice this tube going under the trousers and this leg bag that’s full and bulging underneath by the bottom of your leg.
Annie wished she didn’t need a leg bag or daily antibiotics. She’d like a catheter that allows...
Annie wished she didn’t need a leg bag or daily antibiotics. She’d like a catheter that allows...
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If I really had my wish, if I won a wish I would wish that I didn’t have to have a leg bag anymore. And that there’d be some magical solution to the urinary tract problem which didn’t involve a leg bag and didn’t involve speeding myself onto the loo every half an hour. And didn’t involve anything like that. Some magical solution, but I can’t imagine what it would be.
But the leg bag is a nuisance, it is a nuisance and it’s not nice to have a great reservoir of urine attached to your leg. The only time it’s an advantage is if you’re driving up the motorway and there’s a traffic jam and your leg bag fills up. You can empty it into a bottle and you don’t have to worry, whereas everybody else in the car is fidgeting around ‘cos they need to go to the loo and they can’t. So that is the one time when you just think, “Well okay, that’s a plus point.” There aren’t many, but that’s one of them.
You’ve mentioned some interesting things that, you know, if it could, for example if someone was going to design a new catheter, what kinds of things would, improvements would people like to see. So a leg bag is something that you would, some other solution other than a leg bag?
Yes. I would prefer, if I could have had some sort of surgical intervention which would have meant I could have catheterised myself through my abdominal wall. And there was no danger of having a bladder leak if you left it perhaps half an hour too long, like if you’re an ordinary able bodied person you might want to spend a penny but you don’t have to spend a penny absolutely instantly firstly. If you could have had that sort of situation, and then at night I didn’t have to wake up every hour to empty my bladder otherwise I would have an accident, then that would be a perfect solution. I wouldn’t mind if at night I just had to go onto drainage to keep my bladder empty so that I didn’t have a flood. But it just, there just doesn’t seem to be a way of doing that.
I really would much rather not have to take any medication. I mean, you know when you say this, is there anything that you would like? It’s like watching the horizon and seeing the sun rise. The thought that I could actually just not have to think about my bladder ever again, not have to have an indwelling catheter, not have to be on antibiotics, but deal with it in a completely reliable way. It would be absolutely like a new dawn to me. It really would.
Alex would like a discreet catheter and a range of bags to choose from for different occasions....
Alex would like a discreet catheter and a range of bags to choose from for different occasions....
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Have you got any suggestions for catheter designs as well?
Well only off the top of my head, small things like, don’t make them bright orange, you know. I know I’ve got a catheter there. I’d rather it kind of blends in with my skin and doesn’t glare out, you know, I’ve got a catheter.
I would like a range of bags to be made so that, for example, if you’re going out of an evening and you don’t need to drink loads of liquids, you could have a smaller bag so that it would be more discreet and you can wear skirts.
Also, I would quite like a bag for, and you could design a bag for having sex so that it’s smaller, lighter more discrete.
Also, I am the sort of woman that likes to wear quite tight clothing so I’d like it to be thought about, having a bag that can accommodate that.
I found lots of work around. One of them is, I wear hold up stockings, and what I do is I wear one, let’s say a black pair of hold up stockings then I put the strap, my thigh strap to hold the tube in place then the leg strap to hold the bag in place. Then I put another pair of hold up stockings, dark opaque on top. Cut off the foot of my left foot tight because then you can just roll up the outer tight just a bit, reveal the valve, empty the bag. But you don’t see that you’re wearing a bag because it’s concealed by the second dark opaque hold up stocking on top.
Good idea, a wonderful message to other people.
And then you can wear skirts but you have to wear boots so that your bag can go into a boot. But so it’s possible, you know, if you think of ways, it is possible to wear a dress, wear a skirt, be sexy and not have to show your catheter in an embarrassing way.
Several people wondered why a new design hadn’t yet been introduced, especially since other medical technology has advanced greatly. Others said they’d like a new catheter designed to solve their specific problems. These included wanting a catheter that:
- doesn’t cause UTIs and blockages
- doesn’t pull
- doesn’t cause trauma around the catheter site, soreness or overgrowth of granulation
- doesn’t separate from the leg bag, causing leaks
- can be used with a catheter valve that can be cleaned and re-used rather than changed for a new one every week
Melanie was ‘horrified’ to learn that the catheter’s design hadn’t improved in over 80 years. She...
