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Penile sheaths

Evidence‐based approaches

Rationale

Penile sheaths are external devices made from soft and flexible latex or silicone tubing. They are applied over the penis to direct urine into any standard urinary drainage bag, from where it can be conveniently emptied (see Figure 6.6) (Kyle [118]). They can be used by men to manage urinary incontinence.

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Figure 6.6 Penile sheath: standard design.

Penile sheaths (also known as condom catheters or male external catheters, or by the trade name Conveen) are only to be considered once other methods of promoting continence have failed, as the promotion of continence and treatment of incontinence should be the primary concern of the multidisciplinary team (Smart [229]). Penile sheaths should be considered as a preferable alternative to other methods of continence control, such as pads, which can quickly become sodden and cause skin problems, and catheters, which have several potential complications (discussed further below) (Smart [229]).

Indications

Penile sheaths (Figure 6.6) may be used to relieve incontinence when no other means is practicable or when all other methods have failed. Penile sheaths are also used to avoid or prevent catheter‐associated UTIs (Gray et al. [92]). Penile sheaths are associated with many common problems, which are identified by Smart ([229]); these include difficulties relating to fitting, leaking, kinking, falling off, allergies and UTIs.

Contraindications

Penile sheaths are contraindicated for men with very small or retracted penises, sensitive skin and allergies to specific materials such as latex (Nazarko [159]).

Pre‐procedural considerations

Equipment

Silicone types are now preferred due to concerns about latex allergies; additionally, the use of silicone enables the wearer or carer to assess and monitor the condition of the skin of the penis (Nazarko [159]; Smart [229]).

Sizing and fitting

Modern sheaths come in a variety of sizes and the correct size can be determined by measuring the girth of the penile shaft. The penis should be measured in the flaccid state (Nazarko [159]). Most devices come with a manufacturer's sheath sizing guide with different diameters cut into it, so that the correct size can be easily determined. Sheaths are available in a variety of different sizes, which generally increase in increments of 5–10 mm and in either standard or short lengths (Macaulay et al. [137]).

The main methods of fixation in current use follow two different approaches. First, the sheaths can be self‐adhesive, so that the sheath itself has a section along its length with adhesive on the internal aspect that sticks to the penile shaft as it is applied. The second method is a double‐sided strip of hypoallergenic or foam material applied in a spiral around the penis (which increases the surface area of the sheath adhered to the penis) and then the sheath is applied over the top.

Additionally, newer devices have been developed that move away from the condom catheter‐based system and employ a unique hydrocolloid ‘petal’ design that adheres only to a small area of the glans penis, around the meatus, ensuring a comfortable and secure fit; these are ideal for men with a retracted penis (Nazarko [159]).

Sheath material

As mentioned, silicone sheaths are advantageous as they are transparent, allowing the patient's skin to be observed. A silicone sheath also allows the skin to breathe, thus avoiding moisture build‐up and preventing skin damage (Kyle [118]).

Procedure guideline 6.3

Penile sheath application

Table 6.1 Prevention and resolution (Procedure guideline 6.3)

Problem	Cause	Prevention	Action
Leaking or backflow of urine under the sheath	Penile sheath is the wrong size or incorrectly applied	Measure penile shaft using the sizing tool.	Re‐measure the penile shaft, select the correct size and apply using guidance above.
Twisting or kinking of sheath	Lack of care taken when applying; drainage tube unsecured	Assess patient mobility before application and select suitable type and method of securing the drainage bag.	Secure drainage bag to leg or stand.
Difficulty fitting sheath to patient with a retracted penis	Anatomy of the patient	It may be that a penile sheath is not the most appropriate device.	Observe the penile length when the patient is sitting. If the length of the penis is less than 5 cm when sitting, use a hydrocolloid petal‐design sheath.