My husband is 72 and has advanced Parkinson’s disease. He has needed a catheter through the penis for about eight months despite taking two medicines. The medicines do not appear to be working and he has also been falling frequently.
Surgery has not been recommended because of his overall health. His doctors have now advised a long-term catheter inserted through a small opening in the lower abdomen.
Is this a better option than continuing the catheter through the penis? What does the procedure involve, what are the risks, and what problems can occur with long-term use?
Quick Answer: Is a Suprapubic Catheter a Good Long-Term Option?
If someone cannot empty the bladder, surgery or medication cannot correct the problem, and intermittent catheterization is not practical, a long-term suprapubic catheter can be a reasonable option. It is often preferred over a long-term urethral Foley catheter when permanent bladder drainage is required.
- The catheter described by Mrs Lee is called a suprapubic catheter (SPC).
- It enters the bladder through a small opening in the lower abdomen just above the pubic bone.
- It is not the same as creating a urostomy or surgically diverting the urinary tract.
- The catheter still requires regular replacement; the word “permanent” means long-term bladder drainage, not that the same tube stays there forever.
- Potential advantages over a urethral catheter include less long-term urethral trauma and, for some patients, easier hygiene, comfort and care.
- Possible problems include urinary infection, blockage, leakage, bladder spasms, bleeding, bladder stones and problems at the catheter site.
- Placement also carries a small but important risk of injury to nearby structures such as the bowel.
What Is a Suprapubic Catheter?
A suprapubic catheter is a flexible tube placed directly into the bladder through a small opening in the lower abdominal wall, just above the pubic bone.
Its purpose is exactly the same as a Foley catheter passed through the urethra: to drain urine continuously from the bladder.
The difference is the route.
| Catheter Type | How It Enters the Bladder | Long-Term Issue |
|---|---|---|
| Urethral Foley catheter | Through the penis and urethra into the bladder. | Long-term use can damage or erode the urethra. |
| Suprapubic catheter | Through a small opening in the lower abdomen directly into the bladder. | Avoids chronic urethral pressure but introduces a catheter tract through the abdominal wall. |
Why Would Doctors Recommend a Long-Term Catheter?
A long-term catheter may be considered when the bladder cannot empty adequately and the underlying problem cannot be corrected safely or effectively.
NICE recommends considering long-term catheterization in men when medical treatment has failed, surgery is not appropriate, and intermittent catheterization cannot reasonably be managed.
Possible reasons include:
- persistent urinary retention;
- very poor bladder contraction;
- neurological bladder dysfunction;
- bladder outlet obstruction;
- urethral disease;
- or serious frailty or illness making definitive surgery unsuitable.
In men whose retention is caused by enlarged prostate (BPH) , catheter drainage may sometimes be temporary while medication or surgery is considered.
In other men, particularly those with severe neurological disease or a poorly contracting bladder, catheter drainage may become the long-term solution.
Why Advanced Parkinson’s Disease Changes the Situation
In this particular question, I would not assume that the prostate alone explains the urinary retention.
Parkinson’s disease can affect the nervous-system control of the bladder. Patients may develop:
- urgency and frequency;
- difficulty coordinating urination;
- incomplete bladder emptying;
- or, in some patients, substantial urinary retention.
A severely underactive or acontractile detrusor means the bladder muscle itself does not contract effectively enough to empty.
The Question Is Not Just “How Large Is the Prostate?”
In a man with advanced Parkinson’s disease and persistent retention, the urologist may need to determine whether the main problem is prostate obstruction, neurogenic bladder dysfunction, weak bladder contraction, or a combination of these.
This distinction matters because even technically successful BPH surgery may not restore normal urination if the bladder muscle cannot contract adequately.
Is a Permanent Indwelling Catheter Always the First Choice?
No.
When feasible, urological guidelines generally prefer intermittent catheterization to leaving a catheter continuously inside the bladder.
Intermittent catheterization means passing a catheter several times per day to empty the bladder and then removing it.
EAU guidance prefers this approach for persistent high residual urine because it may reduce complications such as:
- urinary infection;
- bacterial colonization;
- bladder stones;
- and overflow incontinence.
However, intermittent catheterization requires sufficient:
- manual dexterity;
- cognition;
- mobility;
- or reliable caregiver assistance.
In advanced Parkinson’s disease, this may simply not be realistic.
