Questions about Suprapubic catheter

I read Graham’s helpful article about the suprapubic catheter. My brother, Steve, is 63. He was born with spina bifida, complicated with myelomeningocele. He is moderately intellectually disabled (due to hydrocephalus), in addition to his rather severe physical disability. He is incontinent and has a serious problem with recurring UTIs. He has developed a tolerance to most oral antibiotics. Right now, the only thing that seems to work is Macrodantin (nitrofurantoin). But I don’t know how long he can keep taking it before it stops working too.

For whatever reason (perhaps an enlarged prostate), he can no longer empty his bladder without manual catheterization. Although he tries very hard to do this procedure in a hygienic way, his urologist believes this is one reason for his recurrent UTIs. The other reason is that (due to his disability) his bladder does not empty completely.

His urologist wants to insert a suprapubic catheter. But after reading Graham’s article, I have serious concerns. It seems that there is still many opportunities for UTIs to occur, unless you are scrupulous with your hygiene and other things, like drinking plenty of fluids. I am worried that the process may be too complex for Steve to deal with.

My other concern has to do with his quality of life. He lost his job a year ago. I found a senior center near his apartment. He goes there 3 times a week and really seems to like it. In the past, he had a condom catheter with a leg bag. Odor was a constant problem. He is extremely self-conscious about this (understandably). I am afraid that if there is a noticeable odor with this new type of leg bag, he will stop going to the senior center. The last thing I want is for him to feel so uncomfortable about social situations that he avoids them all together.

I hope someone here can offer comments or advice. Once I feel that I understand all the pros and cons of the suprapubic catheter, then I can discuss it with Steve.

Thanks in advance,
Patti