CIC

Hi Arlington,

A good void and intake log is helpful in finding the cause of CIC frequency changes. It can help differentiate bladder capacity issues from OAB to simply more urine output by the kidneys.

Jim

Agreed.  Been doing it daily for 3 1/2 years!

So per the logs, when you went from 2 CIC's a day to 5-6, was it because of urgency at lower bladder volumes? Lower NV volumes? Or was it because of higher 24 hour volumes?

Jim

That might explain a bit of it; however, I think the bulk of it (and I should have mentioned this) was due to the fact that after a year and a half of catheterizing (w/ a 1:1 ratio of natural voiding to catheter voiding) my natural voiding rapidly dropped to zero.

Would your natural void still be zero if you went back to only 2 caths a day? If so, maybe you should cath less as long as your total volumes are under 400ml. If not, then it sounds like something else is going on such as your obstruction getting worse. I don't see how self cathing by itself, everything else being equal, would effect the volume of natural voids except positively.

Jim

more urgency sooner - which I assume means at lower volumes

What bladder volume did you use to cath at and what volume are you cathing at now?

Jim

With few exceptions, it has stayed the same at between 200-400cc's (per my urologist's guidance).

Thanks Jim.

All I can think of is that your bladder pressures have dropped due to its being decompressed by CIC, which isn't necessarily bad, but perhaps not enough to push through your obstruction. Urodynamics should have some answers in that respect. Meanwhile, in case it's a some OAB mixed in, you might try spacing out the CICs incrementally more and see if your natural voids return. This might involve some temporary "holding it in" but should be safe as long as your total bladder volumes don't go too much beyond 400ml. Do you know how much your bladder was holding prior to starting CIC the first time?

Jim

Plausible - thanks.

My liquid intake is only about 50 ounces daily.  When I move past about 4 hours, the cath volume is usually steadily rising above 400cc's.

I had the urodynamic studies prior to my 9/28/14 PAE.  The functioning was okay then.

Antihistamines pushed me over the edge in to AUR in July '14.  At that point they drained 1500cc's in the ER.  I've been CIC'ing ever since.  I don't know the post void residual prior.

Everything being equal, CIC frequency should not increase over time and in many cases it will decrease as natural voids increase. Seems like in your case everything else isn't equal. A follow up urodynamics and perhaps cystoscopy or imaging might provide some answers. Could be pressure, could be your obstruction has increased, don't know. FWIW they also drained 1500cc from me after a 450ml natural void just prior to starting CIC. In the beginning I cathed 6x/day with very little natural voids but then as my natural voids increased I was able to decrease the cath frequency. Today I only cath maybe 2-4 times per week. The idea of retraining may or may not work but should be safe as long as your volumes are not too large, even if they went a bit over 400. I have more thoughts on this in the cath "on/off strategy thread, that you might get some takeaways from. But briefly, my theory is that intermittently stressing and then "vacationing" the bladder, by changing up CIC frequency, rehabs the bladder faster than keeping things static. Sort of like easy/hard days at the gym.

Jim

Thanks a lot, Jim.  My median lobe pressing in to the bladder neck may have gotten a bit bigger.  Also, I had quit all caffeine but re-introduced about 1 cup of coffee per day.  That may have something to do w/ non-linear nature of cathing frequency/volume.  For example, I just had to cath after only 2 hrs and 15 minutes and had 540cc's - probably because I had a cup w/ 2 shots of espresso (my daily caffeine limit) 90 minutes ago.  I may try to cut it out again and keep logging results.

Thanks again.  It's interesting to compare notes and I appreciate your skeptical realism re various procedures - particularly FLA - which I haven't ruled out (but need to see more positive clinical results over time).

Experimenting is good as long as you do it safely.

As to FLA, I never expected better functional results than TURP which are around 70%, and very preliminary anecdotal accounts here are confirming that, not to mention Dr. K. himself stated on another forum that it would be unrealistic to expect better functional results than TURP. I think that somehow hasn't gotten lost in the enthusiasm some have for the procedure. Also, we know have our first reported case of sexual side effects from FLA, ie a numb penis head interfering with erections unless the person takes Viagra. For me at least, I'd like to see data from 100 cases and ideally peer reviewed. I believe Dr. K. has only done 20 FLA's for BPH total and no data has been published so far. What I do like is the precision and what had been zero sexual side effects, but the reported erection issue have given me some pause. I believe in one of the earlier FLA discussions (quite heated btw) JerseyDoc said that EVERY procedure had some sexual risks, and he appears to be right.

That said, I am coming from an admittedly conservative watch and wait position which CIC allows me to do.

Jim

Whoops, typo. Not "somehow hasn't gotten lost" should be "has gotten lost"

Interesting.  I didn't realize he had done so few FLA's for BPH.  Another reason to take our time.  70% actually sounds pretty good, though,  considering the likely side effect profile comparison vis-a-vis TURP.

The 70% number was for TURP, and Dr. K's inference was that one could not expect any better than that for FLA. Personally, I don't know if that 70% figure for TURP is high or low or on the mone. I do agree that the advantage of FLA over TURP is the side effect profile, however the reported single incidence of loss of erectile function gives me some pause until we have bigger numbers to better understand the actual odds of such a thing occurring. FLA longevity is another unknown both due to lack of data and the fact that less tissue ends up being removed. But back to the 70%, I think all these odds could be improved (or better projected) with more thorough screening such as urodynamics thereby offering better data for someone to make a decision.

Jim

I don't know about you guy's but 70% has it's ups and down's.  It's that other 30% you have to worry about.  Good luck to all  Ken

Kenneth,

Yeah, I agree, re that pesky 30%!  And 3+ years ago, when I was a newbie the BPH and all, my then-uro-doc wanted to TURP me, and claimed it affected "only 4-5%."  Yeah, uh-huh, sure.  I said to him, "OK, but would YOU want to be among the 4-5%???"  Only time I saw him smile.  Other than those few glorious months post-Urolift, I've been CIC-ing, and like JimJames will continue to do so until something better comes along.

Yes I know doctor don't look at that anymore.  I don't know if I'm going to say this right but I know the main thing the doctor is trying to do is help us pee better but the H...L with everything else.  They say everything will be the same.  They tell us we don't need to ejaculate anymore because were old.  That's crap.   5 % is to high  We are all men but we want different things and some doctor could care less.  They are even trying to take the Urolift away and doing with clips on the bladder neck to keep it open and doing a bladder neck incision.  Which will cause retro.  So what is left  Not much.  I even got 3 e-mail from a women They don't care either.  This is what she said .NeoTract nor any other company regulate doctors or the procedure techniques they perform.  So they are letting the doctor do the procedures the way they want.  They even said that you sign a consent form that you may lose your ejaculation with you doctor not with the company.  So I guess you take it or leave it.  Nice company  Ken