The bladder lining is quite remarkable. It’s coated with mucin which acts as a non-adhesive surface for bacteria. If that mucin surface is breached, bacteria can attach to the surface cells that line the bladder. These are called umbrella cells and have receptors and, if stimulated by bacterial adhesion, this triggers a remarkable antibacterial response. Cells and molecular reaction eliminate the bacteria so we have an organ which can defend itself from infection.

From that point of view, we need to be developing a urine collection system which maintains the anti-bacterial mechanisms of the bladder. Unfortunately, the indwelling catheter that is used, which was designed way back in the 1930s, does damage those anti-bacterial properties.

The catheter is held in the bladder by a balloon, which is filled with sterile water, and this prevents the bladder from emptying completely so that you always have some residual urine in the bladder, and that will be infected by bacteria.

Secondly, the catheter has a protuberant tip and this can damage that surface lining in the bladder and the eye holes are in the tip of the catheter, not at the base of the bladder. So we have here a problem which does mean that the catheter is associated with a very high incidence of healthcare infections. In fact it accounts for more healthcare infections worldwide than any other medical device.

You say that, up until now, you don’t think you’ve ever had any bladder infections?

I haven’t had a moments problem. I’m not even sure now that I’ve got one. And I didn’t send a specimen off today, but it’s just a little smelly and it’s not that, it isn’t the sort of clear urine that looks as though you could swim in, you know. You wouldn’t want to shampoo your hair with it, it’s just a bit cloudy. And who knows, I’ve just increased my fluids and waited events. I’m perfectly well. I haven’t had a fever or anything. I’ve just been aware that it’s not like champagne anymore.

Although the urine’s a little bit cloudy, my wife says she can’t smell it, but I think it’s a bit smelly. Because I’ve been alright in myself, I’ve tended just to drink more and see what happens.

If you wanted it tested, you just take a specimen down to the GP’s surgery would you?

Yes. I’ve got the pots here. In fact I thought we were going to do that this morning, and my wife said, Oh I think it’s a bit better today. Let’s leave it.

So you’ve never had to take any antibiotics so far for your urinary problems?

None at all, no. Nothing at all. Well I did, I know in my Conveen time, I had a couple of times when I needed it. But it always responded very quickly to antibiotics.

You said you get a lot of infections. How often were you getting urine infections?

I can get one a month, or I can go a couple of months. Probably the longest I’ve ever gone, probably be about three months without any problems.

And what are your symptoms when you have a urine infection?

Having to go to the toilet more frequently, pain, some days I can’t even walk with the pain.

Really?

Mm, this is why I packed up work in the end because I just wasn’t reliable. Yes very, I don’t know if it was the infection that’s causing the pain or when you’ve got an infection its starts off the bladder spasms, I don’t know.

So if you suddenly develop an infection do you go down to your GP or do you have some antibiotics available to start taking straight away?

No, I usually take a sample down and they test it. They’re really good. Take it down and the receptionist, I think they all know me down there by now. And then they send, usually the nurse will dip it and it’s usually showing, like everything. A lot of the time, obviously they send it off and usually get the results back the next day. And a lot of times it does come back negative but the GP usually does give me an antibiotic and it always seems to clear it up. Which is strange when it’s coming back, you know, with nothing in it.

Yes, and have they explained why that might be?

No.

UTI’s, I’ve only ever had one really bad one that made me weak and shivery and ill. Normally I’ve just got it, I’ve known I had a UTI. I used to try drinking it into submission. But recently I’ve given up on that. It doesn’t work and some of the nurses have actually admitted that the general perception is that you might as well not bother, it doesn’t work.

Over the last three years until the middle of last year I think, I had a problem with getting a UTI who’s only effect was to make you smell really bad, made the urine smell really bad. And I tried drinking that into submission. I tried taking antibiotics. My doctor leaves me with Citalopram here, so I’ve got a course, a 5-day course of Citalopram in the drawer should I need it. She trusts me to recognise that I’ve got a UTI and I need to take it. I don’t like taking antibiotics because you just wear em out.

But, with this smelly situation, I was getting quite depressed about it and it was going on for months. I took Citalopram, that didn’t kill it either. I went to the doctor and took Flucloxacillin I think it was, not the Citalopram Ciprofloxacin, that was the normal antibiotic. Fluclox was the second level, that didn’t get rid of it either.

So eventually I went to the Spinal Unit for urodynamics, which got rid of it. Which could have been the intravenous antibiotics they gave as a matter of course, or I don’t know, but it went. And it stayed gone for months, five, six months, and then I got it again and I tried drinking like mad, tried the various antibiotics, didn’t do any good. So this time they said they’d do a cystoscopy. That fixed it.

