How are urinary catheters used in medical settings. What are the main types of urinary catheters available. Why do complications often arise from catheter use. How can patients manage long-term catheter use safely.

Understanding Urinary Catheters: Purpose and Function

Urinary catheters are flexible tubes designed to empty the bladder and collect urine in a drainage bag. These medical devices play a crucial role in managing various urinary issues, but their use comes with potential risks and complications. Let’s explore the world of urinary catheters in depth.

What exactly is a urinary catheter? It’s a thin, flexible tube inserted into the bladder to drain urine. Typically, a doctor or nurse performs the insertion, either through the urethra (urethral catheter) or via a small incision in the lower abdomen (suprapubic catheter). Once in place, the catheter allows urine to flow into a collection bag for easy disposal.

Common Reasons for Catheter Use

• Urinary retention due to blockages or nerve damage
• Bladder drainage before, during, or after surgery
• Urine collection for diagnostic tests
• Medication delivery directly to the bladder
• Management of severe urinary incontinence

How long do patients typically need a catheter? The duration varies widely based on the specific medical situation. Some may require catheterization for just a few minutes or hours, while others might need long-term or even permanent catheter use.

Types of Urinary Catheters: Choosing the Right Option

When it comes to urinary catheters, one size does not fit all. Healthcare providers must consider various factors to determine the most appropriate type for each patient’s needs.

Intermittent Catheters

What are intermittent catheters? These are temporary devices inserted to empty the bladder and then immediately removed. They’re often preferred for patients who can manage their own catheter care and have regular voiding schedules.

Indwelling Catheters

How do indwelling catheters differ? Also known as Foley catheters, these remain in place for extended periods, from days to weeks. A small balloon inflated inside the bladder holds the catheter in position, allowing for continuous drainage.

Which type is better? While indwelling catheters offer more convenience, they also carry a higher risk of complications, particularly infections. The choice between intermittent and indwelling catheters depends on the patient’s specific medical needs, lifestyle, and ability to manage self-catheterization.

The Insertion Process: What Patients Can Expect

Is catheter insertion painful? While the procedure can cause discomfort, healthcare providers take steps to minimize pain and ensure patient comfort. Here’s what typically happens during catheter insertion:

1. The genital area is cleaned with an antiseptic solution
2. An anesthetic gel is applied to reduce discomfort
3. The catheter is gently inserted through the urethra or a small incision
4. For indwelling catheters, a small balloon is inflated to hold it in place
5. The catheter is connected to a drainage bag

Can patients insert their own catheters? With proper training and practice, many individuals can safely perform self-catheterization, particularly with intermittent catheters. This skill can provide greater independence and control over one’s urinary care.

Living with a Long-Term Catheter: Practical Considerations

How does a long-term catheter impact daily life? While it requires some adjustments, many people lead active, fulfilling lives with indwelling catheters. Here are some key aspects of catheter care and management:

• Maintaining proper hygiene to prevent infections
• Regularly changing and emptying the drainage bag
• Staying hydrated to promote good urine flow
• Monitoring for signs of complications
• Adapting clothing choices for comfort and discretion

Can you exercise or swim with a catheter? In most cases, yes. Many physical activities, including swimming, are possible with proper precautions and equipment. It’s essential to discuss specific activities with your healthcare provider to ensure safe participation.

Intimacy and Relationships

Does a catheter affect sexual activity? While it may require some adjustments, many people with catheters maintain healthy sexual relationships. Open communication with partners and healthcare providers is key to addressing any concerns and finding suitable solutions.

Catheter-Associated Complications: Recognizing and Preventing Issues

Why do complications occur with catheter use? Despite their medical benefits, catheters can introduce risks to the urinary system. Understanding these potential issues is crucial for both patients and caregivers.

Urinary Tract Infections (UTIs)

How common are catheter-associated UTIs? They’re unfortunately quite prevalent, especially with long-term use. Bacteria can easily travel along the catheter into the bladder, leading to infection. Symptoms may include:

• Fever or chills
• Lower abdominal pain
• Cloudy or bloody urine
• Increased urinary urgency or frequency

Can UTIs be prevented? While it’s impossible to eliminate all risk, proper catheter care and hygiene can significantly reduce the chances of infection. Regular hand washing, keeping the catheter and surrounding area clean, and maintaining good overall health all play a role in prevention.

