Intermittent self catheterization.

I also had a very good outcome with TURP (January 2017).  My recovery took about a month. I’m happy with the results.  It eliminated the urgency, greatly reduced the frequency, and the flow is strong and easy.  

All the procedures work for most people but the ones that don't come to forums like this as well as a coterie of ones who are afraid it will not work for them.

I have BHP and began using an intermittent catheter about six months ago.  I found that using a 30fr or larger diameter catheter once or twice a week seems to “stretch” me making it much easier to void my bladder on its own.  I usually keep it in for four hours or so at a time.  This has not only worked for me but has very nearly worked too well.

For the first 24 hours or so after I do it, if I feel the need to urinate I sometimes have to make a mad dash for the bathroom or risk having an “accident”.

Sometimes I can go a week or more without doing this although if it goes more than two weeks I can begin having trouble passing urine again especially at night.

I realize this kind of a solution is not for everybody but so far it seems to be working for me.  I have searched long and hard on the Internet to find information on this but so far I have turned up nothing. Most “doctor’s advice” strongly recommends to NEVER use a large diameter catheter if can possibly be avoided.  But my experience has been the opposite of that.  I guess I’ll just keep doing it until I have a problem.  Beats the heck out of surgery!

The one time I went into retention and wore a Foley for a few days, I peed great the day they took it out. But I have to think something that big used to stretch things out could be dangerous long term.

Based on your description, it sounds like you'd be an excellent candidate for one of the newer, less invasive, non surgical procedures. No anesthesia, almost no chance of long term complications and a reasonably quick recovery.

How can you get a 30 french catheter in your penis?

Very carefully!

Hi Fred,

Sounds like a Do-it-Yourself temporary stent. My concern would be trauma (temporary or permanent) to the urethra, but on the other hand it isn't too much larger than some Foleys. Any issues with UTI's? Do you know what your post void residual was prior to this and what it is with the technique you describe. Interesting and as you say definitely not for everyone.

Jim

Some additional thoughts. Easier voiding could be from stretching the urethra but as likely is that what you are doing is temporarily compressing the prostate when you open up the prostatic urethra. The concern might be damage not just to the urethra but to the sphincters being stretched which is why you get urgency right after. I'd hate to see you get incontinent using this technique but again there may not be an issue. I might run this by several urologists although they tend not to think out of the box is what I find.

Jim

Do you know what it's called?  I might ask my urologist about it.

How? Beats me.  I've really never had a problem with that.

"Sounds like a Do-it-Yourself temporary stent. My concern would be trauma (temporary or permanent) to the urethra, but on the other hand it isn't too much larger than some Foleys."

?How could I tell if I had "trauma".  So far I haven't noticed any ill effects but that doesn't mean they couldn't happen.  Actually, the make a 30fr Foley that I have used and they seem to work well.

?"Any issues with UTI's? Do you know what your post void residual was prior to this and what it is with the technique you describe."

?Not sure how to measure this.  I think my condition is such that I am able to complete void my bladder on my own but it's just a lot of work. I can spend 10 minutes in the bathroom at night.

Hi Fred,

Trauma would probably present as pain, burning or a UTI. More concerned about the effect on the sphincters because of your reports of urgency after the procedure, but this is not a medical opinion just a lay man speculation.

But speaking of medical opinions, your urologist should have told you your PVR (post void residual). It's a standard office procedure. Also have you had a bladder/kidney ultrasound study and Cystoscopy. The bladder/kidney study is advisable for anyone with retention (assuming you have it) and the cystoscopy is one way to look inside at your prostate for  any abnormalities like strictures which could be causing your ten minutes in the bathroom. Also have you had your prostate measured? 

Point being that it's great to fix things (either with the doc or on your own) but first you should know exactly what it is you're fixing and this requires a complete workup by a urologist.

Jim

There are several and there are extensive threads on all of them. Rezum is probably the most widely done/tested, followed by Urolift and PAE (Both only useful without and enlarged median lobe) and FLA. Based on your do it yourself stent like results (which sounds dangerous to continue IMO) one or more of them should work. None require anesthesia (although Rezum can hurt a lot so I'd consider being twilighted if your doc offers it) and devastating consequences are almost non existent. 

Fred, so you are actually using a 30fr Foley, not a 30fr intermittent catheter. Is it correct ? Hank

"Trauma would probably present as pain, burning or a UTI"  

?

Jim, no I don't really have that.  Sometimes there's a little bit of burning right after I remove the catheter but it usually doesn't last long.  I HAVE had UTI's before but I found that I can avoid that by being very careful and making sure everything remains clean.  Onetime I dropped my cath on the floor just before inserting it.   I toyed with the idea of dipping it in hydrogen peroxide and using it but then thought the better of it.  It went in the trash.

?I actually enjoy having the sense of urgency simply because being able to urinate so easily is such a refreshing change.

"But speaking of medical opinions, your urologist should have told you your PVR (post void residual). It's a standard office procedure."

?No, he's never done that.  He's always just checked my PSA count (which is really low) and done a rectal exam.  

?I really do not like going to the doctor but someone on this list told me once before that I probably ought to find another one.

Thanks for your responses.

?Fred

I would agree with finding another doc. You should know if you're retaining too much as it can cause permanent damage to your bladder and many are retaining a lot and don't know it. PSA and rectal tests don't really tell you much. You should be scoped  and have a full urondynamics test done. For almost sure, based on your results jamming in a large catheter, that your prostate is impeding your flow - but you may have bladder issues too - one often is a precursor to the other.

"Fred, so you are actually using a 30fr Foley, not a 30fr intermittent catheter. Is it correct ? Hank"

Hank,

?Yes, I have used both Foley and intermittent in 30 fr sizes.  32fr and even 38 fr are available in the intermittent catheters but I have not been able to find a Foley larger than 30 fr.  It seems that the more "stretch" I get, the more relief.

Regards,

?Fred M. Cain

Short version: Always diagnose before treating.

Jim

Fred, your situation is so unique. Most people on this forum, including myself, can't fit a 30fr into their uretha. I don't see any harm, as long as you don't keep it in too long, then you raise the risk of temporary incontinence. Hank

The biggest catheter I had was a 20fr.It was not very comfortable.

"Fred, your situation is so unique. Most people on this forum, including myself, can't fit a 30fr into their uretha. I don't see any harm, as long as you don't keep it in too long, then you raise the risk of temporary incontinence. Hank"

?Huh!  That's interesting.  I have regularly used a 32 fr size intermittent catheter and it seems to help me.  I'd use a 32 fr Foley if I could find one that big.  It's the stretching that I seem to benefit the most from.  If I'd try a 20 fr like Donald suggested, I'd get absolutely no benefit from it.  I have absolutely no pain when doing this.  There is some minor burning when urinating immediately following removal but that doesn't last more than an hour if that.

?Some of the comments I've received on this list make me reluctant to keep doing this but I don't know what else to do.  I just HATE to think about surgery.  My cathing with extra large catheters is just pushing off the inevitable.  I've realized that from the beginning.  I'll have to ask about that new procedure.  

Regards,

?Fred

Oh no, Fred. If I were you, I would not look into surgery, period. Just keep doing what you are doing, until you run into problems, even then, should not be anything serious. You are blessed to be able to relieve yourselve from BPH symptoms sides such simple, harmless procedure. Perhaps you are giving ideas to others to pursue similar methodology. Keep us posted. Hank

P.S. I am thinking about trying it out myself. Perhaps you can help others by posting a separate discussion on this methodology.

I had a 20fr foley for few days my TURP .I don't have retention now.

Hi, Fred,

As the saying goes, "One man's meat is another man's poison". Not knowing what your "benefits" are I'd stick to your guns (catheters?) as long as your sizes are available. I am a young 88 years old and at my current maximum of Fr-18 I have also come under criticism. That's OK as far as I'm concerned. I go purely by the feedback sensation and this is the main reason for my not using analgesics of any description, i.e. Lidocaine. Just plenty of plain non-irritant lube. And my Urologist honored my request without question when performing my last cystoscopy.

My gains thus far after two years of CIC are:

Complete elimination of a stricture in the prostatic urethra; significantly improved erectile dysfunction; greatly reduced urinary retention; and no UTIs for a little over one year.

Perhaps you could answer a couple of questions I have: What country are you in? What were the urinary problems you were addressing when you started cathing? Did the passage of blood clots or other detritus influence choice of catheter size? Please feel free to take this conversation to the Private Message level if you prefer.

Best of luck, alan86734.

