How to Know in Advance if your BPH Surgery or Procedure Will Work!

1. I haven't spent much time researching stents, however the data is out there. The current stents seem to serve the function mentioned but better stents could be developed if there was motivation.

2. Self catherization can help rehab the bladder pre-op to a certain degree and therefore give some predictive data if combined with urodynamics. However, a "trial by stent" actually mimics a prostate reduction procedure or surgery. That means more certainty in terms of predicting whether that surgery or procedure would be successful.

Jim

Thanks for the information. Perhaps I wasn't clear with my question. I had assumed that you were writing about some kind of dissolving Stent which would be in place for a few days, then would dissolve . In the process of dissolving, I would expect passing pieces of the Stent would be painful. Is that the case, or are you writing about having a urologist install a Stent for a few days, then go back in there and remove it?

Neal

Neal,

I believe several stents were described in the source articles which I linked to the beginning of this thread. At least one dissolves. My point was that enough hardware and information now exists that the novel idea of a test by stent could be implemented in some fashion by a motiviated patient and motivated urologist. And equally important, that this concept seems deserving of more study. I would leave it up to the urologist to decide which stent and for how long to leave it in, but for the right patient I believe there is a positive trade off of risks versus rewards if you compare the side effects of a stent procedure against the potential permanent side effects of an invasive procedure like TURP.

Jim

Hi Jim,

It sounds like an interesting and novel idea.

Neal

It's just a matter of find a uro with the time and desire to try something a little out of the box. In the past, I have found that very difficult, in fact have found it difficult just to get their thinking cap on and focused on standard stuff! If I was in a position where I wanted to try this approach, I might try contacting one of the study doctors.

Jim

I assume you will bring it up per the studies suggestion to "test by stent" as opposed to using a stent as a long term solution? If so, you might want to print out the studies to give the concept more credibility. Good luck and let us know what he says.

Jim

And your urologist will never see the end of boat payments.

Turp is obviously not the answer.

Neal

I think we are slightly more fortunate in Scotland with the National Health Service as Urologists work for the state and are more interested in reducing their waiting lists rather than tapping into an insurance cash cow. The disadvantage is we get stuck on long waiting lists for everything so problems can take longer to get an answer.

Hi Neil,

Because the trial by stent (TBS) more closely approximates a prostate reduction surgery where the urehteral canal is freed up, in theory a TBS failure suggests poor surgical outcome and a TBS success suggests a good outcome. 

Prednisone, I would assume works by reducing inflammation. So, I would think that with a trial by Prednisone (TBP) that  success *might* suggest surgical success, however a TBP failure would not necessarily predict surgical failure because the Prednisone is only dealing with the inflammation.

I say  "might" because inflammation/prostatitis is such a murky yet important area. In fact some debate over whether a lof of what is diagnosed as bph/LUTS is really prostatitis/inflammation.

I also say "migh" because in your case TBP worked after your PAE and yet your procedure (PAE) did not work. 

So maybe TBP only works with more agressive procedures like TURP, GL, FLA? 

It's all very interesting and too bad more resources and study isn't being put into both the better prediction of outcomes as well as non surgical treatments of prostatitis which may be the culprit more than we think. 

Jim

Thanks Jim. I agree with you here. I was just suggesting prednisone as a quick and dirty first look at the nature of the obstruction as well as bladder tone. If it clears up the symptoms and drives the IPSS score way down as it did with me then that is an encouraging sign but not conclusive.

Personally I believe that BPH is an autoimmune disease (provided there are not physical bladder neck obstructions). I think it starts with acute prostatitis which morphs into chronic prostatitis if not treated aggressively in the acute stage. In my case I believe this happened to me in my first biopsy in 1996 which was done in dirty conditions. Then over time the chronic infection leads to an autoimmune disorder and constant tissue damage which leads to chronic inflammation.

So if this is correct then what will I gain from my upcoming GG-like procedure? Maybe by turning off the high free T concentrations the inflammation fires will be reduced by stopping this growth hormone. Maybe .... But at the very least my varicoceles will be cured.