Suprapubic Catheter vs Long-Term Foley Catheter
| Issue | Urethral Foley | Suprapubic Catheter |
|---|---|---|
| Route | Through penis and urethra. | Through lower abdominal wall. |
| Urethral injury | Long-term pressure can cause urethral erosion, trauma or stricture. | Avoids chronic catheter pressure within the urethra. |
| Comfort | Can cause penile or urethral discomfort. | Some patients find it more comfortable and easier to manage. |
| Hygiene | Genital-area catheter care required. | Abdominal site may be easier for some patients and carers to access. |
| Sexual activity | Catheter passes through the penis and can interfere substantially. | Generally interferes less with genital sexual activity. |
| UTI | Risk increases with long-term catheterization. | UTIs can still occur; suprapubic placement does not eliminate infection risk. |
| Blockage / stones | Can occur. | Can also occur. |
| Insertion | Usually passed without surgery. | Requires creation of a tract into the bladder. |
AUA guidance for patients with neurogenic lower urinary tract dysfunction specifically recommends suprapubic catheterization over a chronic urethral catheter when an indwelling catheter is required.
How Is a Suprapubic Catheter Inserted?
The urologist creates a small opening through the lower abdominal wall into the bladder.
A soft catheter is passed through this opening and the tip is held inside the bladder by a small inflated balloon.
BAUS notes that the procedure may involve:
- a small skin incision;
- passing the catheter directly into the bladder;
- and often cystoscopic visualization of the bladder during placement.
Depending on the patient’s anatomy and circumstances, placement may also be performed with ultrasound or other imaging guidance.
Urine then drains through the catheter into a collection bag or, in selected patients, through a catheter valve.
Does Suprapubic Catheter Placement Require General Anesthesia?
Not always.
The anesthetic approach depends on:
- how the catheter is inserted;
- the patient’s general health;
- ability to remain still;
- previous abdominal surgery;
- bladder anatomy;
- and local hospital practice.
Some placements can be performed under local anesthesia, whereas other patients may receive sedation, spinal anesthesia or general anesthesia.
Advanced Parkinson’s and Frailty Need Individual Planning
The anesthetist and urologist should assess the safest approach for this particular patient rather than assuming that general anesthesia is automatically required.
What Are the Risks of Suprapubic Catheter Insertion?
The procedure is commonly performed, but describing it as having “no severe side effects” would be incorrect.
Potential procedural complications include:
- bleeding;
- infection;
- catheter misplacement;
- injury to nearby blood vessels;
- and, rarely, bowel injury.
BAUS identifies inadvertent injury to nearby structures such as the bowel or blood vessels as an uncommon but potentially serious complication.
The risk varies with individual anatomy, previous abdominal surgery, bladder filling and the insertion technique.
Bowel Injury Is Uncommon but Important
Injury to the bowel during insertion is uncommon, but it may require emergency surgery. This is one reason the procedure should be planned and performed by an appropriately trained team.
What Problems Can Occur With Long-Term Suprapubic Catheter Use?
The catheter avoids some urethral complications, but it does not make long-term catheterization risk-free.
Common or important problems include:
- catheter-associated urinary infection;
- bacteria in the urine without symptoms;
- catheter blockage;
- mineral encrustation;
- urine leaking around the catheter;
- bladder spasms;
- blood in the urine;
- granulation tissue around the skin opening;
- skin irritation;
- accidental catheter dislodgement;
- and bladder stones with prolonged use.
AUA guidance also notes that chronic indwelling catheters act as foreign bodies and increase the risk of urinary stones and chronic bacteriuria.
Does “Permanent Catheter” Mean the Same Catheter Stays Forever?
No.
“Permanent” or “long-term” means the patient continues to require catheter drainage.
The catheter itself is replaced periodically.
The exact interval varies according to:
- catheter type;
- manufacturer instructions;
- local clinical protocol;
- blockage history;
- and the individual patient’s needs.
BAUS patient information describes regular replacement after the tract has become established. Your husband’s urology team should give you his exact schedule.
How Is a Long-Term Suprapubic Catheter Cared For?
Good daily catheter care reduces avoidable complications.
NICE recommends maintaining a closed drainage system and educating patients and carers about catheter care.
Important principles include:
- washing hands before and after handling the catheter or drainage bag;
- keeping the drainage system closed whenever possible;
- keeping the urine bag below bladder level;
- preventing kinks in the catheter tubing;
- emptying the drainage bag before it becomes excessively full;
- keeping the skin around the catheter site clean;
- making sure the catheter is properly secured;
- and documenting repeated blockages or leakage.
