Urinary Sheath Application and

Management
16 January 2018

Equipment
• Bowl of warm water
• Soap
• Flannel / cloth or washer
• Towel
• Measurement tool, tape measure or supplied cut out card
• Range of appropriate urinary sheaths or specific size and type if assessment and measurement already
performed.
• Urinary drainage bag to fit selected sheath
• Anchoring Device
• Scissors
• Pubic hair shield (if not supplied with sheath) or card / paper to create one
• Rubbish bag for waste
• Non-sterile gloves
• If available, information sheet for individual

Recommended Practice
• Prior to use a continence assessment should have been undertaken to determine:

• Diagnosis to exclude urinary retention with overflow

• Person’s suitability for a urinary sheath

PROCEDURE: • Explain procedure to individual and ensure privacy. With support from the Health
professional, the person and carers should be encouraged and appropriately educated to self-care with
application and removal of the urinary sheath.
• Fold the bed-clothes down to knee level. Place a towel underneath person’s thighs. During preparation
place a lap towel across the pelvic area for privacy.
• Following discussion with the person, assessment for sheath size should be performed prior to
commencement of the procedure.
• Wash the penis and scrotum with soap and water and rinse. With the aid of the flannel / washer pull the
foreskin back as far as is comfortable and clean the glans and meatus, ensure foreskin is pulled back fully
over glans. Discard disposables if used.

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• Make sure the area is thoroughly dry; either use a soft towel or allow to air dry.
• If there are pubic hairs that will become trapped in the urinary sheath trim these but do not shave the
area as this may cause skin irritation.
• Apply pubic hair shield if supplied with sheath or make one by making an appropriate sized hole in card /
paper.
• Fit the sheath following manufacturers guidelines, this will depend on type with several available for use.
Do not pull the foreskin back before applying the sheath.
a) Whilst the use of one piece sheaths is recommended for ease of application some problems can be
encountered with some sheaths if the adhesive has to be exposed and comes into contact with gloves.
b) Two forms of two piece sheaths are still readily available. One which has hydrocolloid strips applied to
the penis prior to application of the sheath or the sheath is applied and a foam/velcro strip over the sheath
to keep secured in place; ensure this is not too tight around the penis.
• Connect sheath to appropriate urinary drainage bag. To minimize traction on the sheath, strap the
drainage bag tubing to the thigh with a catheter anchoring device.
• Check the penis 30 minutes after application and at appropriate intervals to ensure there is no reaction
to the urinary sheath, the sheath isn’t constricting a retracted penis due to rolling up and if an external
strip is in place this is not too tight.
• Manufacturers recommend changing the urinary sheath every 24 hours.
• Any problems and complications associated with sheath use should be fully considered.

References

Occupational Health and Safety Considerations

The author declares no conflicts of interest in accordance with International Committee of Medical Journal Editors (ICMJE) standards.
How to cite: The Joanna Briggs Institute. Recommended Practice. Urinary Sheath Application and Management. The Joanna Briggs Institute EBP
Database, JBI@Ovid. 2018; JBI2154.
Note: The information contained in this Recommended Practice must only be used by people who have the appropriate expertise in the
field to which the information relates. The applicability of any information must be established before relying on it. While care has been
taken to ensure that this Recommended Practice summarizes available research and expert consensus, any loss, damage, cost or
expense or liability suffered or incurred as a result of reliance on this information (whether arising in contract, negligence, or otherwise)
is, to the extent permitted by law, excluded.
Copyright © 2018 The Joanna Briggs Institute licensed for use by the corporate member during the term
of membership.

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Urinary Incontinence: Urinary Sheath
16 January 2018

Author
Long Khanh-Dao Le, B.Pharm, MPH, MHHSM

Question
What is the evidence for use of urinary sheaths for management of incontinence?

Clinical Bottom Line

A urinary or penile sheath, also known as a uridome, is an external urinary device that fits onto the penis
and provides a safe, convenient method of collecting urine when urinary incontinence is present.1
Uro-sheaths have been recommended for incontinent men who have adequate bladder emptying and
intact genital skin, and in whom other therapies have failed or are not appropriate.2

• All people who require containment products, such as a urinary sheath, should be assessed for
suitability and application, fitting and tissue viability.1 (Level 3)
• One piece sheaths are preferred to two piece sheaths in respect to overall performance and ease of
application.3,4 (Level 3)
• Silicon sheaths are preferred over latex types as they are clear so that any skin lesions can be seen,
they can “breathe” and latex allergies are avoided.3,5,6 (Level 5)
• The clear advantage silicone one piece adhesive sheath was identified as particularly good for users
and carers when comparing 6 types of one piece sheath.4 (Level 3) However, it was not preferred to a
newer product (convene Optima) in a subsequent small trial.7 (Level 2)
• Post voiding bladder scan should be undertaken to ensure urinary incontinence is not due to retention.
This can be undertaken with a portable scanner.3 (Level 5)
• Sheath applicators are not popular with users.5 (Level 1)
• Urinary sheaths can be more comfortable than indwelling catheters for some men.8 (Level 2)
• The use of sheaths can reduce risk of bacteriuria, asymptomatic urinary tract infection (UTI), or death
compared with indwelling catheters, although this is less so in patients with dementia.8 (Level 2)
• Inspection of the penis for swelling and discoloration 30 minutes after applying the urinary sheath,
repeating the assessment every 4 hours and replacing the sheath every 24 hours is suggested.9 (Level 5)
• A tape measure or the manufacturer’s template should be used to ensure the appropriate size is
selected in conjunction with assessment of suitability.3,9 (Level 5)
• Monitoring for skin damage caused by allergic reaction, poor hygiene or handling, should be
performed.3 (Level 5)
• To minimize complications with the use of a urinary sheath: in men with a retracted penis, ensure that
excess sheath length left rolled up at the base of the penis is not causing pressure to the underside of the
penis; prevent kinking of the drainage tube to avoid accumulation of urine in the sheath and remove the
sheath at specified intervals using a warm flannel/washer or bath; maintain good hygiene to penis and
genital area.6,8 (Level 2)
• If the urinary sheath is twisted, pulled or otherwise manipulated, the risk of urinary tract infection
increases.10 (Level 5)
• Correct placement is thought to reduce the incidence of maceration and ulceration resulting from poorly
functioning drainage systems.10 (Level 5)
• A randomized controlled trial (RCT) was conducted to compare the effect of three continence
management devices (including sheath drainage system, body-worn urinal and penile clamp) and
absorbent pads for men with persistent urinary incontinence ( > 1 year). The study showed that the sheath
was rated as ‘good’ for extended use (e.g. golf and travel) when pad changing was difficult. Furthermore,
it was useful for keeping skin dry, not leaking, not smelling and convenient for storage and travel. There
was a significant improvement in quality of life for sheath and body-worn urinal at 3-month follow up. It
was noteworthy that two-thirds of men were using a combination of absorbent pads and devices during

