Daily Cialis instead of Flomax (Tamsulosin)

Hi David,

I didn't like Tamsolusin either. The Cialis did the same thing with less bothersome side effects.

Sounds like your doctor isn't too open minded which is not uncommon. Maybe time to shop around for another urologist if that is possible. If not, then do your homework (like you are) and see how amenable he is to your sugestions.

I don't know much about how a back problem correlates with retention, but you can have retention problems some days (and some times during the day) and at other times you can be okay. So it could very well be your prostate. Did he do an ultrasound to check things out and also to see how much your residual volume is?

If the Foley helped than self cathing should help. It's really the same concept, you just don't keep the catheter in all the time. Depending on your retention issues, you would cath between 1 and 6 times a day, but the latter is mostly if you can't urinate on your own at all. In your case, you might even get by with cathing a couple of times a week, when problems come up.

The rule of thumb is that if your cath volume is more than 400cc's, then you should cath more often. If you cath volume is under 200cc's , then you should cath less often.

I'm in the U.S. so my insurance pays for up to six catheters a day. Don't know what your situation is there. The catheter I like and recommend is Speedicath (coude tip) by Coloplast. It's a single use catheter, so if you're cathing several times a day, the costs could add up without insurance as each catheter is several dollars.

On the other hand, there are catheters that you can reuse for a week or so, which brings the costs way down to very affordable.

If you do go this route, I'd be glad to share more info. Just insist on prophalactive antibiotics before you start as the body can be prone to utis the first week or so.

Some people find self cathing very easy almost from the beginning, and others like myself, had a difficult time for several weeks. So I won't kid you, if you're in my group then be prepared for some bleeding and discomfort for one to three weeks. But eventually tthat all passes, and then it's easy, painless, and puts you in total control of your urinary system.

And unlike an operation, you can stop doing it at any time and you'll be right back to where you were, probably a little better actually, since cathing gives your bladder a rest.

Hapy New Year

Jim

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Hi Jim! thanks for getting back.

Your positive remarks are very welcome.  I'm 54 so feel too young to be losing my MOJO thanks to Tamsolusin, that's why I was interested in your experience with Cialis - but I seem to be doing OK on nothing at all at the moment.  It;s taken several weeks but the old 'weener' is back to its old self, more or less, which is psychologically really important to me.  On the retention front I'm going to check it out online for a supply.  I live in Wales so if my doctor were to prescribe I'd get them free (although we DO pay into the NHS through our wages!) whereas people living in England would have to pay a small contribution.  Like you say, if it's only now and again it wouldn;t be costly. 

I had a Foley inserted after my operation in June, 800ml held, and again in September when I had the second retention problem - 650ml.  After coming off the Foley in November I had tests to check flow and voiding (spent most of the day at a clinic drinking water!), using unltrasound scan and the bladder is emptying fully. 

When the foley was inserted the first time it just felt weird - didn't hurt thanks to a shot of local anesthetic up the pipe first.  Same second time.  No pain (just a shock!) and no bleeding.  - - but I take your point.  I thought I was on antibiotics while the Foley was in but found out later that Tamsolusin is not an antibiotic.  Therefore on neither occasion was I on antibiotics but I didn't get UTIs.  I know it's important to be scrupulously clean to avoid UTIs but on both occasions I was not freshly showered - once having just come out of theatre and the second time turning up at the A&E after work!  I wonder if the jelly 'local anesthetic' itself has an element of anitbacterial?

I had a double slipped disc (S.1/L5 and L5/L4) with matter pressing on nerves so the operaton was to cut away the excess and grind the vertibrae to fit better and not touch the nerves.  Great success with the op but there was a lot of neurological damage - my left foot is still seriously paralised and part of my lower leg so I;m not walking properly yet - getting there though with physiotherapy and swimming.  The medical staff I have seen have all said that it's not unheard of for the muscle spasm associated with the classic back pains that come with disc trauma to spread to the bladder temporarily too.  Once 'things' settle down it seems to go back to normal - so here's hoping.  As we all know, if you feel threatened or nervous at a urinal the flow stops - this is psychological.  My problem might be triggered by something similar - a memory of pain, perhaps.  I would hope that a single cath or the realisation of having the safty-net of the ability to cath will help.  But Jim, I'm not being stupid.... if things return I agree it could be the prostate so would think about the usual drugs or operations.  This site has been really useful: many of the members are in their 70s but it's useful to know just how successful TURPs etc really are.  The truth is out there somewhere......

Keep your fingers crossed for me.

Happy new year to you too - hopefully happy AND healthy!

David

 

Doctors in England are reluctant to prescribe dialy Cialis due to cost. .

The prescription charge in England is hardly small at £8.05 per item.

Personally I would not risk buying alternative versions of Cialisi on line. You just do not know what you are getting.

