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  • Leaking around my sp stoma

    I've had my sp for 27 years. I'm using a Duette catheter. It works great! A couple weeks ago I was having leaking around my sp stoma. We changed the catheter and it had a blockage of something hard. After the catheter change everything was good for about a week. Then it started leaking again. We changed it and there was no blockage. A couple days later it started leaking. Urologist ordered an xray. Everything was ok. No stones. I started getting sweaty clamy a few days later and went to urgent care. They did a dipstick test and of course I had a UTI. They took a sample for a culture test and put me on Bactrim for five days. No leaking our sweating for those five days. I forgot to mention there was a problem with my sample. So it wasn't tested. Two days after I finished the Bactrim I started leaking again. So I took Cipro for five days. No leaking for those five days. Today two days after finishing the Cipro I started leaking. Any suggestions?

  • #2
    Originally posted by HACKNSACK44 View Post
    I've had my sp for 27 years. I'm using a Duette catheter. It works great! A couple weeks ago I was having leaking around my sp stoma. We changed the catheter and it had a blockage of something hard. After the catheter change everything was good for about a week. Then it started leaking again. We changed it and there was no blockage. A couple days later it started leaking. Urologist ordered an xray. Everything was ok. No stones. I started getting sweaty clamy a few days later and went to urgent care. They did a dipstick test and of course I had a UTI. They took a sample for a culture test and put me on Bactrim for five days. No leaking our sweating for those five days. I forgot to mention there was a problem with my sample. So it wasn't tested. Two days after I finished the Bactrim I started leaking again. So I took Cipro for five days. No leaking for those five days. Today two days after finishing the Cipro I started leaking. Any suggestions?
    You still have a urinary tract infection (UTI).

    Who ordered Cipro for 5 days?

    You are taking antibiotics that may not be the best ones to take for the bacteria that is causing the UTIs, and you are taking them for too short of a course.

    I understand the concept of taking an antibiotic to help mitigate symptoms and keep you comfortable AFTER you have submitted a specimen for lab analysis. But, once the results of the urinalysis (UA) and culture & sensitivity (C&S) have identified the bacteria and most effective antibiotic(s), then you need to switch to the appropriate antibiotic for a course of 12-14 days. After that course is completed, wait 2-3 days, and collect another specimen for UA and C&S to determine if there is any latent bacteria in the urine. If there is, you need to take another 12-14 day course of either the same antibiotic or another one, determined to be effective by the second set of lab tests.

    When you take the wrong antibiotic and for too short of course, you may see a reduction in symptoms, but you run the risk developing antibiotic resistance. The infections we experience are not simple, common, everyday variety UTIs that most of the population experiences when diagnosed with a UTI. Our UTIs are complex and need to be treated differently. Many urologist don't understand this fine point. If your urologist is resistant to your suggestions of a longer course of the preferred antibiotic, then have a consultation with an infectious disease (ID) doctor. ID docs are just more adept at managing antibiotic than most urologists.

    What was the problem with the specimen you submitted? Why didn't the doctor or lab ask you to collect another specimen for testing?

    Get another specimen to the lab for UA and C&S and go from there following the protocol suggested above.

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    • #3
      Thanks for the info.

      I have Cipro just in case I get UTI symptoms. I know it's just a temporary fix.

      All they said was the specimen was bad. I had already started the Bactrim. They said if I felt ok not to worry about another speciman.

      I'm going to see an ID and give another specimen.
      Last edited by HACKNSACK44; 04-06-2018, 10:29 PM.

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      • #4
        What is the best way to get a specimen?

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        • #5
          Originally posted by HACKNSACK44 View Post
          What is the best way to get a specimen?
          Straight out of the supra pubic catheter into a sterile specimen cup. Try not to touch anywhere in the cup with any part of the catheter funnel. Don't take a specimen out of a leg bag.

          Be sure to label the specimen, "Supra Pubic Catheter Specimen" so that the lab is aware the specimen is not a "clean catch specimen." The specimen out of your catheter may always show bacteria, which means the urine is always colonized with bacteria. CFU, Colonizing Forming Units is the important count that should mean something to your health care provider. Once again, if you urologist or primary care physician doesn't get it...see an Infectious Disease specialist ASAP (as soon as possible)!

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          • #6
            Originally posted by gjnl View Post
            Straight out of the supra pubic catheter into a sterile specimen cup. Try not to touch anywhere in the cup with any part of the catheter funnel. Don't take a specimen out of a leg bag.

            Be sure to label the specimen, "Supra Pubic Catheter Specimen" so that the lab is aware the specimen is not a "clean catch specimen." The specimen out of your catheter may always show bacteria, which means the urine is always colonized with bacteria. CFU, Colonizing Forming Units is the important count that should mean something to your health care provider. Once again, if you urologist or primary care physician doesn't get it...see an Infectious Disease specialist ASAP (as soon as possible)!
            Ok that is how we do it. I will label it "Supra Pubic Catheter Specimen". Thanks for the help.
            Last edited by HACKNSACK44; 04-07-2018, 03:01 PM.