Take care.

Oh - by the way - my PCP withdrew my order for the 2 urine tests (NV and CV). She said I was nuts!! So I just ordered the Siemens strips you mentioned and will do it myself.

Neil

May indeed have autoimmune elements. There still isn't a whole lot the med/scientific community agrees about bph/luts and prostatitis other than jumping to an expensive surgery or procedure way too early IMO. 

LOL about your PCP and the tests. You will get better results with the Siemens strips anyway and they are the same ones many uro's use. The results of your two way test should have academic interest, but also mix them up like I suggested to get a real world comparison of your SG compared to others. 

If you haven't ordered them already, you will find pricing on the Siemens strips can vary considerably. There are two reasons for this. First, the European version costs less here and second, the expiration dates. No difference at all with the European version other than the code number on the bottle is different. Make sure in advance that the expiration date is at least 6 months out, unless you plan to do a lot of testing. Think you get 100 test strips per bottle. And, oh, the strips do not like the light. So, try not opening the bottle in direct light and close the bottle once you take the strip out. 

Jim

Hi Jim,

Is it ok for guys who CIC to go swimming in public pools/lakes or do we run an increased risk of infection?

On the trial by stent idea: I find now regularly when I CIC as soon as the catheter gets past the external sphincter I have a strong urge to pee. The catheter is still a good 4 inches away yet from the bladder. If I give in to that urge and just hold the catheter in place then the pee comes flowing out mostly around the catheter. Eventually my bladder is emptied this way but it can make a real mess. So now when that urge develops I rapidly insert the catheter the rest of the way into the bladder so the pee just comes out the eyelets as usual.

So don't you think that this in a sense approximates your idea and shows the bladder is still tonic so some benefit could be expected from a prostate procedure?

Thanks.

Neil (starting to get nervous ..)

I think I had suggested that to someone before with mixed results. The issue, of course, is that a stent fully opens the urethra while what you are doing, while opening it, also adds resistance from the catheter itself. That said, your method, while quite messy, might be one way to avoid a UTI in theory, since the catheter itself never enters the bladder. What happens if you pull the catheter out as soon as you get that strong urge? I imagine it will close right up but then again if there's some elasticity maybe you might get something out. 

Not sure what the risk of infection from public swimming pools is, but I ould  think the risk is the same if you do CIC or not. On the other hand, I haven't had any coffee yet today so maybe I'm missing something

PS another thought. Why don't you try a smaller catheter, leave it in,  and see how that changes the dynamics. Conversely, you could try a larger catheter, but pull it out. 

Jim

Actually you may have your plate full with the upcoming G-G like procedure, but it would be an interesting experiment for someone. I'd try it myself except things (knock on wood) are flowing pretty well these days without the cath. But I'm wondering for those times where I have an issue getting started if inserting a cath just before the internal sphincter would get me over the hump. In theory, should be no chance of UTI or colonization, but that's in theory

Jim

Thanks Jim - all good ideas as usual. I like your idea about pulling the catheter out once the flow starts and see what happens. I will try that. Also I got my Seimens strips yesterday and want to try my comparison test of the NV and CV properties before Monday. My 7 am void would be a good time as the CV pee is very dark compared to the NV (what there is of it). The expiration date is ok and I will keep it away from bright lights.

Thanks.

Neil

I keep my closed container in a cupboard or closet. Best procedure is to take a strip out in dim light, screw the container top back on, and then go do your test. The light will no effect the test you're doing it just degrades the rest of the strips a little faster. Don't forget to do the "mix" as well as testing separately. First morning urine is generally the most concentrated, but you can try different points during the day. You have 100 strips to play around with. How much did you end up paying? Prices vary, but I think I got them for under $20 a couple of times.

Jim

Hi Jim,

Guess I should have paid closer attention to what I bought. The 10 parameter strips are from "Healthy Wiser" from amazon for $20.00. There are 150 strips. It was very well reviewed and ok for what I want.