Melanie was ‘horrified’ to learn that the catheter’s design hadn’t improved in over 80 years. She...
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I was horrified when I found out that, basically, we were using a catheter system that was kind of invented in the 1930’s. That, for 80 years, we’ve been using the same thing and there is, for me, there’s a sort of hidden level of catheter problems that nobody hears about on the NHS.
A huge amount of the budget devoted to giving people antibiotics to dealing with the catheter related problems, and I can’t believe that the amount of technology there’s been in the last 80 years, especially medical technology, that there couldn’t be a better way of doing things.
I personally think that, if you’ve got bio-engineers, technicians, I mean surely there must be something they can do with electrical impulses or…. I’m not a bio-engineer, but it strikes me that it is the Cinderella of the health service. It strikes me that it’s a matter that is, consultants, doctors are very happy just to devolve to the nurses. The nurses are great at it but the nurses aren’t the people who are going to push for something and say, “Look we need an entirely new way of looking at this. A new way of emptying bladder systems that isn’t quite as primitive as the one we have.”
I mean I don’t have any answers. All I know is that we are now developing smart phones with bendy screens that can go underwater. Why the heck can’t we develop something that can empty a paralysed bladder slightly more effectively, with less risk of infection than what we have?
Gavin wondered if a clip could be designed to hold the catheter tube closer to the stomach rather...
Gavin wondered if a clip could be designed to hold the catheter tube closer to the stomach rather...
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For me, I’ve often thought, because of the way I do it, I just clip off with a flip flow valve, I don’t have a bag attached the majority of the time because I’m quite active and transfer a lot, it means you’ve about 20 centimetres of catheter, which I just fold up and put on my lap.
But I’ve often thought that, if there was a clip or something that stopped it from moving down your legs, because potentially you could sit on it or pull on it. I’ve often thought if there was a clip that held it up towards your stomach or towards the area that it came out of your stomach, that would help. So I don’t have to consciously make sure it wasn’t falling down towards my legs. But, other than that, I can’t really see about how it could be improved. But I’d be interested if it could.
A few people said that they were satisfied with the current design because most of the time it had worked well and they’d had few complications. Others said they couldn’t think of ways in which indwelling catheters could be improved or hadn’t thought about it.
If the Foley catheter has been used for over 50 years, Charles said it can’t be a bad design....
If the Foley catheter has been used for over 50 years, Charles said it can’t be a bad design....
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I mean you can’t design something and expect it to, design something and it lasts for fifty years and say, “It’s a bad design.” Because I think someone might have, so it’s a good design but there are probably better designs considering the materials which you’ve got, if you think about it. If you think about materials used in, you may have heard of graphene, you know, carbon fibre, carbon tubes, that sort of stuff. Maybe there’s something in that. I mean we don’t know.
You need something ultra flexible, ultra strong, but smooth, it’s not going to damage. Inert, very important for it to be inert, because your body’s going to try to reject it because it’s an intrusion.
Maybe there’s an alternative for going through, maybe even I would say some sort of mechanical help for the sphincter on the bladder, so you can pee normally. So some sort of help, say, “I need to empty the bladder” something there, open it, shut it, whatever, you know, some sort of, in inverted commas, “clamp” or something. Maybe there’s something in that, I don’t know.
Michelle would love to be able to empty her own leg bag. She said catheters do work and ‘if it’s...
Michelle would love to be able to empty her own leg bag. She said catheters do work and ‘if it’s...
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Have you ever had any thoughts about how they [catheters] could be even better designed?
Catheters themselves? Probably not, ‘cos I find, I find with them, it works, you know, if it’s not broke, don’t fix it. Well I suppose the one thing, I would love to be able to empty my leg bag myself. Because again that would just…
More independence.
Yeah, more independence. But I haven’t yet found anything that would that would allow me easily to be able to do that.
Last reviewed October 2018.
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