 

Is the 8.05 pounds for the 20mg Cialis or for the 5mg? 5mg Cialis, one a day,  is what is prescribed for bph. The price for the 5mg is of course less, or you could cut a 20mg in quarters. You could even try 2.5mg a day and see if you have any benefits. Here in the USA, my insurance only covers part of the cost so my cost is about $3 per 5mg tab. I don't use them every day so the cost is much less.

In England each item on an NHS prescription costs the patient £8.05. The cost to the NHS for a months supply of one day Cialis is well over £54.99. See below.

NHS Doctors are usually only allowed to prescribe eight 20 mg tablets every two months to a patient.

Tablets, f/c, tadalafil 2.5 mg (orange), net price 28-tab pack = £54.99; 5 mg (light yellow), 28-tab pack = £54.99; 10 mg (light yellow), 4-tab pack = £26.99; 20 mg (yellow), 4-tab pack = £26.99; 8-tab pack = £53.98

David,

Never had a Foley, but I got a uti after my first Cystoscopy, and another right after I started self-cathing, so I guess I'm more prone to uti's from urethral trauma than most.  Sounds like you're less prone, so probably won't need them. That said, one or two doses of the right antibiotic taken prophalactively can prevent a lot of problems down the road until the system gets used to the cathing.

There is some debate in the self-cathing community how sterile (or not) the procedure should be. Some will just instruct you just to wash your hands and then give it a go, while others have elaborate protocols to keep things clean. I'm more toward the elaborate end, but even then,  the whole procedure only takes me five minutes, and since I upped my protocol game, no uti's.

Also, many docs will tell you that it's normal to be 'colonized' if you self cath. Colonization is different from a uti in that there are no overt symptons, but it's still bacteria. With my methods, I not only have no uti's but also no colonization.

The cath I recommend does not use any lubricant or jelly. It's a hydrophillic catheter that comes packed in some sort of water solution that makes it  very slippery.  This means less friction than if using a lubricant, and in theory less chance of a uti from urethral trauma. There are a few studies that suggest this is true.

If you are going for single-use catheters, again I recommend Coloplast's Speedicath with Coude tip. The Coude tip makes it much easier to navigate around the prostate. Just make sure you read the instructions and insert the tip in the right direction. I suggest starting with 14 Fr (size) and then switching over to 12 Fr (smaller size) after you become proficient. If you start with the smaller size first, ironically it may not go in as easily because it's more flexible.

Unless you want to go with the "only clean your hands" approach, I suggest you get some Povidone-Iodine Swabsticks to clean the head of the penis and  meatus prior to cathing. Some people use BZK towlettes instead, but I think the Swabsticks give better coverage. I use a BZK towlette after cathing to clean up any Povidone Iodine left on the meatus. (My cath nurse told me I didn't need to clean the penis or meatus, but following her protocol I ended up with a uti)

You also might want to invest in a box of non-powdered latex gloves, both for hygeine and to get a better grip on the cath. Once you get the technique right, you won't even have to touch the catheter tube and can then discard the gloves. (I can go over that another time.) One of those alcohol based hand cleaners are also handy to clean the hands, but I found it too irritating on the penis, therefore the swabsticks.

That's sort of the basics, if you decide to go ahead let me know and I can offer some further advice. Whether you use it as an alternative to an operation (like myself) or just occasionally, it's a very handy skill to have. Another benefit is that self-cathing will monitor your PVR (post void residual)  every time you cath. So no guessing, no having to get an ultrasound, no running into trouble with too much retention.

Jim

 

Tablets, f/c, tadalafil 2.5 mg (orange), net price 28-tab pack = £54.99; 5 mg (light yellow), 28-tab pack = £54.99; 10 mg (light yellow), 4-tab pack = £26.99; 20 mg (yellow), 4-tab pack = £26.99; 8-tab pack = £53.98

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That's a little less than what I pay for a months worth of 5 mg daily Cialis. Looks like you could save a little by cutting the 20mg's in quarters except you mentioned dosage  restrictions on the 20 mg. Hopefully they're allowed to prescribe a months worth of 5 mg. The 2.5 mg look like the worst value, so even if that was your dose you'd be better off cutting the 5 mg in half. 

Cutting tablets is often rather difficult.

I have used a pill cutter to cut other tablets in half but a second cut might not be so good.

Given the price structure, cutting the 5mg into two 2.5mg is a no brainer if you decide on 2.5mg as a dose.

I agree that a second cut is difficult, and the saving is marginal. That said, if you did want to do a second cut, it really doesn't matter that much  if it's exact because of the way Cialis builds up in your system given it's longer half life say compared to a shorter acting agent like Viagra.

So the way to keep the dosage as even as possible would be to take the four pieces on consecutive days, so at the end up day four you would have 20mg in your system, regardless of how good or bad the cuts were.