I tried your idea just now of pulling the catheter out once I get past the external sphincter. I had to pull it out slowly to keep from irritating the urethral lining and it sure made a mess. But the pee kept coming after I pulled it out for a good 30 seconds and I measured 250ml. So if you add in what was on the floor then it was around 300ml which is pretty good. I thought of going back into the bladder with another catheter to see what was left but I don't want to cause trouble just now. Still - a good experiment! Thanks for the idea.

I would think that if this method gives a good void even with the obstruction of the catheter sitting in the urethra then that would certainly bode well for your stent idea and would indicate a still-viable bladder.

I was jsut talking with my wife about your own rehabing of your atonic bladder with just CIC. We concluded that if the this "GG"-like procedure does not work then that is it for procedures and I will just focus on CIC - perhaps increasing to 6 times a day as you did to really help the bladder recover and not just maintain it as I am doing now. This is it for procedures - too much stress!

Take care.

Neil

Excellent test. And yes, when you try it the next time, def go back into the bladder and see how much is left, if any. While I had visualized it in concept, really wish I could try it myself but can't really compare it to much since I can go on my own without CIC most times. Maybe something to build into the rehab process as a kind of interim step.

Jim

Did you get the Siemens 10SG brand or something else. I chose Siemens because that's what I always see in the urologist's office. They used to be made by Bayer previously.

Just wanted to add that this bodes well for any prostate reduction surgery or procedure that releases your urethra. Hopefully your G-G like procedure will. If not, there's FLA (still needs a bit of a track record IMO) or back to CIC where progress also can be made. And the next time I have to cath, I might just try stopping short of the internal sphincter and see what happens although frankly I don't ever remember any pre-sphincter leakage but maybe that's because I do it so fast!

Ji

I think it would depend on the catheter size too. I use 14 coude but I would think 16 would seal it while 12s just get bunched up and never get in. Also I remember Dr K telling me that my large side lobes are acting like another external sphincter of sorts which is why I still have so much trouble getting past that point.

I also wonder if it depends on the PVR and pressure. During the day if my PVR is less than 200ml then I don't get that effect as much and have to go all the way into the bladder to get flow. But when the PVR is above 300ml then I get a gusher under pressure. It feels like a nerve gets stimulated which creates the feeling of peeing. Sometimes even if the catheter is pointed straight up the pee gushes out like oil! If I don't want to deal with the mess then I stop at that point and wait a few seconds and clamp down on the catheter and then resume penetration to the bladder.

There is so much to learn - every time I do it I learn some new subtlety.

I ordered the wrong strips. They are not Siemens but rather "Healthy Wiser". Sometimes amazon tricks you! But it will still work for my purpose which is just SG and protein.

Thanks.

Siemens 10SG aren't on Amazon now, but I saw them on ebay for $19.99 and free shipping. I think it was the same batch I bought a few months ago. I'm sure yours are fine. 

As to your gusher, I guess it varies person to person, but I've always seemed to time it so by the time it flows it's pointing toward the toilet. But then again, our output pressures may be different.

Jim

Hi Jim,

Sorry about the confusion on the Siemens strips. My wife ordered them from her amazon account and I wasn't paying attention to it but I think the ones I got will be ok for what I want.

Can you explain the following to me: last night I CICd at 11 pm and took out 400ml. Then I went to bed and was awakened at 2 am with a lot of discomfort. I CICd again and took out 700ml! Then I was awakened at 6 am again in discomfort and took out 450ml! I didn't drink any more than usual yesterday. This really concerns me. My NVs were almost nil during te night. Thanks.

We're sometimes told fluid in equals fluid out, but that really hasn't been my experience short term.

My volumes are much lower now, but back in the day I've had similar things happen. And even now, with lower volumes, I've had days and nights of lower urine production intermixed with higher production.

Not 1000% sure, but I think for me a lot has to do with sodium/salt intake. For example, if I have a high sodium meal (or day) my urine production may slow down for a bit. Then, maybe a day or two later, all that sodium absorbed fluid will be released by the kidneys and I'll have much higher urine production.

It could be that in your case, but there are so many other variables such as exercise, medications, sleep patterns, etc. 