 

>>Not sure how to measure this.  I think my condition is such that I am able to complete void my bladder on my own but it's just a lot of work. I can spend 10 minutes in the bathroom at night.<<

You should probably take a 2 ml beaker or container and check your PVR.  That is one of the exacerbating factors of this condition; a major one.  Evidently (this is probably an over-simplification) when the bladder stretches on a regular basis it also damages the nerves to the brain that tells us its time to empty.  I used to think that when I peed out say 200 ML and I felt satisfied, thats all there was.   Definitely a difference in sensitivity around using feeling as a gauge of when to empty. Maybe thats just getting old. I've been doing CIC for about 11 months now and I think some of that feeling is returning although I get a lot of false urges where I go to the toilet and stand there and the feeling goes away.  I sometimes press on my abdomen to see if I notice any fullness as I did before CIC.

 

Fred,

You're under no obligation to do surgery, but you owe it to yourself to have a proper workup from a urologist to see what is actually going on. Diagnosis before treatment is the correct order, even if treatment is unconventional.

Jim

Regarding measuring your residual (PVR). Like Keith suggested, you have all the tools at home to do it. Just get a pyrex measuring beaker, then wait till you have the urge to void, and then void into the beaker, writing down the amount in milliliters. Now empty the beaker and right away drain your bladder into it again using the catheter. Write down that amount. The first number will be your natural void volume. The second number will be your PVR (post void residual). The addition of the two numbers will be how much your bladder was holding before the voids. You will want to do this several times at diffferent times of the day and ideally on more than one day, so write down the date and time. No need to use the 30f for this process as it's just for measurement and to drain bladder. 14F would be fine.

In your case, what might be interesting and useful, would be to do the process both during the period when you are voiding better (after you've done your stretching routine) and also during a period when you're not voiding so well (a couple of weeks after your last "stretch".

Jim

Hi Alan, I thought i was the one of the oldest on this forum. I'm also 88 years ,it's good to know  we have something in common. I also have doing CIC around 2 years,so far so good.What concerns me as i get older is what do we do now if we can't CIC because of eye problem or something else. They told me I was to old for this prostate surgery. Have you heard anything like this?Have you had any prostate procedures done? I can not do a natural void,how about you?

Alan lets keep in touch ,at our age I think it would be a good thing.

frank,

Frank - you may be too old for elective prostate surgery like TURP, but quite possibly not for something without anesthesia like Rezum or Urolift. Have you ever been evaluated? Do you know if your problem is your bladder, your prostate or both?

If you get to the point where you can't self cath, in your current situation the best option would probably be a superpubic catheter. If you're in otherwise good health, you might want to consider a full evaluation with a scope and urodynamics test to see what's keeping you from voiding. If its all, or mostly an enlarged prostate, something like Rezum might make sense as a pre-emptive strike against an indwelling catheter for the rest of your life, should you not be able to self cath at some point. You already self cath, which you can continue doing after Rezum. If it works, over a period of weeks you'll start to be able to void naturally. If not, other than the pain of the procedure, there aren't a lot of side effects and you'll just go on self cathing.

I would confirm that BPH is your major issue first, but if it is a procedure without anesthesia could well be OK even at your age and if you ever can't self cath, your options and lifestyle become much more limited.

"Perhaps you could answer a couple of questions I have: What country are you in? What were the urinary problems you were addressing when you started cathing? Did the passage of blood clots or other detritus influence choice of catheter size? Please feel free to take this conversation to the Private Message level if you prefer.

Best of luck, alan86734"

Alan,

I am in the U.S.  My problem started when I was about in my late 50s.  Then I found something out entirely by accident.  My neighbor began having a similar issue but his finally got SO bad that he could not urinate at all and had to take a trip to the E.R. to obtain some relief.

His family doctor inserted a Foley catheter (diameter unknown to me) and put him on “Avadart” and “Flomax”.  Well, after a few weeks the catheter failed and “came out”.  Not sure what happened but after it was out he said he could urinate again as well as he could when he was 18 !

 

So, I got to thinking that this must have stretched his urethra back out somehow.  Hmmn.  Two can play this game.  So, I found some soft, latex tubing at the hardware store (roughly around 30 fr I would guess) and sterilized it with hydrogen peroxide.  I then lubricated it with vitamin E and inserted it and wore it for several hours.  It worked and worked very well.

Unfortunately, this whole proceed was by its very nature unsanitary if not downright “dirty”.  After doing this several times I got a bad UTI and had to go to the doctor to get antibiotics.  I did not tell my doctor what I had been doing.

So, going forward I tried harder and harder to keep everything clean and sterile but it inevitably happened again.  And again.  So, I finally had to give up on that and went to a urologist.  My PSA tested at an astounding 0.2.  Well, at least I didn’t have cancer.  He put me on a regiment of “Avadart” and “Flomax”.  I have to say that after six months of this my condition was greatly improved.  But sadly, after 9 months I began to have what I believe were nasty side effects from the Avadart.  I got some very unpleasant and distracting vitreous floaters in my eyes.  I regard my eyes as pretty important to me.  So, I asked the urologist if this might’ve come from the Avadart.  No way, he said.  Impossible.  However, upon Googling for this I discovered that I was not alone.  There were other men out there complaining about eye floaters after having been on Avadart.

So, I complained again to my doctor and he still dismissed the idea but nonetheless reluctantly took me off of it.  I continue to use Flomax once every other day and zinc supplements on the in between days.

However, about 7 or 8 months ago I discovered that CHEAP catheters can be found on the internet that are guaranteed to be 100% sterile.  One outfit has a 30 fr Foley for 99¢.

So, I decided to try this again and so far I have not had another UTI although I am “knocking on wood”.  I have had the best luck doing it once or twice a week.  If it goes two weeks or longer, I begin having issues again (especially at night).  I have never passed blood clots although occasionally I have had some very small pink mucous discharge after cathing kinda like you might get if you blow your nose too hard.  That nearly always passes in less than an hour.

So, that’s my story

Regards,

?Fred 

"I am thinking about trying it out myself. Perhaps you can help others by posting a separate discussion on this methodology."

Hank,

?Although I have had some success with this, as some have pointed out, my situation might be "unique" so I am, therefore, reluctant to recommend it.

?However, if you or anyone else on this list decides to try it out, I would strongly recommend that you start with your normal French size that you are comfortable with and then gradually begin increasing the diameter over time.

?So, if you have been using a 20fr, try using a 22 fr.  After several sessions, if you do not have any complications, try increasing the diameter to 24 fr for a couple of weeks.  Then if all goes well, bump it up to 26 fr etc., etc. till you hit a large diameter that you feel comfortable with.

And, if you hit any complications along the way, stop doing it and return to your old size.

?Regards,

?Fred 

Fred,

Don't know if your situation is "unique" as in unique unique, but the point to be made is that we are all unique more or less so what might work with one person might not work with another. That's because there are a lot of factors at play including prostate size, shape, bladder elasticity, nerve function, and susceptibility to UTIs. But since this approach seems to be working for you, you might look into the Itind Device. Not sure if they are out of trials and where, but it seems to be the closest less invasive bph procedure to what you are doing and I would guess that if what you are doing helps, Itind would help even more.

Jim

Hi, Fred,

I am now corresponding with two of you: Frank and Fred! Obviously we need to clarify the situation here before it becomes total Chaos and Confusion. Added to this we've suffered several days of snow here so I can't really yell at anyone for the appallingly slow Internet which has led to those messages I wanted to send as PMs being stuffed into the Public category.

So, here goes. This one is for you Fred and I'll be sending an exact copy to Frank. We'll take it from there.

Fred, you are 88 years old and would like us to stay connected? You practice C.I.C with Fr-30 catheters? We have PMed at least once?

Talk to you later today 3/16/2018. Regards alan86734

 

Hi, Frank,

I am now corresponding with two of you: Frank and Fred! Obviously we need to clarify the situation here before it becomes total Chaos and Confusion. Added to this we've suffered several days of snow here so I can't really yell at anyone for the appallingly slow Internet which has led to those messages I wanted to send as PMs being stuffed into the Public category.

So, here goes. This one is for you Frank and I'll be sending an exact copy to Fred. We'll take it from there.

Frank, you are 88 years old and would like us to stay connected? You practice C.I.C with Fr-30 catheters? We have PMed at least once?

Talk to you later today 3/16/2018. Regards alan86734

"Fred, you are 88 years old and would like us to stay connected? You practice C.I.C with Fr-30 catheters? We have PMed at least once?"

Alan,

?Uh, no, I'm actually just getting ready to turn 66.  Although if the next 22 years go as fast as the last 22 I'll be there tomorrow.    Seems like the older we get the faster time goes by till finally it's like a blur, eh?

Not sure what "PMed" is.

Regards,

Fred

"...since this approach seems to be working for you, you might look into the Itind Device."