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the day.11 (Level 1)

Characteristics of the Evidence

This evidence summary is based on a structured search of the literature and selected evidence-based
health care databases. The evidence included in this summary is from:

• National Guideline.1,2
• A prospective, randomized, unblended, controlled trial sheath vs catheters (75 hospitalized men aged 40
and older).8
• Comparative evaluation of sheaths.4
• A randomized cross over trial using 58 subjects and six different self- adhesive sheaths.5
• Prospective randomized, open, crossover study and 6 different subjects tested 10 of each sheath.7
• Four articles based on expert opinion.3,6,9,10
• An RCT including 56 men.11

Best Practice Recommendations

• An assessment of continence and suitability should be performed prior to the use of a urinary sheath.
(Grade B)
• When appropriate to fit, the use of a urinary sheath is preferable to indwelling catheters for males with
incontinence. (Grade B)
• Silicone, one piece urinary sheaths are easier to fit, allow inspection of skin, and are preferred by users
and their carers. (Grade B)

References
1. SIGN Management of Urinary Incontinence in Primary Care. 2004. SIGN, Edinburgh. Available from:
http://www.sign.ac.uk/guidelines/fulltext/79/index.html (Level 3)
2. Nursing Clinical Practice Guidelines. Nursing Management of Patients with Urinary Incontinence, 2003,
MOH, Singapore. Available from: http://www.hpp.moh.gov.sg/HPP/MungaBlobs/10 [Accessed
17/08/2011] (Level 3)
3. Robinson J. Continence: Sizing and fitting a penile sheath. Br J Community Nurs. 2006;11(10):420-427
(Level 5)
4. Thelwell S, Symon C, Gay S, Dean G, Cottenden AM and Feneley RCL. Penile sheaths: a comparative
evaluation. Disability Equipment Assessment Report A15, Medical Devices Agency (UK), 1995 (HMSO).
(Level 3)
5. Fader M, Peterson L, Dean G, Brooks R and Cottenden AM. Sheaths for Urinary Incontinence: a
randomised crossover trial. BIU Int. 2001; 88(4):367-372 (Level 1)
6. Pomfret I. Penile sheaths: A guide to selection and fitting. Br J Community Nurs. 2006; 20(11):14-18
(Level 5)
7. Pemberton et al. A comparative study of two types of sheath. Nursing Times, 2006; 102(7):35-41 (Level
2)
8. Saint S, Kaufman SR, Rogers MAN, Baker PD, Ossenkop K and Linsky BA. Condom versus indwelling
Urinary catheters: a randomised trial. J AM Geriatr Soc., 2006; 54(7): 1055-61 (Level 2)
9. MacConnel EA. Applying a condom catheter. Nurs. 2001; 31(1): 70 (Level 5)
10. Perkas I. Bladder outlet surgery and condom catheter drainage. Phys Med Rehabil Clin N Am., 1993;
4(2):311-20 (Level 5)

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11. Macaulay M, Broadbridge J, Gage H, Williams P, Birch B, Moore KN, et al. A trial of devices for
urinary incontinence after treatment for prostate cancer. BJU Int. 2015;116(3):432-42. (Level 1)

The author declares no conflicts of interest in accordance with International Committee of Medical Journal Editors (ICMJE) standards.
How to cite: Long Khanh-Dao Le, B.Pharm, MPH, MHHSM. Evidence Summary. Urinary Incontinence: Urinary Sheath. The Joanna Briggs Institute
EBP Database, JBI@Ovid. 2018; JBI1124.
For details on the method for development see Munn Z, Lockwood C, Moola S. The development and use of evidence summaries for point of care
information systems: A streamlined rapid review approach. Worldviews Evid Based Nurs. 2015;12(3):131-8.
Note: The information contained in this Evidence Summary must only be used by people who have the appropriate expertise in the field to
which the information relates. The applicability of any information must be established before relying on it. While care has been taken to
ensure that this Evidence Summary summarizes available research and expert consensus, any loss, damage, cost or expense or liability
suffered or incurred as a result of reliance on this information (whether arising in contract, negligence, or otherwise) is, to the extent
permitted by law, excluded.
Copyright © 2018 The Joanna Briggs Institute licensed for use by the corporate member during the term
of membership.