What’s it been like having a suprapubic catheter?

It’s been a daily struggle.

A daily struggle?

Yeah.

Can you explain why?

Yeah. I’ve constantly got an infection.

Whereabouts? In the bladder or round about the site?

Yeah, the bladder. Yeah, in my bladder. And I just never know what one day from the next is going to be like, if I’m going to be ill or not.

When you have an infection, how do you feel?

Just, apart from being ill, it just gets me depressed but I’m always feeling ill.

Do you get a temperature?

No, I don’t do temperatures with infections.

Just feel, how do you feel exactly?

Just really ill, I’ve got no energy. And pain.

And then what do you do when you get an infection?

I don’t know. I go to, I’m under the doctors most weeks as he’s always checking for an infection so I’m on antibiotics constantly.

Do you go down to your local GP?

Yeah.

And do they send a specimen off to the laboratory?

Yeah. And it always comes back as it can’t be treated with oral antibiotics. And so that’s when I end up in hospital.

It can’t be treated with other; you’ve tried all the ones.

Oral antibiotics, yes I’ve got to go in for intravenous.

Which antibiotics are you taking all the time?

Nitrofurantoin, is it?

Well we’ll check afterwards. And you say sometimes this doesn’t solve the problem.

No. It just masks the problem.

And you have to go back to hospital?

Yeah.

And have intravenous antibiotics?

Yeah.

And what’s it like having those?

Like I said before, it’s okay. I know the nurses, I’m not scared, I’m not worried about it. I know what’s coming. I just don’t like the feeling ill with it.

The medical centre are very good. I just phone the secretary and say I’m bringing down some samples, can you do a path form for me And if I get it down there for twenty past twelve, that’s great. It goes off for testing. And they’ll do the path form and it’ll be waiting for me. If that secretary’s not on, I have to then phone up, ask for somebody to come and do it and now they’re pretty good.

But you could be doing that every week because there’s always something showing with the catheter in there because you’ve got a foreign body in your bladder. And they’ll say, Oh mixed contaminants, nothing specific and you know we’re thinking, Hang on, something is going on And then a district nurse said to us, Oh she said, Well each time you have a catheter changed, just do a three days course of trimet, trimethoprim
So we done that and then when we was sent, ah that was it she also gave us some dipsticks, and so we could test the urine ourselves for things like that. And then stuff would go off for testing, come back and it would be responsive to various antibiotics. And the district nurse really made a bit of a mistake because she [Hayley, who he cares for] was taking so much trimeth, she became trimeth resistant.

And so now Hayley’s really careful over antibiotics. She doesn’t take them at the drop of a hat; she only takes them when she needs them.

Why did they have to change it [catheter] every three weeks? Because it gets blocked?

I have it every three weeks because I have recurrent infection, and it’s a recurrent proteus infection, and with proteus infection you get stone formation.

And I have stones that like almost cemented the suprapubic catheter into my bladder. And the stones form round the neck, round like the neck of the catheter, where the eyelets are.

And the balloon is, which when you’ve deflated the balloon and you’re pulling it out, it won’t, it takes a lot of tugging. And the more stones that form, the more trauma it’s causing because every time you deflate the balloon and pull it out, the stones won’t come out with the catheter down the tract.

The stones, when you’re pulling, when it’s being pulled, it has to separate. The stones have to come away from the catheter for it to allow it to come down the tract. So if I go more than three weeks, cos it takes a lot of pulling to come out.

The stones would be harder?

Cos the stones are hard, and the stones have to separate off.

Why are the stones forming more now?

Because I’ve got a proteus infection.

Oh the infection.

Most infections, you know you do get recurrent infections with a suprapubic catheter. I’ve a brilliant GP who, we have a rule that if we send off a urine sample, if it shows hardly any white cells, which are like infection, if it shows red cells which are blood we totally ignore that cos you’re always going to get blood with a suprapubic catheter because of the trauma.

If it grows a bug and the white counts very low, we don’t treat it unless I’m unwell cos the chances are that’s just a bug that’s living in your catheter. If the white cell count is high and it’s growing a bug, we treat it.

I can’t get rid of the infection. I don’t know why. I’m under the hospital, the local hospital to find out why I can’t get rid of my proteus infection.

How long have you had it?

I’ve had my proteus infection since November last year.

Oh my goodness.

So it flares up every now and then. You can tell once it’s better because the changes are easier.