?Jim,

?Never heard of an "Itind" before but I "Googled" for it and it sounds both interesting and promising.  Unfortunately, it also appears as though it has yet to be approved for general use in the U.S. (unless the article I was looking at is out of date).

?I guess I will keep stretching myself with large catheters until I can have this done.

Regards

Fred

Hi, Fred

Thanks for your prompt  response. "PMed" = Private Messaged.

And one question I forgot to ask: Are you a USA, UK, Australian, or Other resident?

Cheers, all the best. alan86734.

 

Hi Fred, when I said you were unique, I didn't mean you are that "unique unique", only in the sense that you can insert 30+ fr catheter. The methodology I think is sound. I was curious about this even before you showed up here. I mentioned to jimjames probably a year ago about this same approach in another discussion. I remember calling it "poor man ITIND". At that time I was discouraged by Jim (typical of people eating too much sardines perhaps 😀 so I dropped it. I am now so glad that you did it.

I think this methodology may help more men. Even at smaller size catheters, it may relieve them from enough symptoms, perhaps to postpone surgery, or reduce medication. Surgeries are still surgeries. Even the best like PAE or FLA, still cause pain and suffering, and yet, no guarantees.

Hank

"And one question I forgot to ask: Are you a USA, UK, Australian, or Other resident?"

?Alan,

I am in the Upper Midwest of the USA, Indiana to be exact.

-Fred

Hi Alan, I see what  you mean , 88 years young!Great keep on doing whatever it is that makes you stay young. I guess i have nothing to really complain about, CiC can get me down at times ,but it  could be a lot worse. I just wish i could have a natural void at least once in a while.I do CIC 6 to 7 times a day.If you hear of a procedure thats not to invasive, kindle let me know ,as i will do the same for you. I have learned a lot on this forum.My Uro says do CIC every 4 hours or less,and 6 hours at bedtime. 6 hours of sleep would be just great ,however impossible. Alan, why do you do CIC when you said you have a natural void?Prostate stimulation, does this help? I wonder if this could shrink the enlarged prostate?

The Uro never mentioned this.What do you think?

frank,

Frank - if you're otherwise healthy, something like Rezum or Urolift could be on the table (literally) if your prostate is the main problem. If testing proves that, no anesthesia is needed, you could just self cath while you recover (as you have been already) ind if the procedure works, you'll gradually start having natural voids.

OB, My understanding is that Frank has been in complete retention for some time now and has not passed urodynamics. One of his urologists therefore gave him 50-50 with TURP and very little chance with one of the less invasive procedures. I tend to agree.

Based on readings and speaking to surgeons for unrelated matters, I do not share your concern about anesthesia for the elderly to the extent that it should be a deal breaker for Frank, however all surgeries have risks and recoveries which have to weighed against maybe a 50-50 chance of success. Aquablation may be something for him to consider after another year or so of data in the field.

Jim

Jim

Jj - we can disagree about anesthesia, but regardless, a major surgery puts a lot of strain on a body at any age, but especially on someone older. A minor complication that might be a few extra bad days for a younger person could prove devastating to an otherwise healthy person.

Aquablation, while much less invasive than TURP, comes with a longer recovery. At 88 and in otherwise good health, I'm not sure how quick I'd be to throw away 3-4 months for something with at best, a 50/50 shot at success. I might suggest a temporary Stent to test if he can void and then Rezum or FL A if he could void with a Stent.

Hi, Frank,

I sent you a short Private Message about a day ago to test our System. It is still showing "Message hasn't been read yet". There are 101 plausible reasons for this, but I am nonetheless left wondering, did you even receive this item?  A brief acknowledgement would be very welcome!

Warm regards, alan86734.

 

Alan, I did not receive an email stating i have a private message? I will send you a PV now.

frank,

Hi Fred - a few questions about the catheter you are using: how long is it? who makes it? is it a curved tip type (coude)?. Is it lubricated or do you have to do that? What does it cost?

Thanks - good luck

Howard

Are urologist insists I get a and is scheduled the procedure already in 20 days. I want to cancel and try other therapies you too fear of erectile dysfunction, Retrograde ejaculation and other symptoms. Is my fear well-founded? Your post seems reassuring. But I am very skeptical about the procedure. Derek can you give me any advice?

Did you have a lot of problems postop? And did it affect your sexual function at all? My doctor insists I get one. But I really want to wait. Can you give me any advice?

Hi, Howard. Please excuse me chipping into your thread here, but something you said caught my eye. Why are you interested in the catheter length? This was my undoing, too, but I solved my problem when I found a catheter that has about 2 1/2 inches over the "standard" 16 inches.

I'm sure we have much information we can exchange to our mutual benefit. Please send me a Private Message, if interested. Since names and addresses might eventually be involved, our Moderator would probably delete a Public Message.

Looking forward to you reply with interest!

alan86734.

 

Hi Johnny,

With the exception of Urolift, all of the established procedures have a chance of retro ejaculation, ranging from around 10% (rezum) to close to 100% (TURP). There is a also a new procedure, FLA, with no reported cases of retro but there's no trial data and only anecdotal data from around 20 patients here.

Best advice I can give you is do not get railroaded into TURP (or any procedure by that matter) by your urologist. He works for you, not the other way around. So take your time, learn more, and make the right decision for you on your own time table.

In the meanwhile, self cathing (CIC) can protect both your bladder and kidneys. You can do it temporarily until you make a decision, in fact you can do it as long as you want. I've been doing it for four years now instead of a TURP.

Are you self cathing now? I assume you're interested in it because this is the self cath thread.

Jim

Hi, thanks for that explanation. It's great. I would definitely be into self-cathing as an alternative. It's natural and you're under control. 

To self inserted catheter, do you use anything too numb the urethra before inserting the catheter? I am really interested in this as an alternative. Thanks so much for the support. it really helps. If I tell the doctor I don't want TURP due to fertility and genetic issues, I'm sure he can't argue with that. And anyway you're right he works for me and I'll have to just refuse the treatment.

Unfortunately I have those bladder lesions that he's going to have to take out. That has to be done. Just hope he's not really mad where there's a problem with getting that done too.

The big hurdle with self catherization (CIC) is not the physical hurdle (easy to learn, easy to do) it's the mental hurdle. The fact you see the benefits without being taken aback by the concept, tells me that your a perfect candidate. The fact is that in most cases it becomes as easy, painless and routine as brushing your teeth after a bit of practice. It just takes a little less time!

I suggest you take the time and read through this thread although a bit of a read. But here's a REALLY condensed version.

In general, you want a hydrophilic catheter because they don't require external lubricant. The best starter catheter I have found for those with enlarged prostates is the Coloplast Speedicath Coude in size FR14. "Coude" means bent tip and that make navigation easier for most people with enlarged prostates. So that's my recommendation. If you're in the states you get them from a distributor and if you need some names I can send you a private message. Medicare pays for up to 200 catheters a month.

Technique wise, I can go over more later, but you don't need a numbing agent. Some people -- and I'm one example -- did experience some pain and difficulty for the first several weeks, but the majority find it fairly painless. But once the "breaking in" process is over, like I said before, it becomes as non eventful as brushing your teeth.

CIC will protect your bladder and kidneys as well as any surgery. Period. You also won't need to take any of the drugs mentioned which all have side effets. In addition, it has the potential to rehab your bladder in some cases. I have a feeling you would be getting in early enough to see some bladder rehab benefits. In my case, I started off much worse than you and therefore had to self cath 6x/day. Now, four years later, I only need to self cath a few times a week. The rest of the time my bladder performs pretty much normally.

Your doctor may or may not be supportive. You will find out when you bring up the subject as an alternative approach. If he's supportive, great. Tell him you want the catheter I mentioned and he will write you an rx. If he's not supportive, easy enough to find a urologist who will be.

Like many here, I also did my research and came to the conclusion that I didn't like what was offered surgically 4 years ago, making CIC the best choice. I still don't like what is being offered so if I had to make the choice today, I would still choose CIC over the surgical alternatives. That doesn't mean something better might not come along, but in the meantime CIC is a great solution.

Jim

 

I agree.  CIC, for me is the best way to go.  I had three turps, in 14 years {estimate}  I wish my uro would have told me about CIC, 14 years ago.  AFter I CIC, I feel very comfortable and don't have to be concerned about where is the next restroom located. I used to have to go to the restroom about every hour half to two hours.  Now, I sometimes can go for up to eight hours before  having to relieve myself.  I am 69 years old, and I hope I can continue doing what I do.  It would be great if my bladder, improved so I could NV all time time...I keep  hoping!