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            • #7
              Originally posted by gjnl View Post
              Straight out of the supra pubic catheter into a sterile specimen cup. Try not to touch anywhere in the cup with any part of the catheter funnel. Don't take a specimen out of a leg bag.

              Be sure to label the specimen, "Supra Pubic Catheter Specimen" so that the lab is aware the specimen is not a "clean catch specimen." The specimen out of your catheter may always show bacteria, which means the urine is always colonized with bacteria. CFU, Colonizing Forming Units is the important count that should mean something to your health care provider. Once again, if you urologist or primary care physician doesn't get it...see an Infectious Disease specialist ASAP (as soon as possible)!
              Well submitted a specimen on Monday. Labeled it "Supra Pubic Catheter Specimen". Got the results today and it said the specimen was contaminated and I needed to submit another specimen. This is getting ridiculous! Am I doing something wrong?

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              • #8
                Originally posted by HACKNSACK44 View Post
                Well submitted a specimen on Monday. Labeled it "Supra Pubic Catheter Specimen". Got the results today and it said the specimen was contaminated and I needed to submit another specimen. This is getting ridiculous! Am I doing something wrong?
                I don't think the lab you use gets it. I haven't submitted many specimens since the supra pubic catheter was placed, but I've never had one returned because it was "contaminated." You may need to ask the lab or your doctor how to take a specimen that the lab will not reject.

                When NL takes a specimen, I drink a large glass of water and we wait for about 15/20 minutes Then, she washes her hands, puts on a pair of nitrile gloves, swabs a catheter plug with an alcohol wipe, disconnects the catheter from the leg bag and plugs the catheter. She waits about 10/15 minutes, then removes the catheter plug and allows a little bit of urine to flow into a plastic or paper cup. Immediately, she opens a sterile urine specimen cup that has been supplied by the lab and drains about 30cc to 50cc of urine into the cup, making sure that the catheter funnel does not touch any part of the specimen cup. She then plugs the catheter funnel back into the leg bag and screws the cap onto the cup. She labels the specimen as required and adds the words "Supra Pubic Catheter Specimen."

                I can't imagine that you would be required to use a foley catheter equipped with a sampling or specimen collection port that is used to aspirate urine into a sterile syringe and then into a sterile cup. But, then anything is possible. See this video that shows the procedure for using a foley with an access port: https://www.youtube.com/watch?v=55ZqPBPWtiQ

                Maybe your doctor's lab order for a urinalysis (UA) and culture & sensitivity (C&S) should include, a statement to the lab that this specimen is a "Supra Pubic Catheter Specimen," and should be processed whether the specimen appears to be contaminated or not.

                Good luck!

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                • #9
                  the way my doc does it we change cathe to a new get sample that way no old bactrica

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                  • #10
                    fyi I did that last year just soaked coming thru stoma did a few test no uti they ordered sme type of pill but I did not take no leakeage since I did kink my cathe a couple of night ago and soaked but that was me

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                    • #11
                      It must have multiple organisms and the lab will ask for resubmit. However, this is common in SCi and your provider needs to ask for the work up all organisms. You have to replace the SPtube and bag then submit it.
                      CWO
                      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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                      • #12
                        Originally posted by SCI-Nurse View Post
                        It must have multiple organisms and the lab will ask for resubmit. However, this is common in SCi and your provider needs to ask for the work up all organisms. You have to replace the SPtube and bag then submit it.
                        CWO
                        How do you get the specimen with a sp?

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                        • #13
                          brand new cathe into sterile container

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                          • #14
                            If you have a lot of urinary tract infections, and need to change to a new one to get a specimen and then change to a new one after you've been on antibiotics for most of the 12-14 day course, it can get kind of pricey at $12-$18 per Duette catheter, if you are purchasing them outright. If Medicare or many other insurance carriers are supplying your foley catheters, you only get one per month at a time. So it makes it pricey and depletes your supply quickly and you have to pay out of pocket to have extras on hand, if that is even possible. Make things complicated, doesn't it.

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                            • #15
                              Originally posted by gjnl View Post
                              If you have a lot of urinary tract infections, and need to change to a new one to get a specimen and then change to a new one after you've been on antibiotics for most of the 12-14 day course, it can get kind of pricey at $12-$18 per Duette catheter, if you are purchasing them outright. If Medicare or many other insurance carriers are supplying your foley catheters, you only get one per month at a time. So it makes it pricey and depletes your supply quickly and you have to pay out of pocket to have extras on hand, if that is even possible. Make things complicated, doesn't it.
                              Yes it does. I'm doing a catheter change and submitting a new specimen Monday. We will see how it goes.

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