Anyone Self Cathing? I still am after over 10 years.

Are you having natural voids as well, or are you exclusively voiding via catheter?

If you do have a natural void, how many ml of urine comes out of the catheter, right after. That would be your PVR (post void residual).

If you're not having natural voids, how much comes out of your catheter each time.

I have found that tracking the numbers can lead to better CIC strategies that may improve the overall condition.

Jim

I do have natural voids before I do the catheter. The residual varies, but it's usually in the 300-400 range. My natural voids are around 50-75 mls.

So adding 50-75 to 300-400, means your bladder at any one time is holding 350-475 mls.

400 should be the maximum, because you don't want to stretch, quite the contrary. The solution then is to increase the number of times you cath today.

When I hit a plateau, I found that giving my bladder a "vacation" helped. So I would increase the frequency of caths per day to keep my total bladder volume down to 300 or even 200ml. After a few weeks of that, I would often find my natural voids started to increase.

I have a few threads here about bladder retraining with CIC, but not sure how to access them.

Most of the time during the day, my voids are around 300 or less. The first morning one is usually in the 400 range. I could do it more often, but I'm already doing it 6 times. Usually 5 during the day and once in the middle of the night.

I actually did read a lot of that thread of yours a few months back.

Yes, both shrinking and hopefully allowing it to regain some elasticity by not keeping it stretched all the time.

It may also make you feel the need to void earlier, so the detrussor muscles will have to push less urine by the enlarged and obstructive prostate. sometimes I'd cath up to 10 times a day for a month or so for what I call a "bladder vacation".

I still do that every year or so if/when I feel things regressing. Haven't had to cath once for the last couple of months, knock on wood.

Found something new to increase natural voids. I'll post a little later about that in this thread.

Good luck and definitely know how things work out.

Jim

This is regarding a new natural void technique I have found helpful, but first, for some reason was not able to edit my last post, is this function still available? Anyway, I wanted to add that of course with over 6 CIC's a day, you will probably not feel the urgency, so it's more or less timed voiding as opposed to as you feel it.

So the natural voids. You know if you take a garden hose and put your finger over the end, the water shoots further? That's because you're constricting the hose diameter, therefore building up pressure.

I found the same thing works with my personal "hose" 😃 The basic idea is that you give it a gentle tug at the start of, or right before you natural void. This lengthens the penis and seems to somewhat constrict the urethra. The result, for me at least, is that the urine comes out under significantly greater pressure. And while I haven't yet, done a volume study, I think the void is also significantly more. It appears that the added pressure, sort of helps suck the urine out of the bladder, almost like a pump. Still looking for a name, but we can use P&P (Pull and Pump) for now 😃 If you try it, curious if it works for you.

One other natural void technique is voiding while reclining or lying down. I came upon this when temporarily bedridden for another ailment and had to use a urinal. What I found was that I got more void volume in the reclining position. This may have to do with the repositioning of my prostate. This can be combined with "tapping" and/or "tickling/rubbing" the bladder while voiding, both of which seem to stimulate the void reflex. I've gotten 400ml plus natural voids this way very often with almost zero residual.

Jim

Jim,

Yes, I do the pump and pull sometimes and get some to come out that would not have. I think this is similar to milking a cow. Why it works I don't know. It may be that it is changing the shape of the prostate and bladder. The penis is connected to the prostate and the prostate is connected to the bladder so when you pull the penis it pulls the whole system. This allows me to get the catheter into the bladder sometimes, by pulling the penis it pulls the bladder sphincter over the catheter rather than pushing the catheter into the bladder. The connection of penis to prostate to bladder, is the reason some penis length is lost after surgery to remove the prostate .

Thomas

Hi Howard, Good to see your name again. Sorry for taking a couple of days to respond but I just got the notification. This site got even harder to use than before. I have a few thoughts and I'll put them down here within the next couple of days.

Jim

Hi Howard,

First, thanks for the kind words. Yes, it sounds like we had good timing. I haven't been here much lately for a number of reasons, not do I seem to get notifications. (A little off topic, but do you know what happened to the whole FLA group? Last time I checked, years ago, some were starting to have relapses.)

So, I just learned something about the Speedicath. Didn't realize the last couple of inches weren't lubricated till you told me! I get pretty close to the end myself, so tonight I'll see if I go past that part or not.