As to lack of NVs, probably a result of the high volumes as it can be harder on the detrussors at those volumes.

I wouldn't worry about it if this kind of thing only happens once in awhile. If it starts to become constant than you have to look elsewhere.

Jim

Should have been "...100% " lol   If someone can pull any strings on this web site it would be nice to add an "edit" function!

Thanks Jim - I did have some deli meats the past 2 days which contain a lot of sodium and other bad stuff so maybe that is it.

I thought you really meant 1000% to emphasize a point!

I would bet 1000% (no mistake here lol) it's the deli meats! I've mentioned before that if I want a solid night's sleep all I have to do is eat a bag of potato chips before bedtime! (Deli meats even have more sodium). That said, I should be on a low sodium diet so really not a good idea. 

Jim

Hey, Neil,

Since you're one to experiment, I'd wonder if you'd try this and give me some feedback. In an earlier post, I mentioned I recently tweaked my CIC technique. I now cover the end of the funnel and keep it covered as I insert the catheter--from beginning to the bladder.

Typically I have 2 tight spots before I reach my prostate--one quite tight. Since I've changed my technique, I move right on past those spots with no pain. I feel slight resistance when I go through the external sphincter. I still take my time, but am able to start draining my bladder in about 20 secs.

Do you suppose that by keeping the funnel blocked that I am changing the air pressure as I insert the catheter, keeping the eyelets from snagging the walls of my urethra? I've been having consistently easy CICs since April 15th--even my recent hernia surgery didn't set me back. I've never had CIC be so consistent and easy.

Stebrunner

Have you since tried going back to not holding the funnel to see if that makes a difference? Should be easy enough to go back and forth to see if that accounts for your improvement. 

If you can isolate this one factor from experimentation, and it makes a difference, then I see a few possible reasons.

It could be something to do with the eyelets not snagging the walls because of more positive air pressure like you surmise, but it could also have to do with the catheter becoming more rigid when air is trapped inside. Another thought is that you are using more of a direct force on the catheter when you change your hand position. And, of course, there is also the placebo effect  

Jim

Hi stebrunner,

That is an interesting idea nd I will try it later today when I cath. In my case I always add some gel to the catheter sleeve when I open it part way while hanging on the wall. I then let the gel slide down and coat the catheter for a minute or two. Then I pull it out slowly.

The catheter is the Speedicath 14 coude hydrophilic so it would seem I adding gel to a hydrophilic saline catheter and I am getting twice the lubrication. This was an important turning point for my success because it eliminated all burning and irritation for me.

But the eyelets are coated in gel when I start to insert the catheter though that may get rubbed off uring the insertion process. I always hold the green cup through the whole process. I put my finger over the cup while withdrawing the catheter but have not tried your idea. I will try it later and report back. Thanks for the suggestion.

Neil

Hi, Jim,

Yes, I've gone back and tried not covering the end of the funnel when I insert the catheter, and when I do it that way, CIC is more painful at my tight spots. When I cover the end of the funnel--no pain. I can still tell when I hit my tight spots but get through them quickly--much more quickly than the other way. I remember when you first told me that CIC would become as easy as brushing my teeth--at the time I struggled so much with CIC I thought that would happen for me when pigs fly! LOL! Looks like they started flying! LOL! It really has become as easy as brushing my teeth!

Your suggestions about the catheter coming more rigid could be a factor. I've tried my new technique with both my Origo fr14s and Speedicath fr12s, and the technique works for both. It could also be the direct force. Whatever the reason, I'm glad it's working for me!

Stebrunner

Steb:It really has become as easy as brushing my teeth!

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That's really wonderful! To be honest, I was a bit concerned about your early difficulties. Not sure I would have been able to persevere as much as you did. Must feel great now to have something that not only works but is easy as well, brushing your teeth!

There's another fellow here, "Wilbur1968", not sure if you're following his story. He just started CIC but having problems. I hope he can push through the beginning part like you did.

So, back to the technique thing, it could be for a number of reasons, but I think makes sense to recommend to anyone having difficulty. Can't hurt to try it. Be interesting to see what Neil says. 