I haven't done the math yet, but you could probably get the same serum levels of Cialis with a 10mg every other day as you could with a 5mg each day.

The formula as I understand it is  that if you take "X" mg of Cialis daily, once it builds up in your system (takes about a week) your serum level would be 1.6 times X

So, let's say you take exactly 5mg of Cialis a day. After it builds up in your system, your serum levels of Cialis would stay at  1.6 X 5 or 8mg, give or take what time of day it was per when you took the pill.

So, while this is not how it's prescribed, I would assume that if you wanted to see how daily cialis works, instead of waiting a week for the 5mg of Cialis to build up to 8mg, you could take a single 10mg pill and get an approximate idea how it works. This is not a recommendation, just my unprofessional thoughts on the matter.

Richard

 

Was the rentention after back surgery due to the surgery itself or possibly the drugs you were given for pain afterwards? And are you still on any pain killing drugs such as opiates or NSAID's? These type of drugs have been shown to cause retention, and I started a recent thread about it here.

Before rushing into self catherization (CIC) I would try and figure out the exact cause and extent of your current retention through examination and imaging such as ultrasound.

That said, yes, CIC can do exactly what a Foley can do except it's more convenient with no tubes or bag 24/7. I'm in the USA, so my catheters are covered by Medicare for up to around 200 catheters a month if need be.  I personally like the Coloplast Speedicath which is a single use hydrophillic catheter. Even without insurance, not expensive if you are only going to use it as a "back up" for emergency situations but someone will have to teach you how to use it and while many take to it right away, for others (I include myself here) the first couple of weeks can be rough. 

Jim

 

Just realized I accidentally replied to David 91143's post over a year old. The main difference between my answer then versus now, is to investigae the role that any pain killing meds may have had with retention. Something I learned recently when a course of NSAID's almost put me in acute retention. Hope things have worked out by now. 

Jim

I think you may be confusing two different things. Daily Cialis is a drug program that like Flomax (tamsulosin) can help some people with prostate problems (BPH). It's called Daily Cialis to differentiate it  from regular Cialis which is often just taken once a week. Daily Cialis is usually 5mg, and regular Cialis is 10 or 20mg. 

I also ended up talking about self-catherization, more formally called "Clean Intermittent Self-Catheterization (CIC)", which is what you seem interested in.

Unlike a Foley catheter, you usually don't wear a leg bag, and unless you have some issue that makes you bed or wheel chair bound, for example, you would probably drain into the toilet directly.

I assume you're under the care of a urologist for your BPH and have done the usual testing for retention, etc?  If so, and if you don't want to do an operation at this time, then CIC is definitely something to talk to your doctor about. Just be aware that not all urologists incoroprate CIC into their practice, so if yours doesn't, then consult with one that does.

But first you might want to ask about some of the other drugs like tamsulosin or daily Cialis which help some people.

As to how often you catherize each day, it really depends on how much of a retention problem you have and how much you are able to urinate on your own.

That said, most people who do CIC, catherize themselves 4-6 times a day, but you might be able to get away with just once or twice a day. Possibly even less. Your doctor will explain how that works, but basically how many times a day you self-catherize depends on how much urine comes out each time.

As a rule of thumb, if you catherize 400cc or more each time, then you increase the frequency, and if you catherize say 200cc or less, then you decrease the frequency.

Not sure where you're from, but here in the U.S.A., the urologists in the major teaching hospitals are more knowledgeable about self-catherization than those in private practice. The most knowlegeable actually, are doctors and nurses who cater to the Spinal Chord Injury (SCI) community, because CIC is the method of choice for their patients.

The important thing is not to just grab some catheters and wing it. Someone should initially show you how it's done and be around if you need help and to supervise your progress.

Good luck and let us know how things go.

Waiting for a better procedure for BPH can cause you bladder and kidney problems. What is your Uro advising? I waited from 1995 to 2005 for a better alternative to TURP as I knew that several laser prcedures were being developed.

By that time my prostate was 75 grams. I had PVP Green Light Laser in June 2005 with a quick recovery but not as good a flow as I expected.

My prostate continued to grow and by 2013 was 125 grams when I had a Thulium Laser procedure. Fairly quick recovery period but again not as good a flow as expected. The other and seemingly preferred treatment is HoLep, Holmium laser.

The hospital that did my PVP moved over to HoLep on a split decision of urologists opinions.

@derek76   Waiting for a better procedure for BPH can cause you bladder and kidney problems. What is your Uro advising?

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I'm not a doctor but I think the bladder problems you're talking about would be both flaccid (stretched) bladder and a thickening of the bladder walls. The kidney problems would be hydronephrosis, which means "water in the kidney" and is a swelling of the kidney do to a build up urine when the urine is refluxed back into the kidney due to a blockage, as for example an enlarged prostate. So instead of the urine going just out, it also gets forced backwards into the kidney. Not good.