Other Potential Complications

What other issues might arise from catheter use? Several other complications can occur, including:

• Bladder spasms
• Catheter blockage
• Urethral damage or erosion
• Bladder stones
• Skin irritation or breakdown around the insertion site

How can patients recognize these complications? Staying attuned to any changes in urinary patterns, discomfort, or overall health is crucial. Prompt reporting of concerns to healthcare providers can help address issues before they become severe.

Alternatives to Long-Term Catheterization: Exploring Options

Are there alternatives to long-term catheter use? For some patients, other methods of managing urinary issues may be preferable. These can include:

• Behavioral techniques (e.g., bladder training, pelvic floor exercises)
• Medications to improve bladder function
• Minimally invasive procedures to treat underlying conditions
• External collection devices (for men)
• Absorbent products for incontinence management

How do patients and providers decide on the best approach? The choice depends on various factors, including the underlying medical condition, patient preferences, and quality of life considerations. A thorough discussion with a urologist or continence specialist can help determine the most appropriate management strategy.

Technological Advancements in Catheter Design: Improving Patient Experience

How is catheter technology evolving? Ongoing research and development aim to create catheters that are more comfortable, easier to use, and less prone to complications. Some recent innovations include:

• Antimicrobial coatings to reduce infection risk
• Hydrophilic catheters for smoother insertion
• Compact, discreet designs for improved portability
• Smart catheters with sensors to monitor urine output and detect potential issues

Will these advancements eliminate catheter-related problems? While new technologies show promise in improving the catheter experience, they’re unlikely to completely eradicate all associated risks. Proper use, care, and monitoring remain essential components of safe catheterization.

The Future of Urinary Care

What might the future hold for urinary management? Researchers are exploring various avenues to revolutionize urinary care, including:

• Artificial urinary sphincters
• Tissue-engineered bladder replacements
• Neurostimulation techniques for bladder control
• Gene therapies to address underlying causes of urinary dysfunction

How soon might these innovations become available? While some of these technologies are already in use or clinical trials, others remain in early stages of research. The field of urology continues to evolve, offering hope for improved solutions in the coming years.

Patient Education and Support: Keys to Successful Catheter Management

Why is patient education crucial for catheter users? Proper knowledge and training can significantly impact the success of catheter use and reduce the risk of complications. Healthcare providers play a vital role in ensuring patients and caregivers are well-informed about catheter care.

Essential Education Topics

• Proper insertion and removal techniques (for intermittent catheters)
• Maintaining catheter and skin hygiene
• Recognizing signs of infection or other complications
• Managing catheter supplies and equipment
• Adapting daily activities to accommodate catheter use

Where can patients find ongoing support? Many resources are available for individuals living with catheters, including:

• Support groups (online and in-person)
• Continence nurse specialists
• Patient advocacy organizations
• Educational materials from reputable medical sources

How can healthcare providers ensure effective patient education? Using a combination of verbal instructions, written materials, and hands-on demonstrations can help reinforce important information. Follow-up appointments and open lines of communication are also crucial for addressing ongoing questions and concerns.

Empowering Patients Through Knowledge

Can education improve catheter-related outcomes? Absolutely. Well-informed patients are better equipped to manage their catheters effectively, recognize potential problems early, and maintain a good quality of life. By investing in comprehensive patient education, healthcare providers can help minimize complications and promote better overall urinary health.

As we continue to explore the complexities of urinary catheterization, it’s clear that this medical intervention, while often necessary, comes with its own set of challenges and considerations. By understanding the types of catheters available, recognizing potential complications, and staying informed about proper care techniques, patients and healthcare providers can work together to ensure the safest and most effective use of these important medical devices.

Urinary catheters – NHS

A urinary catheter is a flexible tube used to empty the bladder and collect urine in a drainage bag.

Urinary catheters are usually inserted by a doctor or nurse.

They can either be inserted through the tube that carries urine out of the bladder (urethral catheter) or through a small opening made in your lower tummy (suprapubic catheter).

The catheter usually remains in the bladder, allowing urine to flow through it and into a drainage bag.

When urinary catheters are used

A urinary catheter is usually used when people have difficulty peeing (urinating) naturally. It can also be used to empty the bladder before or after surgery and to help perform certain tests.