Tossing a compromised cath, such as dropping it on the floor is best. However, if you have a problem and feel you must use or reuse a cath, then soak it in povidone-iodine, such as beta-dine, then rinse well with water before use. A urologist said I could do that, soaking over night. I did that when I first started using caths because I had difficulty finding an approved supplier for my insurance plan. With good hand washing, wiping the end of the penis with an antiseptic towelette, then wiping the penis again with a povidone-iodine prep pad I reused caths, only 1 reuse per cath, for 18 months without having an UTI. Since I have accumulated a 9 month supply of Caths, I decided to stop reusing them. However I like the cleansing protocol of hands and penis and I continue with that protocol.

Glad it's working out for you. Have you tried any of the bladder rehab strategies I mentioned in the "on/off" CIC thread?

Jim

Are you saying you used each catheter only twice? With the exception of hydrophillics, most catheters can be reused a dozen times or more. Some people go for over a month with the same catheter. My insurance pays for hydrophillics, so I use them once and toss them.

Jim

Jim,

What is the "on/off" CIC thread? I did try looking for it. 

I have been trying to count how much liquids I take in in order to know when I need to CIC. I can drink 600 ml like I did this morning and only have 300 in my bladder. It was during a work out so maybe that had something to do with it. I also try and be very conscious when drinking beer and try and CIC after 1 1/2 or 2 beers at the most. Would you know how long it takes liquids to get to your bladder? I don't always feel the need to go, probably because of how badly my bladder is stretched.

Thanks for you help!

Tom

I'll try and get you a link to the thread but as you know, navigating this site can be a nightmare

As to the liquid transit time, it's more complicated than that. The kidneys are the gatekeeper and they can have a mind of their own when they release urine into the bladder. That's why some folks void primarily at night (nocturia) as opposed to mostly during the day (normal). Also, it's first in, first out, so the fluid coming out after you drink that beer is probably something you drank yesterday.

Jim

Jim, thanks so much for all your support you really helped me. I found this morning and canceled. There wasn't a problem. They said that I would get a new consent form for just the TR UB. I was going to send them Via Fax, your revocable he canceling the previous consent forms. Just to make sure they know that they're not allowed to go near my prostate. During the TURB for their tiny little bladder lesions I have, I'm going to get an epidural so I can make sure that they don't do anything else. That procedure takes about five minutes apparently. Thanks a lot for all your support you gave me a lot of motivation to do this and think about it a lot more really appreciated amazing advice and true incredible support thanks again

Link to "on/off" thread:

https://patient.info/forums/discuss/self-catherization-an-on-on-off-strategy--591671

Hi, Fred,

This is in response to our exchange of postings two weeks back. I had mistakenly identified "frank74205" as the person performing C.I.C with Fr-30 catheters and up, when in fact it was you. Put it down to the system crash we suffered at about that time plus my own involvement with Fluoroquinolone Toxicity Syndrome (mea culpa), However, this may have been the culprit for the floaters in your eyes. In my case I was prescribed Cipro another antibiotic belonging to the fluoroquinolone family. As antibiotics they are extremely effective; only problem is that they take down the host as well as the bacterium! There are several threads running in "Patient", if you would like to keep informed.

Several of my posts were blown away by the Moderator, at my request. I had intended them to go in as Private Message, since they contained personal data, the one giving my e-mail address and other stuff did go as a Private Message in some cases. Do you have this, or should I send it to you again?

Our common interests seem to be C.I.C. in general, clearing strictures, regaining healthy urine flow, and associated issues. If you would like to keep in touch, via Public or Private Messaging, I would be delighted to maintain contact with you.

Warm regards, alan86734.

 

Hi Allan - I've been on Avodart since 2011. While it did help my BPH in the first 5 years it has since turned into a monster drug. Apart from ruining my libido, my energy and no longer being effective at reducing prostate size, it also caused massive floaters in both eyes following PVD (Posterior Vitreous Detachment) about 5 years ago. The floaters remain in my field of vision and have caused a significant degradation in my quality of life. And the kicker is that once you are on this poison for more than 5 years or so, yo cannot get off of it. The reason is that the prostate learns how to become super efficient at making DHT from minute amounts of Free T via alternative pathways so if Avodart/Proscar is stopped then massive amounts of DHT will be produced leading to renewed aggressive growth of the prostate. This drug should be banned or at least carry with it huge warnings which I would have heeded back then had my uro told me. Take care. Howard

Dear Howard,

I'm very sorry to hear of your troubles dealing with Avodart. Your the second person reporting floaters resulting from this drug, in just a few days. I'll dig the reference up for you, if you want me to. Unfortunately this is right outside my experience so there is nothing I can do for you other than to "walk" with you. If there is anything you would like to talk about please go ahead and do so. I suggest you use the Private Message system if "off topic".

Warm regards, Alan.

 

Hi, Howard,

With all that's going on I completely forgot to pass on to yo an "operational tip" which I hope you find relevant. The issue is to do with catheter lubrication.

My description starts at the point where you are "ready to go" and the catheter package is stuck to the edge of the counter, or wall, and hanging down vertically. You have opened the package to the point where the funnel is exposed.. Before pulling the catheter out of its package, swing the whole thing out through a little more than 90 degrees - package and catheter - and hold in this position with the catheter tilted slightly in towards the counter or wall. After a few seconds you will see the liquid (saline) flow up around the funnel.

Hold it in this position until the catheter is thoroughly wet. Spin the catheter to make sure all sides are wet.

Proceed with the unpacking/insertion process as you have been doing.

Regards, Alan.

Thanks Alan for another great tip. I will try that on my next CIC later today. Your other tips have already made a big difference to the ease with which I get the catheter in. I now peel down the sleeve 2/3 of the way instead of 1/3 and really coat on the lube and then take it out slowly rotating as it goes w/o delay. This way I have not had any sticking at all. I will add your new twist here as well. I keep the bathroom temp. not less than 75F as lower temps cause the gel to get more viscous. All the best. Howard

Howard, I used to be on Avodart for about as long as you, or maybe even longer.  I am off of any kind of medication because I CIC.  Yes, it used to inhibit my libido and cause me to have a stuffy nose.  Now, I feel more normal again! Now as I recall, I was on Avodart and Doxazosin at the same time.  All those medications were necessary, I guess, but now I feel so much more healthy at age 69.

Hi, Fred,

"So, I found some soft, latex tubing at the hardware store (roughly around 30 fr I would guess) and sterilized it with hydrogen peroxide.  I then lubricated it with vitamin E and inserted it and wore it for several hours.  It worked and worked very well."

Your venture into the hardware store has intrigued me for some time, and some questions have popped up as a result.

I assume you bought a few feet of the latex tubing,which came off a roll? How did you trim the business end - the one that goes into your bladder? The ends of this material can have sharp edges where they have been cut off. What did you do for eyelets? How did you pass it down your penis without scratching the urethral lining? I've seen some guys using clear PVC tubing and that does have sharp edges.

I have a need for long tubing to match my equally long urethra; any ideas you can pass on to me are of practical interest to me.

Warm regards, Alan.

jim,

this me sound dumb, but if you have one had on the catheter and one hand on your penis, how do you hold the beaker ? would the best method be to stand and put the beaker on top of the toilet bowl lid?

thanks

That's what I do. I just balance the beaker on the toilet bowl lid with the seat up. In four years, it only toppled I think once because I was probably half asleep to center it. You can do the same thing outside of the bathroom using a suitable surface and height. If for some reason, you can only use the floor, then I recommend a very wide pot which you can then pour back into the beaker for measurement.

Jim

I just put mine on top of the tank so its quick to grab, and then when the stream starts I put it in the stream.  I simply add in the 20cc (estimated) that I miss to my calculation.  Close enough.

I fit the beaker in to a big Coleman thermos and put it on the floor in front of the toilet and do it sitting.  Works for me!

Unless you're testing for how much you're retaining, I don't see the need for a beaker - I always just used the toilet.

I use a plastic Toilet Hat Specimen Collector that sits in the toilet seat. It measures up to 1000ml so I just empty my catheter into that to get the measurement and then empty the hat into the toilet. The hat just costs $2. and is available at the drug store or at a medical supply store or online. It works great and I juut store it behind the toilet. Howard

Thanks to jim, Keith and all the others for their responses. I’m going back Tuesday. He said he’ll show me different caths and how to do it.  He had also said that I’ll probably only need to do it for now as needed  probably in the morning, evening or both. Is it common just to do it when you feel you need to or is a set schedule better for your bladder?

Best to set a schedule like every 6 hours or every 8 hours. I often feel empty and don't feel a need to CIC and then am very surprised to see the volumes I remove. Good luck. Howard

CJ: Is it common just to do it when you feel you need to or is a set schedule better for your bladder?