If external lube doesn't stick to the catheter surface without the coating, have you tried to coat generously the entire catheter? I did that for a bit when I had some difficulties. What happens is that the lube will then get into your urethra a little, so hopefully when you get to the dry part, it will slide easier. If you try it, let me know how it works out. If that doesn't work, maybe try cathing in different positions, like sitting, where the urethra may be shorter although not sure how convenient that might be.

But if none of that works out, why do you have to go from 12F to 16? Isn't there a 14F? And I guess if nothing works out, you might have to start trying either other hydrophilic's, or non-coated coude catheters that should take external lube better.

So with me, funny thing going on and not sure why, but have a few theories. A couple of months ago had a UTI so was doing a lot of cathing, maybe six times a day. Treated it and since then, no need to cath at all. None. And the crazy thing is that I don't even need to cath if my bladder is holding more than 400ml, which in the past made it impossible for my detrussor's to push the urine past the prostate.

I am going to try and locate my dusty bladder scanner -- haven't used it for years -- and do my own urodynamic study to see if anything has changed, especially with my diverticulum, but it is odd. It's almost like I turned back the clock to a point ten years before I even had to cath!

That said, I did notice that if I don't cath at all my PVR's are high and between my void and PVR, it's definitely over 400ml, which means the bladder may eventually stretch, so as a compromise, even though I don't have to, I'm cathing twice a day, morning and before bedtime, just to give the empty the bladder completely at least twice and also make sure my kidneys are protected, even though I don't think I'm anywhere near a back pressure situation that I had just before I started CIC.

Again, not quite sure why this happened after all these years. One possiblity is that I started doing pelvic floor exercises for an abdominal muscular issue. Maybe 15-20 minutes each morning. Maybe that is it?

Let me know how things go and again, good hearing from you.

Jim

Hi Howard, I thought that you once solved your bleeding problems with the Coloplast Speedicath 14fr Coude hydrophilic by switching over to the softer Cure catheters. I can see that you now switched back to Coloplast Speedicath 14fr Coude hydrophilic, still with bleeding problems. Did you have problems with the Cure catheters? I'm still using them. Hank

Hi Jim,

I too just got your notification. It's too bad they changed their notification methods.

I will write you later tonight and thanks for responding.

Howard

Hi Hank - good to hear from you. I did switch over to Cure for a while but I just could not get them through my very long prostate. They just bunched up. My urologist said he has never seen such a long tight prostate when he did a cystoscopy on me. BUT I did learn from you a very important technique which has stopped my bleeding for the most part and that is to go very very very slowly once I reach the prostate. That has been the cause of my bleeding and if I ever slightly rush the catheter through the prostate itself I get serious bleeding. I recall you were thinking of doing holep? I looked into doing holep as well but decided against it.

All the best.

Howard

What were your main reasons for deciding against HoLep? Which procedure is your first choice now?

If the problem is bunching up, you may want to try next higher size.

Hank

For the bunching up problem, you may want to try stiffer catheters like GentleCath or McKesson. They are stiffer than Cure but not as stiff as the Speedicath. Hank

Hi Jim,

My problem with the top rough 1 1/2 inches of the catheter is that when the catheter just pierces through the start of the prostate the pee being held back by that "middle sphincter" flows on the outside of the catheter and washes away the lube that I used to coat the catheter all the way to the green cup. My prostate is 4 inches long so I still have 4 inches to go to get into the bladder. When I get to the rough part there is no lube left because it has been washed away. It really hurts the meatus then and often starts urethral irritations for me. I've written Coloplast about it but they don't care.

Now I did get a sample box of their catheters that are 16 inches long. They are still 14 fr and coude but add 2 more inches. They are called "Self-Cath Plus" Referenece number 4614. But they are not Speedicaths. They are not hydrophilic coated or in saline solution. They are just plastic. Also they don't have the ridge on the green cup for alignment but instead just a blue line. Also they are much less rigid then the Speedicaths so I don't know if I can get one in. I got them last week and will give it a try . Have you heard of them?

I've lost touch with the FLA guys but I know some of them reverted back. Dr K went back in the hospital to work. FLA worked great for median lobe obstruction. Did you ever manage ZZ Top? They are coming here next month - must be in their 80s but still going strong!

Howard

Hi Hank,

I was hoping to just do CIC forever as long as I can but if not I will get an Open Simple Prostatectomy here. My local uro has really advanced the procedure with little blood loss and fast recovery. He did a 300 gm prostate last week in 2 hours and it looked just like a robotic procedure but in 1/3 of the anasthesia time.