Specific reasons a urinary catheter may be used include:

• to allow urine to drain if you have an obstruction in the tube that carries urine out of your bladder (urethra). For example, because of scarring or prostate enlargement
• to allow you to urinate if you have bladder weakness or nerve damage that affects your ability to pee
• to drain your bladder during childbirth if you have an epidural anaesthetic
• to drain your bladder before, during or after some types of surgery
• to deliver medicine directly into the bladder, such as during chemotherapy for bladder cancer
• as a last resort treatment for urinary incontinence when other types of treatment have been unsuccessful

Depending on the type of catheter you have and why it’s being used, the catheter may be removed after a few minutes, hours or days, or it may be needed for the long term.

Types of urinary catheter

There are 2 main types of urinary catheter:

• intermittent catheters – these are temporarily inserted into the bladder and removed once the bladder is empty
• indwelling catheters – these remain in place for many days or weeks, and are held in position by an inflated balloon in the bladder

Many people prefer to use an indwelling catheter because it’s more convenient and avoids the repeated insertions needed with intermittent catheters. However, indwelling catheters are more likely to cause problems such as infections.

Inserting either type of catheter can be uncomfortable, so anaesthetic gel may be used on the area to reduce any pain. You may also experience some discomfort while the catheter is in place, but most people with a long-term catheter get used to this over time.

Read more about the types of urinary catheter.

Looking after your catheter

If you need a long-term urinary catheter, you’ll be given detailed advice about looking after it before you leave hospital.

This will include advice about getting new catheter supplies, reducing the risk of complications such as infections, spotting signs of potential problems, and when you should get medical advice.

You should be able to live a relatively normal life with a urinary catheter. The catheter and bag can be concealed under clothes, and you should be able to do most everyday activities, including working, exercising, swimming and having sex.

Read more about living with a urinary catheter.

Risks and potential problems

The main problems caused by urinary catheters are infections in the urethra, bladder or, less commonly, the kidneys. These types of infection are known as urinary tract infections (UTIs) and usually need to be treated with antibiotics.

You can get a UTI from using either a short-term or a long-term catheter. However, the longer a catheter is used, the greater the risk of infection. This is why it’s important that catheters are inserted correctly, maintained properly, and only used for as long as necessary.

Catheters can also sometimes lead to other problems, such as bladder spasms (similar to stomach cramps), leakages, blockages, and damage to the urethra.

Read more about the risks of urinary catheterisation.

Page last reviewed: 03 February 2023
Next review due: 03 February 2026

The Hidden (And Not-So-Hidden) Dangers Of Treating Incontinence With Urinary Catheters

This is the second in a 3-part series on urinary incontinence in men suffering with benign prostatic hyperplasia. Dr. Richard Roach, of Advanced Urology in Oxford, FL, discusses the challenges of using urinary catheters to treat men with BPH-related incontinence, and the drawbacks of long-term catheterization.  

In my last BHEALTH blog post, we touched on the peculiar, yet common link between BPH and incontinence. Among other topics, we reviewed the progression of BPH disease state, to the point that symptoms begin to manifest themselves through urge and stress incontinence. Likewise, we also discussed the role that urinary catheters play in men who are not good candidates for BPH therapies.

So let’s now take a closer look at this population of men who must rely on urinary catheters to manage BPH-related incontinence symptoms, and examine the shortcomings of long-term catheter use:

Losing the ability to void naturally

The first (and most obvious) drawback of chronic catheter use is losing the ability to urinate at-will. Of course, managing supplies and components can be a hassle, but there are also health concerns associated with preventing your bladder to fill and empty on its own. Chronic catheterization, particularly with an indwelling catheter, can increase the risk for deterioration in overall bladder health, which can lead to a permanent inability to store and drain urine naturally, or even cancer.

Heightened infection risk

Perhaps the most immediate health concern with chronic catheter use is the heightened risk of infection. According to the Centers for Disease Control, more than 500,000 patients each year in the U. S. develop urinary tract infections (UTIs) while in the hospital, and indwelling urinary catheters (commonly known as Foley catheters, which reside inside the bladder for either a short or long period of time) are the leading cause. And the CDC numbers only count UTIs acquired while in the hospital; many others develop infections from long-term indwelling catheter use at home.

Compromises to quality of life

The last, but no less important, drawback of chronic catheter use is the impact on quality of life. Many men are simply unable to perform day-to-day activities inside and outside the home. The embarrassment or inconvenience of a drainage bag is a commonly lamented life-limiter, and some types of catheterization restrict a man’s ability to be sexually active, which can strain relationships.

These challenges represent the key reasons that healthcare professionals around the world are seeking alternatives to long-term catheter use. And though it’s not always feasible to have a catheter removed, it’s important to point out that there are alternatives to long-term catheterization.