There is a way you could figure out if it's the covering up of the hole or the direct force thing. Just temporarily clog up the funnel head with chewing gum or something and then cath exactly as you did before. Something tells me it will still be easier, but you are getting me curious!

Jim

Do you use your "trigger finger" by any chance to cover the funnel? Been mulling over names and came up "Dive Bomber Trigger Finger Variation" or maybe "Dive Bomber, Finger in the Hole"

Jim

Whoops. Turns out the Urban Dictionary has quite a different  meaning for "finger in the hole" which in my mind was a derivative of "fire in the hole".  Maybe needs more thought

Jim

Hi Stebrunner,

I tried your experiment and it was interesting. When I cath I always hold my thumb over the green ridge on the funnel to make sure the coude tip always faces me when it is going in. So my index finger is always free just above the funnel top. When I withdraw the catheter after draining I place my index finger over the top to keep all the pee in and then empty the catheter in the toilet. So I am surprised I never thought of your idea during the insertion process since my finger was freely available.

Anyway, while slowly inserting before reaching the external sphincetr point of resistance, when I covered the funnel I noticed that the head of my penis actually expanded a little as well as the rest of the penis in my hand. If I removed my finger then that dilation reduced back.

Then when I reached the tough section it actually was more difficult for me to get the catheter past. So I had to remove my finger.

I think what happens is that the catheter eyelets act as a bit of pressure relief valve as the catheter goes in. Even though the eyelets are covered by urethral tissue they still can relieve some pressure. Sometimes I can even hear a little air come out of the funnel when I insert.

Maybe my added gel forms a seal when the catheter expands because then I also did not have pee come out around the sides before getting inside the bladder.

But for you maybe the added pressure in the urethral canal when you close of the "pressure relief valve" dilates or expands the urethra enough to make the insertion process easier? Just a guess but it shows how we are all different and how much there is to learn about the subtleties of CIC.

I will try it again this evening. Thanks for the suggestion.

Neil

Mistake above: not "catheter expands" but should read "urethra expands".

Interesting. For experimental purposes, I'm wondering if Stebrunner tried one size up (without the finger block) to see if it's also easier. He may indeed be doing that anyway by tuning the diameter and/or flexliblity. Both of you might also compare finger positioning as I believe Stebrunner is holding it different for more force transfer? And then there's the xtra lube which may effect the eyelets.  Neil, have you considered asking Mayo for a second opinion on this

Jim

Hi Jim,

I just cathed now and tried stebrunner's idea again. Basically the same results for me. When I cover the funnel and keep inserting it feels like I am pushing on a piston and compressing the air. It gets tight and then it is hard to push in anymore. When I lift my finger I can hear a little air swish or air and the whole penis contracts a bit. Even the catheter itself gets a bit stiff probably because the air in it is being compressed.

There certainly is a tendency to push down more on the catheter and maybe that is part of what is helping steb.

Hold the mayo please ....

Unfortunately (really fortunately) I can't directly participate since I'm not currently self cathing but later I may tried to pierce a peeled orange using both methods and publish the results at the local fruit stand. 

Jim

I hope one day when CIC also cures my voiding issues that I too can make fun of all the guys still running a 14 in straw up their penis 4 times  a day!

I think I've earned my right cathing up to 8x/day for more than two years to mix in a little humor with the serious. That's all it was. Wasn't making fun of anyone. And btw even though I haven't cathed in awhile, I still don't consider myself cured. In fact, I have thirty new Flex Coude's on the way to me now just in case.

Jim

Hi, Neil,

You and Jim crack me up! Thanks for trying my new technique. I know we have different prostate architecture--I have a large median lobe, and you have 2 large side lobes, etc. I have tried 2 sizes of catheters, fr12 and fr14, both with and without my trigger finger over the funnel. They both respond the same. I do notice that when I cover the funnel on the fr12 that it will bend when I get to the tight spots. But a quick bit of finesseing gets me right through.

