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CHAPTER 26
urinals, in which the sheath, top and reservoir bag cannot be detached from each other,
are, as a rule, not suitable for paraplegics, as in some the rubber top is too hard. The Stoke
Mandeville type of urinal is shown in Fig. 165. It has the advantage over other designs
that the various parts of the urinal can be easily disconnected, which facilitates cleansing.
It consists of a double bag with a one-way valve between and on top of that a second
one-way valve. The urinal's top which is either straight or of swan-neck type, is provided
with a detachable sheath which is replaceable at low cost. There are several sizes of the
sheath varying from
\
in to ij in in diameter to ensure an accurate fit to the penis. The
one-way valve between the urinal top and upper reservoir bag has an internal diameter
of | in to prevent back pressure in patients resulting from strong detrusor activity.
The top piece of the urinal and each bag reservoir can be disconnected for cleaning
purposes. New sheaths are needed from time to time but, in contrast, to one-piece
urinals, the main parts of the Stoke Mandeville type may last for I year to 18 months.
(Manufacturers Down Bros., Mayer and Phelps, 32 New Cavendish Street, London
Wi). This urinal, as most of the other types, is supplied with a canvas belt and suspensory
straps to the front and back of the urinal top where they are fixed by buttons. It is obvious
that in cervical lesions with loss of finger movements the urinal has to be applied to the
patient by his attendant. In Great Britain, paraplegics and tetraplegics are supplied with
two urinals by the Health Service on doctor's prescription.
An alternative type of urinal which has become very popular in this and other
countries, is the condom type of urinal. It was first used in U.S.A. The great advantages
of this urinal are (a) that there is no hard material in contact with the genital region,
especially no constricting pressure exerted on the penis, (b) it can be easily applied and
removed. However, in cervical lesions with paralysis or great weakness of the ringer
muscles this urinal as any other type has to be applied by the patient's attendant, (c) it
can be used by patients with very short and retractable penis and even for small children.
Its disadvantage is the increased cost (one condom for 23-24 hr plus Latex adhesive
solution). Furthermore some patients become allergic to Latex and develop a rash on
penis and groin. The least irritating Latex at present is that manufactured by the American
FIG. 166.