The final post in this series will highlight the story of one such patient who stopped using a catheter after several challenge-fraught years, and gained back his ability to urinate when he wanted to – without components or supplies, without infections and (most importantly for him) without any significant compromises to his everyday life.

Read part 3 of this series here.

Dr. Richard Roach attended the University of Wisconsin-Madison Medical School and completed his residency at the University of Wisconsin-Madison Hospital and Clinics. After graduation, Dr. Roach moved to Minocqua, Wisconsin and joined the Marshfield Clinic, where he practiced for the next 26 years. In 2013, he moved to Florida and is currently a partner in Advanced Urology Institute. He is certified by the American Board of Urology. His specialties include plasma vaporization for BPH, treatment of female stress incontinence and penile prosthesis for ED. He is also an expert in laser & laparoscopic surgery.

Urinary incontinence: causes and treatments

How rehabilitation can help with urological problems

The topic of urinary incontinence is considered taboo, many are ashamed of the problem and put off visiting a doctor. At the same time, incontinence negatively affects important aspects of life – from the emotional state to the ability to leave the house and travel.

There are various causes of incontinence, such as post-surgery stress, stroke, spinal cord injury, and other nervous system disorders. In this text, we will analyze in detail the causes of incontinence, as well as effective methods of treatment and rehabilitation.

Causes and risk factors for urinary incontinence

One of the most common risk factors for urinary incontinence is older age. Women over 60 report daily urinary incontinence in the range of 9% to 39%, men over 65 experience this problem half as often – from 2 to 11%. Urinary incontinence in the elderly is statistically associated with a decrease in strength and overall muscle tone, especially in the pelvic floor muscles.

Regardless of age and gender, the risk of urinary incontinence is increased in people with diabetes and overweight. For young women, childbirth, gynecological and infectious diseases can become an additional risk factor – from 7 to 37% of women aged 20 to 39have been reporting this issue for years.

Urinary incontinence may be due to a stroke. In 32-79% of patients, incontinence occurs upon admission to the hospital and in 25-28% remains at discharge.

Normally, in order to prevent leakage of urine, the sphincters (valve muscles) of the urethra should be closed during the accumulation of urine in the bladder, and the bladder muscle should be relaxed.

When the bladder is full, signals from the bladder are transmitted to the spinal cord and then to the brain, after which the response signals follow the same path, causing the bladder to contract and the sphincters to open. As a result, urine flows out of the bladder.

Frequent urination after a stroke is associated with an overactive bladder muscle, which occurs due to impaired communication between the central nervous system and the bladder. Risk factors for urinary incontinence: paresis (decreased strength in any part of the body), depression, cognitive impairment, age over 75 years, dysphagia (impaired swallowing), loss of visual field and a large area of ​​\u200b\u200bbrain damage (lesion of the cortex and subcortical region) .

“Recently, a patient came to our clinic after a stroke with frequent false urge to urinate and episodes of urinary incontinence day and night,” says Ivan Kolbin, a neurourologist at the Three Sisters Clinic. – Before each physical therapy session, the patient goes to the toilet because he is afraid that involuntary urination will occur during the exercises. At night, a man does not get enough sleep, as he wakes up at least four times because of the desire to go to the toilet. All this greatly affects his quality of life and emotional state. But this is solvable. If you choose the right therapy, then after 2-3 weeks the symptoms will go away or significantly decrease.

The main functions of the bladder – the accumulation and excretion of urine – are also impaired in spinal cord injuries. It is not uncommon for patients with spinal cord injury to stop feeling bladder fullness and the need to urinate. It is also likely that the person will not control the work of the sphincter of the urethra.

“If the patient has damage at the cervical or thoracic level, then frequent urination and urinary incontinence is associated with a spastic bladder that does not hold urine when filled. Although the signals between the bladder and the spinal cord are passing, the signals between the brain and the bladder have disappeared, so the person does not feel the fullness of the bladder and cannot control urination. The bladder muscle and urethral sphincter in this case are hyperactive, in addition, the joint work of these muscles is disrupted, says Ivan Kolbin. – In patients with lesions at the lumbar or sacral level, the situation is the opposite: the tone of the bladder is reduced, there are no contractions, the bladder gradually overflows and incontinence from overflow occurs. Failure to completely empty the bladder can lead to problems. Temporary placement of a urethral catheter is recommended in these patients to avoid overdistension of the bladder and prevent urinary tract and kidney complications.”