Best of luck to you next week when you have your GG. You've done a great job of researching the procedure, and I'm looking forward to hearing your follow-up report. For my hernia repair, I decided I wanted it done without mesh. Took some doing to find a surgeon who does it that way--there are only a handful in the States. I compared their techniques and results, and I went with the one I felt best suited me. So far I'm really pleased with my results. I know you're doing the same with GG.

Stebrunner

Oh Jim .. I was just joking  - that's the problem with impersonal forums like this - you don't know when someone is just having fun. If you had seen my face when I wrote that I was laughing and laughing. Jim - not to be too gushy but you are my hero here and I am sure lots fo other guys feel he same way.

Neil

Thanks stebrunner for the good wishes. It was a good idea and I will try it a few more times. I hope GG works then we can all have a catheter-disposal party!

Neil

All good. Initally I thought I had gone too far with the "peeled orange" experiment and upset you. Then I thought, "no, he's joking" but had already posted and as you know there's no "edit" feature here.  The other funny part is that I was actually serious about the experiment. Not sure I will use a peeled orange (and I won't post results on a fruit stand but still curious how the rigidity of a catheter is affected when you close off the funnel. In fact, I may try closing off the eyelets a well which is something hard to do on yourself. Thinking of a banana now

Jim

 

That's good - I was worried that I had offended you by accident. If you only knew how much you are admired and appreciated on the forum! You are saving men's lives unselfishly with no gain to yourself other than to help people - it doesn't get any better than that IMO! Thanks for everything.

Neil

Thanks for the nice words. As a group, the folks here, including yourself, are the best. Especially in light of the difficulties all of us experience at times.

Jim

Hi, Stebrunner,

I tested your technique and got some incredible results!!! I managed to insert a straight Coloplast Hydrophilic right into my bladder and barely noticed it passing through the outer and inner sphincters. I almost panicked thinking I had created a false passge or worse, perforated my prostate. Why my alarm?  The catheter I used was a Fr 18!

My background is in engineering and I think I know what is happening here. I am retired but my profile on Patirent is current. However, I don't want to barge in on other people's contributions.

So far no one in this Forum has come up with what I believe to be the correct explanation. But, with your kind permission, I would love to research this a little further becuase I believe it could help a lot of people out there.

Alan

Glad things went well! Love to hear your theories, but just so you know, Steb's results was not able to be duplicated by another member so one conclusion was that it wasn't blocking the funnel hole with the finger but rather a change in hand position resulting in more direct force. Have you tried cathing without holding your finger over the the hole? What catheter are you using? Related, I suggested Steb try clogging the hole with something like chewing gum and then switching back to a more conventional hand position to see if it's the closing of the hole or hand position that makes a difference. 

Also, you're using quite a hammer with the FR18. Did you have problems passing the prostate with say a FR14 or 16? Rule of thumb is to use the smallest size catheter that will work. I currently use FR12 with Coude tip. Speaking of which, using a FR18 suggest resistance that a Coude might overcome. Have you tried one. Beside the regular Speedicath Coude there's a newly designed Speedicath FLEX coude that some like. 

Jim

PS For some reason your profile ("About me" section) isn't showing up when I click on your name.

I continue to experiment with steb's idea but have to conclude that it is just the downward pressure control that eliminates side-to-side motion thta seems to help the catheter go in easier. Also there may be a little rigidness added to the air being compressed inside the catheter since I don't hear the air escaping through the cup.  But that is minor.

It depends a lot on anatomy, catheter size, degree of lubrication, whether or not one NVd prior to CV etc etc. OR maybe it is the power of suggestion? Anyway, I do it every time because it makes it easier to control slight pressures so thanks to steb!

So I guess no one here can cath and chew gum at the same time I thought my chewing gum "funnel plug" might give more info, but maybe it might come down to which gum you use? Yes, lots of variables.

Jim

Hi, Jim, wonderful to hear from you! Along with so many others, I owe much to your many posts for which I thank you from the bottom of my heart.

Presumably you read my letter to Steb. I am just trying to ensure that he gets due credit for his contribution.