----------

Depends on your objective, but in general you want to set up a schedule so that your bladder is never holding more than 400ml or urine at any one time. That would mean the sum of your catheterized void plus any natural void just preceding it. If you find that it's frequently or signficantly over 400ml, then you want to cath more often. For this reason, important to keep a void log, especially in the beginning.

Jim

Jim

Depends on your objective, but in general you want to set up a schedule so that your bladder is never holding more than 400ml or urine at any one time. That would mean the sum of your catheterized void plus any natural void just preceding it. If you find that it's frequently or signficantly over 400ml, then you want to cath more often. For this reason, important to keep a void log, especially in the beginning. If you are holding more than 400ml, then you risk both stretching your bladder and/or reflux into the kidneys.

Jim

Exactly - which is why I keep a schedule of all NVs and PVRs on the wall next to the toilet for the past 18 months. I highlight all totals over 400ml and mark them with a "jj" for jimjames who taught me this and has cured my hydronephrosis over the past year to the disbelief of mu uro. If I just cathed by feel I would be in a  pickle by now. I hope everyone listens to you Jim as your advice works with minimal impact.

I'm still collecting "data" on the pinch of salt before bedtime and will post results in a few days - results are great so far (no nocturia for 3 nights!). Howard

Howard,

LOL on the wall initials. Assuming it's going to work out, you might want to quantify your "pinch" with one of those small measuring spoon sets. A pinch is normally 1/8 to 1/16th of a teaspoon. Also, how close to bedtime are you taking it? Also curious what your average sodium intake is during the day,  if you know.

On my end, I'm no longer on a very low sodium diet, and perhaps  because of it,  my nocturia has increased lately, but there could be other factors at play, like not having chips before bedtime

Great that your hydronephrosis has gone away. That's generally the case when you take the pressure off your bladder by emptying it completely. CIC can do that as well as any surgery, in fact it can do it better because no surgeries guarantee a zero PVR (or even a safe and acceptable one) but CIC can!

Jim

 

Hi Jim - I do have a 1/16 tsp measuring spoon so it is precise and the sodium = 11 chips. I take it about 1 hr before bedtime. I want to be sure of this so after a week if it still works I will start a new thread on it and quantify it as much as possible. So far though I have had 3 nights w/o having to get up at all and that is a first these many years. Thanks a always. Howard

Hi Howard, that sounds great, sleep through the night.My uro tells me i should cic every 4 hours or less if the urge is there, also bedtime cic no more then 6 hours.I wish i could sleep 6 hours ,the most for me is 4 hours.I don't have NV maybe thats why.Howard do you have a NV ,or is it all CIC?

frank,

Jim, Do you think rezum would work for me?I have been in urine retention 16 months?Whats your opinion ,i value that.

thanks Jim

Probably not as well as TURP or the newer Aquablation. Best is to get evaluated by someone who does both Rezum and TURP. Keep trying to contact JerseyDoc here for advice, as I believe he does both.

Jim

Hi Frank - I do have a good NV - usually 150 to 250ml during the day. Last night though my salt experiment did not work and I got up at 4 am and took out 700ml with no NV. This morning my NV is good at 250ml but I cannot the catheter in to CIC! It is all so variable. Good luck Frank. Howard

Howard,

The kidneys are fickle and perhaps they were reading this thread and decided not to cooperate with your experiment last night! If I read you correctly, you couldn't get the catheter in this morning? If so, I sometimes find that the CIC process itself can cause a mild inflammation of the prostate, so perhaps the difficulty was a result of your 4am cath and will resolve soon with a little rest. I only cath a few times a week now, but I find that if I have to cath once, I might have to cath again several hours later, and I think it's inflammation at play.

Jim

Thanks Jim. I tend to be superstitious about reporting good things until I know for sure, so sure enough I was up at 4am! I might sprinkle the salt on a potato chip to taste better.

I had a good NV of 300ml before I tried my CIC this morning at 8am. So maybe I emptied well. Also I had a good poop just before and sometimes the mild pushing from that can interfere with the catheter getting past the external sphincter. As well I read that one of my big biotech investments crashed this morning due to a failed Phase III on metastatic breast cancer. So maybe not a good time to try CIC!! I took 2 advils and will try again later.

To get off topic here for a moment, this biotech had a very successful Phase II trial a few years ago where the patients and doctors know they are getting the new drug. Phase II trals are often very successful but then fail in Phase III in the double blind study. To me this just shows the power of the mind to help drugs be effective against the disease. After all in the real world patients know they are getting the drug. So why not accept Phase II trials and save lives right away. It seems the medical community are bent on removing any effect the mind has in the mind-body system. This is know to be a fasle premise in eastern medicine and I think these "failed" Phase iii trials show that. It is all so sad .. everyone loses.

Howard

jim,

my goal is hopefully to do it as needed. im very nervous about it

Im worried about doing any damage(not sure what the damage could be) and also UTI's. I travel alot and the safe surroundings of doing it my home puts me on edge.

That's a very good natural void, especially since you were completely emptied at 4am. An alternative explanation then for being unable self cath is as you inferred -- that you were already empty. In this case, your internal sphincter may have been slammed shut as often is the case. That's normal and good and why the catheter may not have passed. It's happened to me a number of times when I was pulling the catheter out to drain the bottom of bladder only to pull it out a little too far. When I tried to go back in (to an empty bladder) I couldn't because of the sphincter.

Sounds like you know more about me regarding trial phases, but given the self serving nature of most of their sponsors, with all the inherent bias, it doesn't surprise me when drugs or procedures go South when they are forced to be more rigorous and expansive in their testing. You might want to google "New FDA Report Cites 22 Drugs That Passed Phase II But Crashed and Burned in Phase III".

I remember reading the smaller phase II trials for Aquablation and saying "wow", turp like results and zero retro. Then the phase III results came out and all of a sudden retro reappears in significant numbers although somewhat buried in the presentation. I would imagine between stage II and III the stock went up and they probably raised a lot of money (and hopes). Let's see how warranted that all is when we actually get some real world data.

Are you saying you don't want to go Phase III with Chips? You seem like a very unbiased individual, so based on your phase I figures I'm ready to follow you once you finish quantifying. Any disclosures you'd like to make with say, Morton's salt

Jim

"Damage" from CIC is not uncommon and almost always temporary and treatable. You could get a UTI, especially in the beginning, Then there's false passage and stricture, neither of which I've had in 4 years, and most here report the same.

If I had to do it all over again, I'd ask my doc for prophylactic antibiotics for the first few days. After all, they do that with cystoscopy and urodynamics, so why not with CIC which IMO is potentially more traumatic than either for at least the first couple of weeks, for some of us.

Important is the correct catheter, size and material. We all differ, but IMO best first shot would be with a hydrophilic catheter like the Coloplast Speedicath in size FR14. If your prostate is obstructing, as with most of us, I would use their Coude tip model. FWIW most of the uro's I've seen know very little about CIC, or catheters, so you may have to learn on your own and educate them if you want to take the time

Jim

 

CJ - just want to ditto jimjames wrote here. I use the catheters he recommends, especially the curved coude tip which is essential.

There is often a little bleeding with CIC. It is just like when you first start to floss and your gums bleed. The urethral tissue is very sensitive and can bleed easily. It looks bad but isn't - just like flossing. After a while it stops as the urethral lining toughens up - again just like flossing.

But even after thousands of caths you will still get occasional bleeding. I had some blood in the catheter this morning from pushing it when I couldn't get in. But just now I cath'd and everything was fine. It helps to cath when you feel you have to pee as that tends to open up the sphincters more easily.

Good luck.

Howard

>>In this case, your internal sphincter may have been slammed shut as often is the case. That's normal and good and why the catheter may not have passed. It's happened to me a number of times when I was pulling the catheter out to drain the bottom of bladder only to pull it out a little too far. When I tried to go back in (to an empty bladder) I couldn't because of the sphincter.<<

I appreciate you mentioning this JJ.  I've also noticed that happening when I slowly withdraw the catheter and then try to re-enter only to find a blockage.  I've been a little concerned that this.  i don't know what I thought it was...  the inside of my bladder or something.  Makes more sense its the sphincter closing.  So, the pressure from inside the bladder helps get the catheter in initially?  Just from experience that DOES seem to be whats happening.  

Yes, bladder pressure is higher in a full bladder so the internal sphincter will be  more relaxed. This doesn't mean you should wait until your bladder is too full to self cath because you don't want to stretch your bladder with too much urine, nor do you want to create too much back pressure which is not good for the kidneys.

Jim

It really depends on your current physiology. TURP and aquablation remove more tissue, but many men find that the results from Rezum are more than adequate. TURP and aquablation have long recoveries and TURP carries some surgical and long term risks. If testing concludes that prostate obstruction is causing most or all of your problem, it would make sense to try Rezum first - the risks are much lower, the recovery is faster and if it doesn't work you can always opt to do TURP or aquablation.