Temporary placement of a urethral catheter is recommended for these patients to avoid overdistension of the bladder and complications of the urinary tract and kidneys

a number of other cases.

“Prolonged use of a catheter sometimes causes a nosocomial infection that can contribute to urinary incontinence. Hygiene and regular intermittent catheterizations are important to avoid inflammation of the urinary tract, because the longer urine remains in the bladder, the more likely bacteria will multiply and cause inflammation. It is also important that the bladder is completely emptied and that there is no residual urine left in it, which contributes not only to inflammation, but also to the formation of stones. An indwelling catheter should be changed regularly. During catheterization, it is important not to damage the urethra, as this also creates the prerequisites for inflammation.

Urinary incontinence, in both men and women, can be stressful. Stress incontinence in women is more often associated with birth injuries, hormonal disruptions, and surgeries. In men, stress incontinence in most cases occurs after a prostatectomy (surgery to remove all or part of the prostate for prostate cancer) and after a transurethral resection (surgery for a benign prostate tumor).

Incontinence after prostatectomy is also due to the fact that when the prostate gland is cut off from the urethra, its back wall is partially damaged. The function is restored, as a rule, within 6 months after the operation. The number of patients with persistent urinary incontinence after surgery can reach 11.9%.

Treatment and rehabilitation

Pelvic floor training

Regular exercise is said to make the pelvic floor muscles stronger and stronger. Classes are held under the supervision of a doctor or with a smartphone, which tell the patient when to contract muscles and when to relax. It takes an average of 20 weeks to achieve results.

Kegel exercises help strengthen your pelvic floor muscles. But they are not shown to everyone. For example, in men after a stroke, mostly neurogenic damage occurs, in which drug therapy is sufficient. Muscle tone is more likely to decrease in women, especially with additional risk factors such as childbirth.

Electrical stimulation

This method is effective for men with urinary incontinence after prostatectomy.

Electrical stimulation (ES) activates the pudendal nerve. This causes the pelvic floor muscles to contract and also keeps the urethral sphincter closed and reduces the urge to urinate.

Electrical stimulation can be anal – when a special probe is inserted into the anal canal, as well as percutaneous – when overhead electrodes are placed (for example, on the hamstring or in the sacrum).

Extracorporeal magnetic innervation

This technique is effective in the complex treatment of urinary incontinence and works on the same principle as MRI: a device that is built into the seat of the chair creates a magnetic field. Next to the chair is a power supply unit with which the doctor can adjust the strength of this field. The doctor selects an individual dose of magnetic radiation for the patient, which improves the conduction of the nerve impulse and stimulates the contraction of the pelvic floor muscles. Unlike anal electrical stimulation, this method causes less discomfort for the patient.

General advice for patients with urinary incontinence

It makes sense to consult with your doctor about some aspects of your life. Perhaps he will advise:

• Limit fluid intake, drink in doses (no more than 200 ml of water at a time), drink less after 18:00, and also empty the bladder before bedtime so as not to get up at night and get better sleep.

“These are temporary restrictions,” says Ivan Kolbin. “Once the bladder again accumulates and holds a large portion of urine, you can return to the usual way of life.”

• Avoid excessive consumption of caffeinated, alcoholic and carbonated drinks.

“Caffeine stimulates urination even in patients without neurogenic disorders and stroke. Therefore, it is better for patients with urinary incontinence to limit coffee and, if there is such a need, drink it in the morning. If the patient himself notes the relationship between the intake of caffeinated drinks and incontinence, then it should be completely excluded, ”Ivan Kolbin.

• Do physical exercises to strengthen the muscles of the pelvic floor.

“The intensity of exercise depends on the condition of the patient. In most cases, Kegel exercises are enough to do 30 sets 3 times a day, ”- Ivan Kolbin.

• Watch your weight – Being overweight can put pressure on your bladder and make you want to urinate.

The experience of the Three Sisters clinic in helping people with difficult urination

Patients with urinary incontinence are most often admitted to the Three Sisters Clinic after a stroke and spinal cord injury. In these cases, rehabilitation specialists work with them to strengthen the muscles of the pelvic floor. For example, Kegel exercises are recommended. The doctor supervises the exercises and teaches the patient to do them on their own so that they can continue exercising at home after discharge.