I found the thread “How to know in Advance .......” quite intriguing, but no mention of the air in the catheter lumen expanding due to it coming up to body temperature during and after insertion. I expected pressure to rise by an infinitesimal amount but, you never know. So I followed this procedure:

I took the largest catheter I had (SpeediCath straight Fr-18) and drained the saline from it.

Next I plugged the funnel with a proper catheter plug before insertion (hold the gum).

Inserted catheter and fed it in slowly to allow it to come up to body temperature.

And, Viola! Passed the whole thing in until the funnel was resting on my meatus.

As I stated, I barely felt the catheter passing through the two sphincters. Other considerations,  my urethra is about 25 to 50 mms longer than what is regarded as normal for most folks. I performed the foregoing tests without any additional lubrication.

This was yesterday. Today I repeated the experiment using a straight SpeediCath Fr-16 and a straight SpeepiCath Fr-14. The Fr-16, which is the one I use routinely three times a day, performed a little better than usual, while the Fr-14 offered noticeable resistance.

Perhaps a small quantity of air (5 cc – 10 cc) injected down the catheter would work even better.

Changing the subject a little, the SpeediCath Flex Coude is, in my humble opinion (I am not a doctor) an excellent device and I concur with most of hank 1953 and other’s observations. I got caught, just as you were, by the catheters “stealth” characteristics and missed the toilet. A great product and I’m sure it will be very welcome to those with hypersensitive urethras.

Wishing luck, and thanks once again,

Alan86734

 

It could be also be that closing off the funnel by itself increases the air pressure making it more rigid which helps some of us. Lots of variables but experimentation is good!

I've had mixed results with the new Flex, the last not so good. That said, only have tried it a few times since I'm not cathing much these days. I also missed the toilet with the Flex but chalked that up less to the its "stealth" characteristic (it actually hurt a bit) but rather because the FLEX has different characteristics (full sheath and floppy) compared to what I'm used to "dive bombing" with the more rigid standard Coude. However, still recommend folks give the new Flex a try. 

Jim

 

Hi, Alan,

Thanks for trying my technique and reporting on it! If you can explain why it works so much better for me that would be great! I normally cath using Origo FR14s and Speedicath FR12s--and both are incredibly easy for me to use now. The difference has been between night and day!

Haven't tried plugging the catheter funnel with a plug or gum yet, but the other night when I got up to CIC at 1:30 a.m., I forgot to put my finger over the funnel. And I started to have trouble inserting. My first thought was, "Oh, no. My run of easy cathing is over!" Then I realized my mistake--corrected it--and the rest of the CIC went easily.

Stebrunner

Hi, Steb,

It is I who owes a whole lot to you for pioneering the technique then making it known to the rest of us!

Apart from physical differences, we probably have different needs. I use much larger catheters and it is as Jim James adises-  use what you are comfortable with.

I normally use a straight SpeediCath Fr-16 three times a day. However, since I have successfully resolved a stricture right in my prostate I like to run a larger Fr-18 every now and then to keep the urethra dilated. However, I found that I could not use the larger size continuously without making myself super sensitive.

Then you posted your technique and I was very interested. The one factor not  mentioned by the others was the thermal expansion of the air trapped in the catheter lumen. Obviously this was not going to be very much, but easy enough to test. So, "finger-on-funnel-hole" of a Fr-18, and away I went. I could hardly believe the result.

I barely felt he catheter passing through the outer sphincter then, almost as easy, the bladder sphincter!

I'm sure there is more to this and I want to do some more formal testing as soon as I find the time. But, in the meantime, I have increased my usage of the Fr-18s. Eventually I woulld like to introduce this to the clinical setting, even though I'm not related to this activity in any way.

I am also going to make sure that you get full credit for this technique unless, of course, you want otherwise. Either way, I do consider myself to be a benificiary of your method, for which I thank you. I will do my best to keep you iformd of any further developments.

Warm regards, and thanks for getting back to me. Alan.