I worry about incontinence once my large prostate is removed. I suffer from nocturia and dump over 1 liter every night when I CIC at 3 am. If I had the prostate out it would come out in the bed!

I would have to travel far for holep and I want to stay near home. Holep has problems with strictures after a few months as do all these laser methods.

I wrote Jim about these new 16 inch 14fr catheters I got from Coloplast as a sample. They are quite soft and flexible - as soft as the Cure's I tried so I will see if I have less irritation. They are aslo coudes.

Howard

Haven't heard or tried that one, but I found a 16" Hydrophilic here:

So Dr. K is no longer doing FLA for BPH?

The 60's? Don't remember a lot of what on then 😃

Jim

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Hi Howard,

I tried Coloplast Self-Cath catheters before and really liked them. They are just as soft, or even softer than Cure. However, I stay with Cure because of its lower cost. Hank

I've been using the McKesson 14 F, 16 in coude catheters at $.54 each.

I find them very easy to insert and the price is great. I put just a touch of lube at the tip and in it goes.

Hi Ted, what specific brand of lube do you use? I have been lubing almost the whole length of the catheters. Hank

Also, $.54 for a coude is very good. Is it cash price or after insurance? Where do you get it? Thanks. Hank

Hello Hank,

I actually put a drop of betadine on the tip to sterilize a little and just a touch of Surgilube. It slides in very easy. I've even done it with only the betadine and it went in without a problem. I like the stiffness of the McKesson. It goes in much easier than the softer ones and I don't feel any discomfort.

It's a cash price through Personally Delivered. The cost is less than what I would pay with my insurance. You need a doctor's prescription to get it from them.

Thanks Ted. It just happens that I also buy my Cure catheters from Personally Delivered. 😀 Also, the cost is less than what I would pay with my insurance which is Medicare. I'll try to copycat you all the way, if you don't mind. Hank

Do you clean the tip of the penis with anything before the cathing, or the betadine alone is good enough? Thanks again. Hank

Hank,

I actually put a drop of betadine at the opening of the urethra and then a drop on the tip of the catheter.

Very nice! What is the brand of betadine that you use? I want to mimic as close as possible. BTW, I just ordered some coude McKesson catheters and Surgilube from PD. Thanks again. Hank

I use Povidone Iodine from Target, but they should all be the same.

Let me know what you think of the McKesson.

Ted

Hi Hank,

Let me know how McKesson compares to Coloplast Self-Cath catheters in terms of stiffness. Are yours 16 inches long? Thanks Howard

Hi Jim,

So are your PVRs still above 400 ml? I was a little confused in your description of your situation. You said that even though your bladder holds more than 400 cc you still do not need to CIC? Why is that? Are you able to NV that 400 down to zero?

I noticed when I had to take Amoxicilin for a UTI that afterwards my NVs improved a lot for a few days. I guess it brought down inflammation which in my case is why my prostate is so large. Years ago I had to take prednisone for 5 days for asthma. During that time my PVs went to zero and I could pee like a kid! But after a few weeks it reverted back.

Interesting thought about pelvic floor exercises. Is that the same as Kuegels? So are still not having to CIC now ?

Howard

Hi Howard, this is something I already know.

Mckesson is somewhere in between. It's stiffer than Coloplast Self-Cath catheter, but softer than Coloplast Speedicath that you are using. Yes, they are 16 in long. Hank

Thanks Ted. I already used Mckesson before, for a long while, but decided to pick Cure because it's softer, therefore less chances of bleeding. Now I might go back if I can get away with less lubricant the way you described. I didn't know this before. Hank

Hi Ted, do you have any bleeding problems, even traces of blood, with Mckesson the way you are lubing? Hank

Hi Howard, with the exception of Coloplast SpeediCath Hydrophilic which is 14 inches, all other catheters I know of are 16 inches. Hank

Hi Hank. I didn't know that most other catheters are 16 in long. I thought there was something wrong with me that I am at the end of my Speedicaths 14 inches. Do you and others here need more than 14 inches? The Speedicaths really only have 12 inches that are usable since the top 2 inches is very rough.