IF you're in full retention, there is a good chance that you have bladder issues too - probably caused by long term BPH. Even if you have trouble with natural voids after Rezum, if your prostate is blocking things you'd still have to do something about that in order to rehab your bladder. So you might need a course of self cathing after Rezum.

Jim,

i went in this morning and have to say it was one of the worst things i experienced.

the doctor had the nurse show me. i was able to get the cath(it had a curve at the end) but once i got to a certain spot(most likely the prostate) it was stuck and i could not get further. i pulled it out (saw a little blood)and waited to the doctor.

He decided since it was uncomfortable, the put some numbing gel in my urethra. he had me try a different cath type with straigtht end and it got stuck. he tried and then decided to try a different type.

tthe last one finally "worked" but the process was not smooth. i believe it had a curved end (even though he sent me home with a straight end model- which i think was a mistake). I was able to put it in but once it got to the same area as the others it was hard to move, finally i just had to push it hard to get it to go further. bloody urine came out. in additon i felt like i want to throw up.

is this what its supposed to feel like? is blood usually part of the cathing process or something that happens only at the beginning of this process.

when you cath, do you normally get to that spot where you just hard to push hard and force it to get past the prostate and to the bladder?

anxiously awaiting your reply.

thanks

Sorry you had a hard time. Most people have a much easier time than you describe, some like yourself have more difficulty.

If your doctor was able to get the Coude (curved tip) through, then that's what he should have sent you home with. Do you know what FR size and model number you received? Did it have a hydrophillic coating or do you need external lube? If you don't know, I'd call and find all this out.

Like I mentioned before, I suggest starting with a Coloplast Speedicath Coude in size FR14.

When you hit the resistance spot, did the catheter start bending back on itself or did it just not want to go in? If it started bending back, you might also want to go up a size and try the FR16. If you call Coloplast they will send you samples in different sizes, etc.

Some blood is normal during the first few weeks but you don't want to injure yourself, and it's hard to tell exactly what is going on from here.

Until you get better catheters, you might want to try relaxing (easier said then done) and then when you reach the resistance point, sort of pause, take a deep breath and then apply pressure without forcing it in. I also find a little twisting back and forth sometimes helps.

Did you get prophalactive antibiotics? Giving the trauma you describe, you could very well end up with a UTI and if it were me I'd take antibiotics for a day or so in advance.

Jim

thanks for he quick reply

he had told me that the size that worked was a 14 but i was sent home with a magic 3 male  ref 53614G 16 inch/40cm.

all 3 had a small package inside the main package that i twisted and fluid when into the main package with the cath , lubing? it.

One thing they did was take it out of the package fully when inserting . i thought that i was supposed to keep the cath stayed mostly inside the package when i  start inserting so that it didnt get contaminated. he also at one time had me put my right hand on the part cath that went into the penis to get it in better. i was concerned about germs( i did wash hands and use antibacteira gel prior) but told it was ok

he gave me a bactrim to take before leaving- should that protect me from getting uti?

i just called speedicath and they said if i have a dr fax them a prescription, they will send out 10 samples of which ever speedycath i want to try.see mentioned to put the Coloplast Speedicath Coude Coloplast Speedicath straight, and the Coloplast Speedicath flex coude (which really isnt a coupe) so i could test each. she said the size has to be what the dr decides.

i asked her the difference and she said it only refers to the flow as the caths has the same thichness on the outside). is that true?

 

Hello CJ- You have my sympathies. When I was first shown how to CIC 2 years ago it was also in the doctor's office with the nurse. It was so humiliating and painful. The catheter got stuck like yours and this big burly nurse started banging on the end to get it in. I actually started crying and then I fainted!!

I told them I could never do this so my uro scheduled me for a robotic SP later that month due to my large size (240gm). I then searched the internet and found this forum and jimjames very long story in his thread. I read it over and over and committed it to memory.

Then I ordered the Speedicath 14 coudes. The nurse didn't know about coudes and just tried to ram a straight in me. After a few days some samples arrived and went in the bathroom alone and imagined jimjames standing next to me coaching me through it. I was successful which was a huge victory for me.

I started with his dive bomb method to get the catheter in and then gradually slid it in while gradually pointing the catheter straight down in the toilet. When I hit the resistance point I just applied gentle pressure and breathed deeply. I also tried a little coughing which helps to open it up. Also I tried to push a little in my bladderlike I was trying to pee. It really worked well. True there was quite a bit of blood but that is perfectly normal as the urethra and prostate tissue are very vascular.

Over the next few weeks I added some lubricating gel in the catheter sleeve after I opened it up half way on the wall. That gel (Surgilube) really helped reduce the resistance and I still use it every time. Even though the catheter is hydrophilic in a saline solution and shouldn't need a gel lube I find with my big prostate it really helps.

I am happy to help you get up the learning curve as I know what you are going through. Anyway, I did cancel my robotic simple prostatectomy and am doing great now. CIC is just like brushing your teeth after a while as jimjames would say.

Hang in there!

Howard

ditto Howard and Jimjames.  Same here, occasional bleeding.  Looks scary, but I guess it's not, according to some of the guys here. Yesterday morning, I had blood in the urine, and today no  trace of blood. 

I had issues with a sticking point too and found that twisting the cath until I found an angle that let me in was the path to success. It would have been ugly if I had tried to jam it. Twist and you'll find an unobstructed way in.

Yes, when you break the package, that's the hyrophillic lubricant. Just make sure it gets all over the cath. At this point, don't worry too much about touching the catheter but of course make sure your hands have been washed. Better might be some disposable surgical gloves, don't have to be sterile, from the drug store. They also give you a better grip. I doused them with hand sanitizer or soap and water just to be safe.

So he sent you home with what looks like a straight 14F hydrophillic.

Sample wise, I'd try to get a mix of  Speedicath in both coude and straight in sizes both FR14 and 16, and the new FLEX coude.  Just tell your doc's sec or nurse what you want for the rx. The rx can specify multiple sizes and different types (coude or straight). My rx is written that way and basically covers anything I might want to order.

Some miscommunication versus FR sizes. It's not just the flow rate, the outer diameter of a FR16 is bigger than an FR14.

You also need a good distributor who can help you with the paperwork, additional samples and insurance, etc. They know more than the doctor and really expedite things. Check your private messages in a few minutes.

The Bactrim should help, yes. I assume he just gave you one which is standard. You might ask him for a couple of more days worth if the trauma continues.

Jim

 

Hi Ob,That info sounds good.I am in retention this is why URO won't tell me i would be able to have NV after surgery. I now have a new issue ,high blood  pressure. I believe this medicine is making me CIC 8 or 9 times a day.Have you heard any similar problems like this?.

frank,

thanks jim,

going to check private messages shorty.

As you can see from some of the stories here, CIC can sometimes be very challenging in the beginning. Like Howard, I almost fainted in the Doctor's office while the PA was coaching me through the process for the first time. I remember voiding into the 1000ml beaker and about half way through I knew it wasn't going to be big enough but the PA tells me it's big enough according to the ultrasound. I said, "it's going to overflow!" so she fortunately got me another beaker. 1400ml ended up coming out, and by that time I was literally leaning on the wall! Flash forward a few months later and CIC became routine. Today, I don't know what the big deal was all about, but for many of us it does take awhile for the body to adjust. Just keep telling yourself it will get better.

Jim

I've used FR 14 before but I wanted to get the least amount of trauma to my urethra as possible so I settled on a 12.  Speedicath FR12 seem to be stiff enough that I can get them in with no trouble.  I use the hydrophilic FR12 Speedicath with the straight end.  I've tried the coude tip ones and in some ways they do go in easier but I found the tip to be sort of sharp and I was getting slightly sore where it nearly entered the bladder.  The straights work better for me and are cheaper if you're paying out of pocket.  The FR12 takes longer to drain than do the 14 but since I'm probably in to this for the long term and nothing leaks around the outside of the 12 then they're perfect for me.  I took one of the speedicath hydrophilic into my Urologist's office once and, when she asked, I showed her one that I had with me.  It was "show & tell" in the office there for awhile.  I guess they'd never seen anything like it.  Not my doctor; he wasn't there.  But the nurse asked me if she could show it to somebody (not sure who). and then she brought it back a minute later.  They had some disposable catheters there but I don't think they'd seen the disposable hydrophilic ones.  What can I say.  I live in Idaho, USA

I keep Macrobid handy for possible UTIs - it has always worked for me with little side effects.

Also for irritations I use AZO for Urinary Health - 2 tablets which you can get over the counter at any drug store.

For outer skin irritation/sensitivity I use Polysporin - works well.