 

Hi Steb, just curious, are you still using the finger over the funnel technique ? Hank

Hi, Hank,

Yep, still using the finger over the funnel technique. It's really helped me a lot by making insertion much easier. However, this past week I had some slight trouble as my urethra was quite sore for some reason. I think I was flirting with a UTI, but it has cleared.

Stebrunner

Thanks Steb, hope you get well soon. Hank

Hi Steb, all morning I felt some mild soreness inside my penis during peeing. At first, I thought I was getting a UTI. Then I suddenly remembered that last  night before bedtime, I self cathed using your "finger over tunnel" technique. I probably roughed up my urethra due to less finger sensitivity. 

BTW, it did seem to go into the bladder a little more easily.

Hank

Hank,

FWIW my take is that putting your finger over the funnel simply makes the catheter

a little stiffer. This could either be helpful, or not so helpful, depending on what you

want to accomplish. If you've having problems getting around the prostate, then a stiffer catheter might be helpful, either by holding your finger over the funnel or just going up a catheter size. On the other hand, a stiffer catheter potentially causes more urethral trauma, that's why you only want to go as stiff (or as large) as you need. In your case, you should ask yourself the question if you need the added stiffness as the trade off might be more urethral trauma. Personally, I'd recommend going Coude before going stiffer, but there is no single way to find the best method to get from the meatus into the bladder, other than understanding a few simple principles and listening to your body.

Jim

Jim, I have no problem with my 12fr straight so I'll pass the coude. Just ran across steb's post by accident and my curiosity got the better of me so I gave it a try. I'd rather spend the extra 10 seconds than risking urethra trauma. Thanks. Hank

Hi Hank,

I wasn't suggesting a coude to you. That was a secondary point regarding another way to pass the prostate. My point to you was that the trauma you felt may have been do to an added stiffness by holding your finger over the funnel, and that stiffness in a catheter sometimes has a trade off -- easier passage but additional urethral trauma.

Jim

Jim, I don't follow your method all the way in which I hold the catheter not at the funnel, but at the hose part just below the funnel. This gives me more sensitivity of the tip so I can guide it better. It is not as sterile I know but I have not had any UTI yet. Hank

Hank said previously: " I self cathed using your "finger over tunnel" technique. I probably roughed up my urethra due to less finger sensitivity. ------------

Hank, this is all I was talking about. My point again was that if you put your "finger over funnel", it potentially makes the catheter stiffer and therefore it MIGHT be the cause of your "roughed up" urethra. I wasn't referring to my technique at all, just covering the funnel versus not covering the funnel.

Jim

I understand you Jim. I always do. I was just trying to explain why finger sensitivity matters to me that I can't benefit from steb's technique. Thanks. Hank

Hi Jim,I switched catheter to coloplast . Thinking of your dive bomb method.I like this method,however i find it difficult to get into the penis.Maybe i'm doing wrong.How do you keep the penis open?Is there a special way of doing this?

thanks,

frank,

Hi Frank, 

I hold the plastic funnel of the catheter with my dominant (right) hand. I gently pull my penis up toward the ceiling with my left hand. At the same time I gently open up the meatus by applying a little pressure with the thumb and forefinger of my left hand on the head of the penis and pulling outward. Now I have a nice target to drop (dive bomb) in the catheter. 

Jim

Jim,I sometimes miss the target,and land on the penis> I wonder if this could cause a UTI? 

frank,

Frank,

Yes, that sometimes happens. As long as it lands on a part of the penis that has already been disinfected, you should be OK. Just try again. However if it lands anywhere else, I just throw the catheter away and use a new one. 

Jim

Hi, Frank. If you stand up to do your cathing (which I do) I rest my (dominant arm (the one with the hand holding the catheter) against my body to steady it. Hopefully this will work as well for you as it does for me. Try it.

Regarding your UTI concern, if you have disinfected the head of your penis you should be O.K.

Regards, alan86734.

 

Jim, I use BZK ANTISEPTIC TOWELETTE--I HOPE THESE ARE GOOD ENOUGH. I BUY 1000  AT AMAZON .WHAT DO YOU USE JIM?FRANK