You also asked why I did not do holep. The main reason was that some of the doctors who do holep told me that a 12 inch urethra is the limit of their scopes so they said they could not complete the procedure on me. Other doctors said they could do it but would probably need to do a perineal urethroscopy to complete it. No way! Howard

The Speedicaths are long enough for me. I just don't like them because their stiffness causes bleeding easily while no others do that to me. Your urethra length is at the high end of the range. You should try Mckesson which is stiffer than Cure, so they probably won't bunch up on you. Hank

Hi Howard,

Coloplast SpeediCath Flex Pro Catheter is another one that you might try. It is only 13 inches but all of it is prelubed and useable. It is my favorite, but expensive so I only use it when I am away from home due to its compactness. It is packaged in a pouch that fits nicely in my pocket. Hank

Hi Ted, how do you apply the lube to only the tip of the catheter? Hank

Hank, no I don't have any bleeding.

I first put the betadine on the catheter tip with a medicine dropper so that I don't touch it. Then I put a drop of betadine on my pinky and coat the urethra opening. Then I put a drop of lube on the pinky that has the betadine coating and just apply it to the catheter tip and insert it. This seems to me to be a "sterile" technique.

I have trouble with the softer ones bunching up. I feel that they are more difficult to use and therefore more traumatic.

Thanks Ted for sharing. I had so much bleeding problems with Coloplast Speedicath hydrophilic, which is very stiff, so I went out all the way picking soft catheters. Cure is fine for me but I have to lube most of its length so in general it takes more time. Overall, I can use any catheters, except for the Coloplast mentioned above.

I love your procedure. It makes lots of sense. Hank

Hi Ted, I tried out few Mckessons with the Surgilube only at the tip. They go in OK but only slowly and I can feel some rubbing going on inside my urethra so it didn't work out as I hope. I probably will go back to my old way, lubing almost the entire catheter. It turns out that Mckesson is just as soft as Cure. I might try on some firmer catheter, like Gentlecath, if I remember correctly. Thank you just the same. Hank

Hello Hank, you can try coating the entire catheter with the betadine. I found that it acts as wetting agent and I have inserted it without any lube, without a problem. For some reason, lubing the whole things makes it harder for me.?

Thanks Ted, very interesting! I'll try the betadine. It must be the missing ingredient. I did not use it and use alcohol instead, because I wanted to avoid the stain. I will use it if it acts as a lubricant. Hank

Hi Ted, coating the whole catheter with thick gel like Surgilube may create some insertion difficulty. I either use very thin layer of the lube, except for at the tip, or use thinner liquid lubricant. BTW, I just ordered some povidone iodine. I'll get it tomorrow. Hank

Hi Hank and Ted,

I've been following your posts with great interest. I ordered some samples of McKesson 14fr 16 inch coudes.

The way I got to stop the bleeding with the Speedicaths was to hang them on the wall and peel down the outer cover about 6 inch and then squeeze some Surgilube to cover that 6 inches. Then I very slowly pull out the catheter rotating it slowly.

Then I very very slowly insert the catheter all the way to the bladder. This was key to stopping the bleeding. Remember the" one-minute club"? That got me in trouble big time!! But if I am very careful to go super slowly then I don't get any bleeding. It has been a long time since I had that problem now.

I would be ok then with the Speedicaths if they didn't put that rough plastic on the last 2 inches which really hurts my meatus region just as I get into the bladder. Apparently it is for men who cannot control the catheter from the green cup so they want to hold it further down. I don't see why the rest of us have to suffer by losing 2 inches of catheter!! Howard

For the last couple of years my situation was that I could do a NV as long as my bladder was holding under 400ml. If over 400ml, then I had to CIC. When I did do natural void during that time, I usually emptied down pretty well.

Then a few months ago, I started to be able to void at any bladder volume. Still haven't figured out why, but not looking a gift horse in the mouth 😃

One theory is that it happened after treating for a UTI, but this wasn't my first UTI successfully treated, so not sure if that. The other thing is that I started doing pelvic floor exercises, mostly for my lower back. So maybe that was it? I do have a bladder scanner at home collecting dust, so one day soon I am going to fire it up and see if I notice any difference in bladder/diverticulum structure as I've always had a moderately sized diverticulum.

As to my PVRs. For the first month after this came about, I just did natural voids all the time. Didn't use a catheter at all. Eventually, I checked my PVR's and not suprisingly they were up, because while I no longer needed CIC, my bladder probably stretched a bit. So for the past few weeks, decided to go back to CIC, twice a day, just to keep the bladder toned. I haven't checked PVR's lately, but I will assume they have come down some.

