Assessment 

After full assessment and evidence of residual has been excluded, a penile sheath to channel the urine into a collection bag may be the preferred management for men. They are designed to be connected to a urine drainage system and may be worn continuously or intermittently.

Special consideration is needed when selecting sheaths:

• For men who suffer with confusion or dementia, as they might pull it off
• If the penis is small or retracted consider bioderm, retracted penis pouch, please contact bladder and bowel specialist service
• If the patient or carer is unable to manage the sheath and drainage system

Men for whom sheaths are not suitable, appliances may be a form of management for urinary incontinence. Referral to Nurse Specialist for fitting of appliances is necessary. If an appliance contractor is used, this should be discussed with the prescriber.

When choosing an appropriate sheath for an individual, the following factors must be taken into account:

• Measure the shaft of the penis. If the gland is bigger than the shaft, measure both and choose a size in between
• Please note sizes and measuring devices vary. Therefore the measuring device must correlate with the sheath manufacturer
• The skin condition of the patient
• Independence of the patient or availability of carers
• The manual dexterity of the patient or carer. This will have a major impact on the kind of sheath that they can manage

Sheath styles

A variety of sheath designs are available.

Most commonly used is the One-piece:

• This has adhesive applied to the inner surface
• It is self-sealing
• Latex and non-latex material available. However, sensitivity to latex and various adhesives should be checked

The Two-piece system of sheath is also available:

• This has a separate adhesive strip applied to the inner surface

Using a sheath

Wash and dry the genital area thoroughly. Long pubic hairs should be trimmed. Avoid using creams or powders on the penis, as this will prevent the sheath from sticking.

Unroll the sheath over the penis making sure that the foreskin is not pulled back. A gap of approximately 2.5cm should be left between the tip of the penis and the outlet of the sheath.

When the sheath is first used, the penis should be inspected frequently making sure that the skin is not becoming red and to ensure that the sheath is not too tight. The sheath should be replaced at least once every 24 hours.

To remove the sheath, apply warm, soapy water to the sheath and penis and then roll it down the penis. During a shower or bath is an ideal time to do this. The adhesive will usually come off with the sheath and any remnants can be washed off with soap and water.

GB Libra latex free sheath (Great Bear Healthcare)

• Standard 24 – 40mm (£51.48 = 30, £1.72 each)
• Pop On 24 – 40mm (£51.48 = 30, £1.72 each)
• Wide Band 24 – 40mm (£51.48 = 30, £1.72 each)

Clear Advantage Spirit (Rochester Medical)

• Style 1 (Standard) 24 – 40mm (£55.68 = 30, £1.86 each)
• Style 2 (Pop On) 24 – 40mm (£55.68 = 30, £1.86 each)
• Style 3 (Wide Band) 24 – 40mm (£55.68 = 30, £1.86 each)