Introduction

Despite their historical widespread use1, absorbent products are commonly used in the incontinent male population but have been proven to be associated with complications such as dermatitis, and may compromise skin integrity, predispose to cutaneous infection, and may increase pressure ulcer risk2 when other factors are present.

Urinary sheaths offer an opportunity to enhance patient care, improve overall quality of life, and provide a crucial role in promoting discretion and comfort for men with urinary incontinence3.

What are the options for urinary sheaths?

Urinary sheaths have been exclusively developed for men and can be categorized into three main types:4

• Drainage sheaths with pre-applied adhesive on the inner surface, ensuring the sheath is self-adhesive. Certain self-adhesive sheaths are supplied with their dedicated applicator or positioning device.

 • Drainage sheaths without adhesive, wherein the packaging includes a separate adhesive strip, either single or double-sided. This strip is applied to the penis, and subsequently, the sheath is secured over the strip, ensuring its proper placement. Such systems are commonly referred to as 'two-piece' systems.

• Drainage sheaths that do not include adhesive, but instead provide a separate skin adhesive solution in a tube or bottle for application to the penis before sheath placement. Various incontinence fixation strips are available for these types of sheaths, including those designed for external use around the sheath's exterior, and prescription-based adhesives supplied independently from the sheaths.

Supported by evidence-based guidelines

Evidence-based guidelines in support of urinary collecting systems have followed publication of the first randomised controlled trial to compare the benefits of urinary sheaths with absorbent products on quality of life in men with moderate-to-severe incontinence3,5.

The guidelines, published by the EAU Guidelines on Urinary Incontinence in 2020, highlighted evidence comparing urinary sheaths for men with urinary incontinence to pads3,5:

“A short-term (two weeks) crossover RCT in men with urinary incontinence found that disease specific QoL was better when using an external sheath and more men preferred it, compared to pads” - EAU Guidelines on Urinary Incontinence3,5

Did you know?

“

I have a wonderful feeling of liberty that has really improved my daily life.”

- Carlos, Continence care user

Considerations when choosing collecting devices

Importance of correct assessment and fitting of urinary sheaths

When choosing a penile sheath, it is essential to ensure the correct size that matches both the girth and length of the penis. Opting for a sheath that is too small can lead to issues with urine drainage and restricting blood circulation to the penis shaft. Conversely, a sheath that is too large may result in folds and creases, leading to urine leakage and potential for the sheath to fall off or fail.8

Latex vs non-latex urinary sheaths

According to a study,9 comparing latex with silicone urinary sheaths, evidence suggests that those made from silicone are better in certain categories to traditional latex sheaths. Not only do they eliminate the risk of latex allergy but they have also been shown to bind more securely to human skin so reducing the risk of the penile sheath falling off.9

Moreover, clear silicone sheaths allow the condition of the patient’s skin to be monitored without removing the sheath and have greater moisture vapour transmission properties than through latex.9

Picking the right collecting bag to match the patient profile

Consideration of the appropriate urine bag largely depends on the capacity required to suit the level of incontinence and whether the patient requires a sterile urine drainage bag.

Drainage bags are commonly available in a range of capacities. For a patient with mild incontinence, a small capacity bag (250 – 350ml) should be sufficient. If the patient has moderate or severe incontinence, a larger bag (500 – 750ml) would be more suitable.

Some patients may like the option of a smaller bag for occasional use (e.g. when wearing shorts) or a larger one (e.g. for a long journey).

If a patient is dependent upon a carer to empty their drainage bag, they may find a larger capacity (1.5L) to be more convenient.

Overnight, the smaller capacity body worn bags should be connected to a 2L capacity night bag that is placed on a stand or hanger by the bed.

Sterile urine drainage bags are recommended in situations including10:

  • Indwelling catheterisation in general10
  • Intermittent catheterisation in long-term care facilities11

Non-sterile but clean urine drainage bags may be used in situations such as:

  • In conjunction with urinary sheaths when a user has no history of infection12
  • In conjunction with clean intermittent self-catheterisation in the community13  

Explore topics

Male bladder management Urinary incontinence