If you get into bladder spasms which is not uncommon with urethral irritations/UTIs then I take prednisone (10mg) for 2 or 3 days. It will stop all the discomfort but I don't like using it too much. It was the drug I used to also me to NV when I was in retention before I learned CIC.

 

Jim, I need your advice.I have been doing CIC 8 or 9 times a day . I get the urge then only 150 or 200 ml come out ,after say 2 or 2 in a half hours. I'm always under 400 ml . If i  hold off and wait 4 or 5 hours and the ouput is istill under 400 ml is this bad for the bladder?

Thanks

Jim

frank,

Whether you feel the urge or not, as long as you're under 400ml then your bladder will be OK. So it's OK to wait, and it's also OK to cath when you feel the urge.

Jim

Jim Thanks for that info.Jim what is a median lobe? My URO never explained it just said i have this?

Thanks JIm,

frank,

It's a part of the prostate. If this particular part is enlarged it can make some procedures like Urolift more difficult.

Jim

THANKS JIM

FRANK,

howard,

when you say that you use "Macrobid handy for possible UTIs" whats a possible uti? how many and how long do you them for. also how do you know if its an actual uti?

 

I have to say, this stuff starts making sense after you start cic.

i have been cathing since sunday once a day, after wake up and have some coffee. my routine has been to try a NV 2 or 3 times prior to cic. have yet to measure other than my nv right before i CIC . i realize now that i should. my nv was 80 and my cic was 250. since i had done 2 smaller voids earlier, i probably was holding about 400 when i woke up.

this morning was my largest NV the first day since since i took 2 tamsulosin. Unfortunately due to the side effects im being taken off.

1 - i am currently sleeping through the night. but wondering if i should consider a nighttime void? i dont think i need to yet but if anyone can tell me their thoughts on when i might need to i'd appreciate.

2 - Im heading out of the country. since im one doing once a day in am. i can do in room but am concerned as its not the same environment that im used to. what preventative measures can i do to try and not get uti when traveling.

3 - should i ask the doctor for an antibotic(either to take one a day as preventative or if i feel something wrong like possible uti)

4 - ive never had a uti. is it just massive burning in penis and if so,how hard is it to cic when you have one.

thanks to all.

 

Regarding #1:  I think you're fine CIC'ing before bed and upon awakening (esp. since you're sleeping through the night). 

#2:  I wash hands thoroughly, use Purell and wipe meatus with alcohol swabs before CIC'ing; after, I put Neosporin at opening and around meatus  (I'm extra careful when travelling)

You will know when you have a urinary tract infection (UTI) as there is intense burning in the urethra when you pee and you will pee small amounts every few minutes while screaming your head off.

But sometimes all you really have is just irritation in the urethra which has similar symptoms. So what I do is test my pee using a 10-parameter kit you can get online which is just a dip stick with different colors.

If nitrite shows up then it is probably an infection and needs to be treated with an antibiotic like Macrobid or Cipro. Otherwise it is irritation and can be treated just with nsaids or prednisone.

But you don't want to mess with a UTI as it can spread to the kidneys so it is always a good idea to send a sample to your lab and have them run a culture which takes a few days to see if anything grows. If so they can tell you what antibiotic is best but by then you could be in trouble so Macrobid is a good general antibiotic as it has few side effects. Good luck.

1. As long as your total bladder volume (TBV) in the morning is under 400ml, no need to do a middle of the night CIC. To compute early morning TBV more accurately, you might just want to CIC upon awakening and note what comes out, even if you don't feel the need for a natural void. At least do that once. I'd even extend the 400ml guideline to 500ml or posssible 600ml for first thing in the morning, although 400ml is better for bladder rehab.

2. I pack paper towels with me to provide a cleaner surface to put my stuff on.

3. Yes, something like a course nitrofurion, a non quinolone. To be really safe, esp if you're not going to be near a big city, also pack a course of a broader base antibiotic like Cipro which is a quinolone. I would start with the nittrofurion (Macrobid).

4. With me, it's burning when I void, but not just a tingle, burning to the extent that I'm grimacing to void or almost can't void at all. There are other symptons like fever, urgency, etc, and everyone is different. The thing with CIC is that you don't treat just based on a positive urine culture but only if you are truly symptomatic. So a little urgency or tingling will not qualify even though a local doc might want to treat you based on a positive culture.

Jim

Hi Howard,

Have to disagree with you here.

As a CIC practioner, you don't treat a positive dip stick test, even if nitrites, leucocytes and blood are positive.  I go in and out of all three without antibiotics. The exception is if the positive test is accompanied by true UTI symptons such as significant burning, fever or scrotum pain. Asymptomatic bacturia is called colonization and again different guiidelines apply for those who self cath. I also would dissuade anyone from using nsaids, and especially prednisone without consulting with both their urologist and GP.

Howard, you case may be different, but the above is for everyone else unless their doctors make a good case otherwise.

Jim

In case you missed my post to Howard, I would not treat UTI's based on dipstick tests or even cultures, only on symptons. I would also ask both your urologist and GP about NSAID's and especially Prednisone.

Jim

Hi Jim

I agree with your disagreeing with me. I was only laying out the sequence of what I do following severe pain, burning and bloody urine as well as bladder spasms to the point of almost fainting. But I never check the dip stick if I don't develop those kind of symptoms. But if I do then to survive the night I find that 10mg prednisone usually stops the symptoms for me. I use to start an antibiotic right away as well but found that it has always been just irritation because the catheter was sticking and removed some of the mucous lining from the urethra that led to the irritation. In fact since I started CIC 2 years ago I have only had one true UTI in the first month. So I needlessly took a lot of antibiotics.

Is occasional use of ibuprofen bad and if so why?

On another topic, your salt experiment is a miracle cure for my nocturia.

Howard

howard/jim

I’ll ask the doctor for a script. I won’t have a parameter kit so Would I only take it if I start feeling the burning of a uti, take it if I think I’m getting something or take it as preventative ?

Also someone mentioned putting neosporin on my meats while away, is that something others also do. 

I've been doing CIC for awhile  and travel once or twice a week, just got back from a 1000 mile one day trip.

I can still do a bit of NV so I drink lots of caffeinated drinks, without sugar, to keep pushing fluids to prevent infections and keep the potential for infection down. I carry a couple of Cather's  to make sure each day's fluid intake is covered and  I don't hesitate to self cath (after a few months of getting used to it) in public restrooms.  Before  I leave I self cath to to make sure the bladder is completely empty.

You are still new to this, but from my experience the fastest way to get used to CIC is to be traveling.

Don't worry too much about infections, if you get one get it treated, but for me at least, self cathing at least on the same schedule as I had before the trip seems to insure I wont have an infection while traveling.

Personally, I'd stay away from the antibiotics... push fluids instead, certainly an infection has the potential to do harm but in my experience, at least, drinking lots of water and then keeping the bladder empty with CIC greatly reduces the chance of a UTI...

Hi Howard,

No issues with what you just said. I was only pointing out to others that prednisone is not a standard treatment, shoudn't be taken lightly and only after consultation with your urologist and GP. As to NSAIDs like ibuprofen, the info seems to be mixed but some suggest it might make retention worse, so at a minimum something to watch.

Jim

In general, you only want to take antibiotics if you have a full blown UTI, for example burning while voiding to the extent that you're grimacing and/or fever. Ideally it should also be confirmed by a positive urine culture but sometimes you can't wait. Dipsticks can be a handy thing to have around -- I use Siemens 10SG -- but again, just because the dipstick shows positive leucocytes and nitrites doesn't mean you should start taking antibiotics. Never used or needed neosporin.

Jim

Thanks Jim - not the place for it but last night I forgot to "take my salt" before bed and I awoke at 3 am in full retention and took out 800ml!

Hi CJ - I forgot to mention to you that my first line of defense if I feel a urethral irritation coming on like burning and pain while peeing is to take 2 AZO (Urinary Tract Defense). You can buy this product at any drug store and it is usually all you will need.

But for me at least, if the problem intensifies rapidly like within a couple of hours I will check my dip stick and if it shows just irritation (often accompanied by blood in the urine from the urethral lining) then I go to something stronger for inflammation like 10mg prednisone but as jimjames says you should discuss prednisone with your doctor as it is a steroid. At that point I will take a pee sample into the clinic for testing for a UTI just to be careful. With me at least the problem subsides on its own after 2 days but if it continues to flare after all the anti-inflammatories have failed to work then I would start Macrobid unless I have back the lab results that show no infection or a different indication for an antibiotic.

Sometimes the irritation is just on the tip of the penis so I will just dab on a little polysporin cream and that will help.