The patient and caregiver should receive training before managing the catheter independently at home.
What If the Suprapubic Catheter Becomes Blocked?
Catheter blockage can cause:
- little or no urine entering the bag;
- lower abdominal discomfort;
- bladder spasms;
- leakage around the catheter;
- or urine leaking through the urethra.
Check for obvious kinking or compression of the tubing, but persistent loss of drainage needs clinical attention.
If a Suprapubic Catheter Falls Out, Act Quickly
The catheter tract can begin closing relatively quickly. BAUS advises immediate action if the catheter falls out rather than waiting for the next routine appointment.
Are Urinary Infections Inevitable?
Bacteria commonly colonize long-term catheters over time, but bacteria in the urine do not automatically mean there is a symptomatic infection that requires antibiotics.
Warning signs that may suggest a clinically important infection include:
- fever;
- chills;
- new or worsening lower abdominal pain;
- flank pain;
- new significant confusion or systemic illness;
- or other symptoms identified by the treating team.
Cloudy or Smelly Urine Alone Does Not Always Mean Infection
Long-term catheter users commonly develop bacterial colonization. Antibiotics should generally be used when there is a clinical reason, not simply because a urine culture is positive.
The Falls Described in the Question Also Need Review
Mrs Lee mentioned that the two urinary medicines appeared not to help and that her husband had been falling frequently.
That deserves separate attention.
Some medicines used for urinary symptoms—particularly alpha-blockers—can contribute to dizziness and orthostatic hypotension.
Advanced Parkinson’s disease can itself substantially increase fall risk.
The medical team should therefore review:
- the exact prostate/bladder medications;
- Parkinson’s medication;
- blood-pressure medicines;
- sitting and standing blood pressure;
- hydration;
- and other fall-risk factors.
Our BPH medication guide explains why some urinary medicines affect blood pressure much more than others.
So Is the Suprapubic Catheter the “Best” Option?
No one can determine that from the original question alone.
But the recommendation is medically understandable if:
- the bladder cannot empty adequately;
- medication has failed or causes unacceptable adverse effects;
- definitive surgery is considered too risky or unlikely to work;
- intermittent catheterization is impractical;
- and long-term bladder drainage is therefore unavoidable.
In that situation, a suprapubic catheter can have important practical advantages over continuing a urethral Foley catheter indefinitely.
Current EAU guidance states that long-term indwelling catheters should generally be avoided unless other options are unsuitable, but when one is required, suprapubic catheters are preferred over urethral catheters.
Questions Mrs Lee Should Ask the Urologist
- What is actually causing the retention? BPH, weak bladder contraction, neurogenic bladder from Parkinson’s, or a combination?
- Has bladder function been assessed? Would urodynamic testing change the treatment decision?
- Is intermittent catheterization realistic? Could a caregiver perform it, or is it impractical?
- Why is surgery not appropriate? Is the limitation anesthesia risk, frailty, poor bladder contraction or another factor?
- What anesthesia will be used for SPC placement?
- How often will his catheter be changed?
- Who should we contact if it blocks or falls out?
- What symptoms should make us suspect infection?
- Can any urinary medication be reduced or stopped after reliable catheter drainage is established?
Dr. Albana’s Answer
Hello Mrs Lee,
From your description, the procedure being proposed is almost certainly a suprapubic catheter.
It is different from a urinary stoma. The doctors make a small opening in the lower abdomen and pass a catheter directly into the bladder so urine can drain without the tube passing through the penis and urethra.
I would also correct one important assumption from the older answer. Nothing in your description tells me that your husband must have either a very enlarged prostate or prostate cancer.
Because he has advanced Parkinson’s disease, I would be particularly interested in whether his bladder itself has become poorly contractile or whether he has another form of neurogenic bladder dysfunction.
This distinction matters. If the bladder muscle does not contract effectively, removing prostate tissue may not restore normal urination, which may partly explain why his doctors do not recommend surgery.
When possible, intermittent catheterization is generally preferable to leaving a catheter in continuously. But for someone with advanced Parkinson’s disease, impaired mobility and substantial care needs, this may not be practical.
If long-term continuous catheter drainage really is necessary, I can understand why his urologists would suggest changing from a catheter through the urethra to a suprapubic catheter. Long-term urethral catheters can damage the urethra, whereas the suprapubic route avoids that particular problem and can sometimes be easier for carers to manage.