I actually had all of the above when I walked into my urologists office a couple of years ago complaining of difficulty in urination.

There may be other reasons for these problems, but commonly, and in my case, they were all caused by significant urinary retention. In fact, the first time I cathed, over 1400cc's came out. That combined with the 350cc's I had just urinated means I was carrying close to two liters of urine in my bladder.

It was my doctor who suggested the self-catherization as a prep for a turp procedure. The catherization empties the bladder, relieves the bladder, and depending on how much damage has been done, can rehabilitate the bladder to a certain extent. The emptying of the bladder also relieves the back pressure on the kidneys and therefore stops the

hydronephrosis. 

I had mild hydronephrosis in both kidneys when I started self-cathing, two weeks later barely detectable hydronephrosis in one kidney and two weeks after that no hydronephrosis. That still holds true to today.

The self-cathing went so well for me, that I decided not to have the Turp and wait for something better. Hopefully, something without retrograde ejaculation.

So, back to your orignal question again,  delaying an operation and waiting for a better procedure (at least in my case) does not cause bladder and kidney problems, but actually helps solve them. In the same way an operation can solve them, just going abou it dfiferently.

My current urologist treats me as an anomaly, as the rest of his patients in my condition get directed to some sort of operation. That said, he is very supportative of my decision because it's working for me.

This is not unusual, because except in the Spinal Chord Injury (SCI) community, self-catherization is not the "go-to" procedure. Instead people are directed are to Turps, Greenlight, Holep's, etc. And maybe because that suits the patients better, or maybe it's just because fixing things by operation is the modern convention and sticking a tube into one's penis several times a day sounds kind of barbaric to some.

The truth is that self-cathing, once over the initial period, is a quick and painless procedure that gives you full control over your urinary system.

Last night I cathed at midnight and I woke up at 7am to urinate, after a full night's sleep.

I look at self-cathing as an extension of  my prior "watchful wating" strategy. It's just that instead of taking drugs like Tamsulosin to delay an operation, I'm self cathing.

-- Richard

 

How big is your prostate? Would you be a candidate for Urolift?

 

A couole of years ago it was 30g by transrectal and 57g per ultrasound. Waiting for more of a track record on urolift and some of the other newer procedures. 

My Urologist is so busy he told me to wait until the cystoscopy is done then we can talk  about going forward, even though I had cystoscopy done 5 years ago at 49 by the same doc.  My GP (general practitioner) told me what my BPH was during a rectil exam, but I didn't pay much attention. I never had a ultrsound, maybe cause it's in a taboo area, lol. 

I'm a little weary as to what to do now after reading some info here, I'm still leaning toward self cath,  it seems expensive. But I only live once and I'm not getting any younger .  

Hi Kevarada

We're the same age, it seems, so I understand your reluctance to have an irreversible and - largely - unknow results-wise operation.  My urologist told me that once the op is done you ALWAYS get retro ejaculation - plus impotence.  I felt really uncomfortable on Tamsolusin, which is why I asked Jim about Cialis:  I was getting headaches, upset stomach, really ichy back plus erectile dysfunction and retro ejaculation.  I've stopped taking the pills and everything is back to normal now, after about 3 weeks.  My problem was that the entire waterworks just seemed to lock down - I was getting urges to go every half hour but unable to pee properly and my 'retention' means that I couldn't pee at all in the end, even with a full bladder.  SInce having the indwelling (Foley) catheter it seems to have allowed my bladder to recover.  You should be able to get Cialis on the NHS even though it is expensive and also be able to get a supply of catheters if need be.  I'm going to go back to my GP as I'm not really happy with the urologists attitude or prognosis, and ask about both.  I think, for me at least, i prefer the self cath route too, like Richard says, because it doesn't affect the rest of your body.

Don't let people fob you off with that 'I'm too busy' routine.  We pay their wages, don't forget!  If you are ill with something that is affecting your life you need to get it looked at at least.

I started a new thread called, "Self Catherization. An alternative to Turp, Greenlight, HoLEP...?". I will reply there later. Thanks, and Happy New Year!

I started a new thread called, "Self Catherization. An alternative to Turp, Greenlight, HoLEP...?". I will reply there later. Thanks, and Happy New Year!

I did not get retro from Green Light PVP in 2005. The team who did mine reckoned that less than 40% of their first 38 patients did. However with Thulium laser the surgeon said that I most probably would. Why is retro a problem to you?

I very much doubt the impotence statement even after a TURP, it would take a total prostatectomy to do that. 

Is it ok that I answer this over in the new "Self Catherization. An alternative to Turp, Greenlight, HoLEP...?" thread? Might make things easier for folks to follow since this is not a Cialis issue. Thanks.