The main goal of rehabilitation is to regain control of urination and urinary retention. It is important that urination is voluntary and the patient, depending on the severity of the violation, has time to get to the toilet or other auxiliary means of rehabilitation.

If a person is holding urine, then the next goal is to increase the intervals between urination and work on control. For example, if an urge appears, the patient needs to learn how to hold urine so as not to interrupt the session and not immediately run to the toilet. The quality of rehabilitation and life in general depends on this.

Physicians also prescribe medication individually:

• Alpha-blockers, which are recommended for men because they help relax the sphincters and the prostate gland. This allows urine to pass freely, and alpha blockers also help reduce the pressure in the bladder that occurs when urine passes.

• In addition to alpha-blockers, botulinum toxin preparations can be used to relax the bladder and sphincters. This method helps to reduce spasticity and hypertonicity of the bladder.

• Anticholinergic drugs are given to people using intermittent catheterization. Anticholinergics relax the bladder and prevent contractions in the bladder muscle fibers that can cause urinary incontinence.

Text author: Polina Fomintseva, medical journalist, graduate of the School of Modern Journalism of the European University in St. Petersburg

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What to do after removing a catheter for prostate surgery

This information will help you know what to do after removing your catheter for prostate surgery.

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What to do after prostate surgery

Control urinary problems

Your bladder and urethra will be weak for 2 days after your catheter is removed. Don’t try to push while urinating or force yourself to urinate. Let the urine come out on its own. Do not strain when emptying your bowels.

Limit your daily fluid intake to 4-6 glasses (8 ounces or 240 ml) of fluid per day. This will help reduce urine leakage. If you are leaking urine, limit the amount of alcohol and caffeine you drink.

Limit fluids after 7:00 pm and empty your bladder before bed. This will help you avoid having to get up at night to urinate.

You may notice blood or blood clots in your urine for several weeks after your catheter is removed. This is because the incisions (surgical cuts) inside your body heal, and the crusts that form on them are excreted in the urine. If you notice blood in your urine, drink more fluids until your urine clears. If there is still blood in the urine after 24 hours, call your surgeon.

Do Kegel exercises

Start Kegel exercises (pelvic floor exercises) 3 days after catheter removal. Discuss with your healthcare provider which exercises are safe for you. For more information, read the resource Pelvic Floor Exercises (Kegel Exercises) for Men.

Take your medication

Finish your antibiotics.

Get your results

Results will be available approximately 10 business days after surgery. Call your doctor for results.

Schedule prostate specific antigen (PSA) blood tests

Do a PSA blood test according to the following schedule:

• 6–8 weeks after surgery;
• 3–6 months after surgery;
• 12 months after the operation.

After 12 months of surgery, have your blood tested for PSA every 6 months. With this frequency, the analysis should be performed within 5 years after surgery.

After 5 years of surgery, have a PSA blood test every 12 months. It is recommended to perform throughout life.

Your doctor may ask you to test your PSA blood more often.
In this case, the nurse will provide you with additional information.

Get your PSA blood tested at MSK if possible. If this is not possible, you can contact the health care center at your place of residence. Ask for the results to be faxed to your doctor at MSK.

Follow your sexual activity plan

Talk to your health care provider about when it is safe for you to resume sexual activity after your procedure.

You can start your erection medication on the evening of the day your catheter is removed. You may need to take one of these medicines daily for up to 1 year after surgery. Discuss with your surgeon how long you will need to take these drugs.

Your doctor or nurse will give you information about your medication schedule. Follow this schedule until your post-op appointment with your surgeon.

The following are options for this schedule:

Bolting dose information

Bolting dose is the maximum dose of the drug. This is most likely the dose needed to achieve an erection (the hardening of the penis needed for intercourse). When you take a loading dose, take it on an empty stomach (on an empty stomach). Drink the medicine about 2 hours before dinner.

The medicine starts working after 30-60 minutes. Its effect will remain in the body for up to 8 hours. At any time during these 8 hours, try to achieve sexual arousal from contact with a partner or from self-stimulation. Write down what happened and tell your doctor about it at your next appointment.

If you haven’t had an erection after 4 weeks of loading dose, call your doctor. He can refer you to our sexual health specialists.

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When to call your surgeon

Call your surgeon immediately if you have:

• there was a strong (very strong) pain in the lower part of the abdominal cavity (belly) when urinating;
• no urination.

These symptoms may indicate that the catheter needs to be reinserted. If you are unable to come to MSK, you can have a catheter placed at your local urologist or at the nearest emergency room.