I would not describe the procedure as risk-free. Urinary infection, blockage, leakage, bladder spasms and stones can occur during long-term use, and the insertion procedure carries a small risk of bleeding, infection and injury to surrounding structures, including the bowel.
Also remember that “permanent” does not mean the same catheter remains permanently. The catheter tube must still be changed regularly according to the schedule given by his urology team.
Finally, I would ask the doctors to review the medicines associated with his falls. Alpha-blockers used for urinary symptoms can lower blood pressure and contribute to dizziness in some older men, while Parkinson’s itself also substantially increases fall risk.
In a frail patient where surgery is unsuitable and long-term drainage is unavoidable, a suprapubic catheter can be a reasonable and often preferable long-term solution. The final decision should depend on his bladder function, overall health, caregiver situation and his urologist’s assessment.
— Dr. Albana Greca, MD, MMedSc, Family Physician / General Practitioner
Most Asked Questions About Permanent Urinary Catheters
What is a permanent catheter through the stomach?
It is usually a suprapubic catheter. The tube enters the bladder through a small opening in the lower abdomen just above the pubic bone. It does not normally enter through the stomach itself.
Is a suprapubic catheter better than a Foley catheter?
When long-term indwelling catheterization is unavoidable, urological guidelines generally favor suprapubic catheterization because it avoids chronic urethral damage. It still has risks such as infection, blockage, leakage and bladder stones.
Can someone live permanently with a suprapubic catheter?
Yes. Some patients require suprapubic bladder drainage for many years. Ongoing catheter changes, skin care and monitoring for complications are necessary.
Does the same suprapubic catheter stay in forever?
No. “Permanent” refers to the continuing need for catheter drainage. The catheter itself is replaced at regular intervals according to the urology team’s protocol.
Can a suprapubic catheter cause urinary infections?
Yes. All long-term indwelling urinary catheters increase bacterial colonization and infection risk. A suprapubic catheter does not eliminate this risk.
Can a suprapubic catheter become blocked?
Yes. Mineral deposits, sediment and biofilm can obstruct the catheter. Recurrent blockage should be reviewed and documented so the care plan can be adjusted.
What happens if a suprapubic catheter falls out?
Contact the clinical team urgently because the catheter tract can begin closing quickly and replacement may become more difficult.
Does suprapubic catheter insertion require general anesthesia?
Not always. Local, regional or general anesthesia may be used depending on the insertion technique and the patient’s overall medical condition.
Can Parkinson’s disease cause urinary retention?
Parkinson’s disease can affect neurological control of the bladder. Urinary symptoms may therefore reflect neurogenic bladder dysfunction as well as or instead of prostate obstruction.
Is prostate surgery better than living with a catheter?
It depends on the cause of retention, bladder function, prostate obstruction, frailty and surgical risk. If the bladder cannot contract adequately, prostate surgery may not restore normal urination.
Related Urinary Retention & BPH Guides
About Older Reader Comments
Older comments below this article describe individual experiences and are not medical recommendations. Claims that herbal remedies can cure Parkinson’s disease or other serious illnesses should not be relied upon and should be removed if they contain promotional or misleading medical advertising.
Medical References
-
European Association of Urology.
EAU Guidelines on the Management of Non-neurogenic Male Lower
Urinary Tract Symptoms — Disease Management.
2026.
EAU Male LUTS Guideline -
American Urological Association / SUFU.
Adult Neurogenic Lower Urinary Tract Dysfunction Guideline.
AUA/SUFU Neurogenic Bladder Guideline -
National Institute for Health and Care Excellence.
Lower Urinary Tract Symptoms in Men: Management.
NICE Male LUTS Guidance -
British Association of Urological Surgeons.
Insertion of a Permanent Suprapubic Catheter.
2025.
BAUS Suprapubic Catheter Information -
National Institute for Health and Care Excellence.
Healthcare-Associated Infections: Long-Term Urinary Catheter Care.
NICE Catheter Care Guidance
Medical information notice: Long-term catheter choice depends on the cause of urinary retention, bladder function, neurological disease, mobility, caregiver support, infection history and surgical risk. This page does not replace the individualized recommendation of the treating urologist.
Written & medically reviewed by Dr. Albana Greca, MD, MMedSc • Family Physician / General Practitioner • Last medically reviewed: August 2026