Urine is produced by the kidneys to remove waste from the body.
It flows from the kidneys to the bladder through tubes called ureters.
The urine accumulates in the bladder which is like a muscular sac.
The bladder regularly contracts (squeezes), causing the urine to empty through a tube at the bottom, called the urethra. The bladder contracts when the muscle wall is stretched. Bladder emptying (urination) is also controlled by the brain which controls the muscle.
The urethra ends with the urethral opening, an opening that is at the end of the penis in males and the center of the vulva in females. Urine leaves the body via the urethra.
Two muscles (sphincters) act as doors to open and close the urethra and bladder; the external sphincter is in the urinary meatus, close to the surface of the skin and the internal sphincter is at the junction of the urethra to the bladder. They remain closed, ie, contracted to keep urine in the bladder until we go to the toilet.
There are many reasons that the bladder might not empty properly. Examples include: side effects of some medications, neurological conditions, and spinal cord diseases. A bladder filled with urine too long prevents the kidneys from emptying normally and can cause urine to flow backwards into the kidneys. This damages the kidneys.
A bladder catheterization involves introducing a catheter (thin flexible tube) into the bladder to allow urine to empty out of it.
An intermittent catheterization means that the catheter does not remain in place permanently. It is inserted when the bladder is full and is then removed when the bladder is emptied. It is done on a regular schedule, several times a day, depending on the child’s needs, mimicking our natural bladder emptying patterns.
When a child is quite independent and able to manipulate objects, he can learn to do his own catheterization, under the supervision of an adult.
How does it work?
The catheter is inserted:
in the urethra through the urinary meatus to the entrance of the bladder or,
into a tunnel, surgically constructed, (called a “Mitrofanoff”) leading from the bladder to the outside of the body, on the surface of the abdomen, close to or through the navel. The opening of this tunnel is called a stoma.
Once the catheter is in the bladder, the catheter allows urine to flow out.
The stoma of Mitrofanoff has a valve to prevent urine leaking between catheterizations and to prevent water from entering when bathing, showering or swimming.
When catheterization is properly performed, it allows your child to do his daily activities normally.
There are catheters of various types and different sizes. Your child’s catheter may change over time depending on age and weight. Your healthcare team will guide you based on your child’s needs.
A catheter may be disposable or reusable, plastic, silicone or latex, soft or firm, straight or angled, pre-lubricated or not, having an open drain end or an integrated drainage bag.
The catheter should be changed:
if there is a change in its appearance or texture (eg, if it becomes opaque, rigid or too soft) and,
depending on the length of time it should be used as suggested by the manufacturer.
To clean the reusable catheters, follow the manufacturer’s recommendations and those of your healthcare team.