Interestingly, the position I'm in now is about the same it was 30 years ago when I didn't need to self cath, but had larger PVR's.

Jim

Hi Howard, what you are doing is adding lots of expensive lubricant to an already expensive hydrophilic catheter. I can't imagine myself going that route. Thanks for sharing however. Hank

That is really interesting. I also have good NVs below 400 cc but above 500 cc say I have to CIC. Below 400 cc I can NV half the volume and then must CIC to remove the remaining 200 cc.

So it is very interesting that your PVRs can go to zero! Do you think much of your retention is caused by a bladder neck obstruction rather than a huge prostate? If that is the case then the obstruction could move around slightly enabling you to have 0 PVRs.

I've had 3 cystoscopies over the years and they all confirm a very large prostate ( 4 inches long) with a very tight channel to the bladder. I cannot imagine how that could come and go unless you were taking anti-inflammatories which could reduce the prostate size. In my case I have to take prednisone once in a while for my asthma and a happy side effect is that my PVRs go to zero temporarily.

Or maybe you have a median lobe that moves around just a bit to open/close the gate?

Did you ever have an U/S that confirmed the size and geometry of your prostate and related bladder neck configurations?

Howard

Hi Hank. Fortunately my Part B pays for the catheters but the lubricant definitely is an expense. I go through one tube every 3 days but it is worth it to stop the bleeding. McKesson catheters are made in China whereas Coloplast are made in Denmark. I am not confident in quality control medical devices from China.

Still the best advice was what you told me a long time ago and that is to just go in one millimeter at a time and stop as I go through the prostate. Just that alone stopped 90% of the bleeding but it doubles the time to CIC which is a small price to pay for no bleeding.

Howard

It is a bit of a puzzle and I did take an anti-inflammatory earlier for something else, but that is well out of my system now. And maybe the new antibiotic I used a few months ago may have played a part. Or, like you said, something could have shifted/changed, including the opening between diverticulum and bladder. Or maybe these daily pelvic floor exercises have rearranged things in a postive way. I will investigate that further, but it's a nice puzzle to have and at the end of the day I will not look the gift horse in the mouth. Even though I was very happy where I was before, being able to void at any bladder volume without CIC is a real plus. It's like I turned back the clock 30 years and without CIC that never would have happened.

Jim

Jim - Could you please tell me how you do your pelvic floor exercises? I'll give it a try and hopefully confirm your results.

Howard

Lots of them on YouTube, but here's one routine I followed for awhile. It's targeted for women with Diastasis Recti after childbirth, but basically pelvic floor work. Don't try to do all at once and build up gradually. What she doesn't emphasize enough is that on the inhale parts, you're doing isometric pelvic and abdominal contractions. And when doing the actual exercises, you're keeping the contractions while breathing in and out. Takes a bit of practice.

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Hi Howard,

Did Medicare part B paid for the whole cost of the catheters? I thought that you still have to pay for 20% copay. Hank

Yes - my supplemental health insurance through United pays the 20% after a $300.00 deductible and $175. monthly premiums.

Thanks Jim. Could you PM me the link as the moderator removed it.

I'll PM soon. No idea why link was removed, but I'll pursue with moderators later as I think it could be useful in the public forum.

Hi Ted, I tried cathing with only betadine and it worked. It worked even though I only dipped it into the betadine bottle, so only about 4" of it was coated. Wow, what a find! Now the question is ... If you already knew it, why do you still bother using any lubricant at all ? Hank

Hello Hank,

I'm glad that it worked for you. I put just a drop of lube, I guess to be on the safe side. I've had situations where I had some bleeding. However, there are times when I get lazy and I don't lube.

Thanks Ted for this valuable knowledge. Have you tried straight catheters? I found that they are easier and more comfortable than the coude. And they cost much less. Hank

I also tried this trick on my favorite Cure straight catheters and it worked just as well. 😀 Hank

I'm glad that it helped. The Uros are useless. The one that got me started on cathing had me using a re-usable one, without any hygiene instructions. Even after getting frequent UTIs, he never advised anything different. He said that's it's not a sterile technique and that I can use the same catheter for years. He said that patients stay on a low dose antibiotic! Anyway, I used a coude from the start. I never tried a straight one. I thought the curve of the coude makes it go in easier. I may ask for samples of the straight ones.