It's a complicated process and you will find your own best way to deal with it as we all do. Good luck. Howard

So should we take the "Chip Protocol" with a grain of salt Actually, someone else just reported good results, so next step is to get a double blind peer review study funded. Since it costs millions, maybe a potato chip manufacturer lay Lays might be interested?

Jim

thank you. the doc gave me  nitofurantoin mono/macro 100mg. he said if i want to do preventative take one a day while away but should take 2 / day if feel i have uti.

based on what i heard , sound like i should wait at least a day if i feel burning and if it continues take then.

i know jim you mentioned when first starting out, maybe better just just take preventative antibiotics so not sure if that better or wait until uti.

also - i saw doc had bzk antiseptic towlettes with an active formula of benzlkonium chloride to wipe penis.. are those the same or better than the towlettes that have 70% alcohol?

thank you

 

Or a salt company like Morton's. Anyway if it works in Phase II where everyone knows who is getting what then why bother with a double blind? Maybe it is just a placebo effect but it works which means that chips + the mind are a winning combination against nocturia! I will keep updating on my other thread. Thanks Jim.

I did recommend taking one or two tablets prophylactically  but only the first time you self cath, just like you would when you have a cystoscopy. Unless specific circumstances warranted it, I would not recommend taking antibiotics prophylactically under other circumstances. You want to minimize your exposure to antibiotics for a number or reasons including the more you take the more likely you will build up a resistance. BZK are standard wipes for CIC but I personally find them on the dry side, so bring extra. I  don't use alcohol wipes because they sting and irritate but YMMV.

Jim

howard,

how much liquid do you intake in a day? that sounds like a lot !!

thanks jim. you should write a book on this.

 

In you log, how do you account for the voided amount in situations where you cant measure such as in a public restroom or if your on a business trip.

larry

Hi Larry -  I drink 3 - 500ml water bottles a day plus food and yoghurt so I get between 2L and 2.5L of fluids. Also 1 cup of coffee in theam.

I use to measure my natural voids even when I did not CIC but over time I got a good feeling for how much my NVs are. I can tell now when my NV is 100ml or 200ml or 250ml fairly accurately.

those nv's are great. im afraid to drink that much now.

yestedday morning I had some trouble trouble getting past the prostrate. I was worried that I would not be able to cic. Finally after a long process I got it in.

1-What do I do if I can’t get the Cath in? I was in crisis mode.

2- the urethra has  been feeling a little sore when going in. Should I try to get an external lube to add the the Cath and if so how do I put in on and not worry about 

Thanks

Check your PMs.

Jim

Thanks

Hi CJ - I've been there and I know the panic feeling, believe me.

Here is how I have dealt with it:

1. Take some anti-inflammatories like Advil and try again in a few hours.

2. Change the insertion positions: After you get the catheter in an inch or more using jimjames patented divebomb method, continue slowly inserting the catheter with light pressure and with your index finger over the cup to help stabilize it. Then slowly bring the catheter down pointing straight into the toilet so you are now slowly pushing the catheter UP into the bladder. I find this really helps get past my 240gm prostate.

3. Add a lubricating gel to the catheter sleeve. I do this all the time. I hang the catheter on the wall next to the toilet and then peel down the sleeve half way and then squeeze in a lubricating gel and let it slide down for a minute. Then I slowly pull the catheter out making sure it is fully coated. I use the Coloplast Speedicath 14fr hydrophilic coude. yes - they are in a saline solution but I find the gel really helps grease it up for easy entry.

4. Learn to relax your pelvic floor muscles and external sphincter by breathing exercises as you cath so your muscles are not tight.

Let me know how you do. This is really scary when it happens.

Howard

Be sure to try to void naturally (whether anything comes out or not) just before CIC'ing.  I also find that relaxing helps.

What size are you using?  I've found the 12Fr goes in easier than the 14Fr that I used previously.  I use the coloplast male compact speedicath.

I used the indwelling Foley for 6 weeks before learning to CIC and would never go back - if at all possible.  It is much less healthy and very uncomfortable.

Best of luck!

 

Forgot to mention that constipation/bowel movements can be a big factor in blocking the catheter. I used to suffer from constipation and that pressure in the rectum could put pressure on the urethra in addition to the BPH that made it difficult to get the catheter through. I take MgO every day now and that helps.

Also I found that if I had a poop just before CIC and had to push then that too could block the catheter because the muscles were tense. So if I have a poop I wait an hour before CIC.

Also never push the catheter in with force as it causes bleeding of the prostate tissue.

Good luck.

Howard

Adding to the good advice you've been getting the fact is that the perception that you may not be able to CIC is generally not matched by the reality. In most cases, and we've had some very hard cases here, the catheter eventually does go in and with time these types of events become less and less and usually disappear.

Jim

I was able to cic this morning but just had the problem again this evening. No matter what I did I could not get past the prostate. I now just read this. I am hoping to find a pharmacy in the am( I’m out of the country)

Howard 0n point #2  I currently stand with a cup on top of the toilet so I’m already doing what your saying. It’s just when I get to the prostate, no twisting , coughing , etc would get it past. 

I’m using the bard magic 3. That’s what I was set up with. 

I’d like to get other types but was told I need prescription to order or to get trial. Getting drs office to do this is not as easy as I thought. 

Will online places let you order without prescription if u pay cash?

How does the compact compare to the regular side. I have been using course tip. Fr14

Thanks Jim.

You Howard and the rest of the guys are keeping me sane. I was thinking about calling my urologist and just have him do the rezum, but then realize that he’s done a less than 10, not sure it’s proven on large median lobes, and can cause Re . 

As I mentioned above, it’s when I get to the prostate itself that I have the problem.

Jim, one thing you asked prior was if the Cath is bending. If I’m holding the top of the Cath , it is bending as it goes into and down theburetra. If I hold the Cath much lower no bend. 

Or are your asking if the Cath bends when I try and get past prostrate?

What’s the main difference between the compact and the regular

If I use too small of a catheter it will buckle (or bend) and then the temptation IS to hold it down lower in order to feed it all the way in.  But with a 14" long one I only have about 3 or 4 inches next to the nozzle that is not in the urethra so I don't like to touch any part that's going inside even if I've washed my hands thoroughly.  The speedicath 12 hydrophilic works fine for me and even though rather small it is stiff enough to not buckle. I can use the coude or the straight at this point.  I've been doing cic for about 11 months and I'm still very glad I took this route.  I'm starting to see improvements gradually and definitely more urges.  I almost go by urges now more than the clock.  Still in the morning after about 6 or 7 hours of sleep I have no urge and it seems to me that I should after sleeping that long.  I'm so glad though that my system still works correctly this way and I don't have to get up a bunch of times at night.  I don't cath right after sleep but rather wait, have a cup of coffee or water if I feel dehydrated, and wait and see if I get an urge in about 30 min.  If not, I'll cath because I typically feel kind of antsey or nervous sometimes when I need to cath rather than a real urge to pee.

HI CJ - Are you using a coude (curved tip) catheter? This is very important to get past a large catheter. Coloplast which makes these catheters is all over the world. Check where you are and you may be able to get 5 free samples from them delivered to your hotel quickly. Ask for the Speedicath 14fr hydrophilic coude tips. Also if there is a local medical supply store you could phone them and they would deliver them to your hotel at a cost.

My catheter always bends a little at the start. So I go slowly and guide it in the first 6 inches with my index finger over the cup to keep it from bending. Then when it is half way in I point it straight down to the toilet and hold the cup between my thumb and index finger and slowly push it upwards. I always have resistance ther so I just hold light pressure and breath slowly and say "relax, relax" out loud and after 30 seconds or a minute it slips into the bladder.

Maybe also just try it without the measuring cup on the toilet as that may be making you tense.

Smaller catheters just bunched up inside and didn't work for me.

Good luck. Howard

Yes there are some sites online that don't rAequire an rx but you have to look around. I ordered  a number of catheters that way to try them out and if memory serves me I was able to order as few as a single catheter of a particular type. I don't remember the exact site but I found it via google and as a heads up there was a mention of rx's being required but when I went to check out my shopping cart I believe I just checked something saying I had a rx as opposed to actually having to produce it.

Jim

Both but usually at the prostate. Holding it lower, closing off the open funnel and going up a size are all methods to stiffen up the catheter which often makes it easier to pass. Have to experiment but gingerly. Speedicaths are quite slippery so if you're going to hold it lower you might want to try non powdered surgical gloves you can find at the drug store. Better grip and hygeine.

Jim

Are you referring to the compact from Coloplast? If so, the compact is of course designed to fit in your pocket so very convenient in that respect. On the other hand it's a couple of inches shorter which I didn't find ideal but still serviceable. It is also larger at the top (funnel design) so an FR14 isn't really FR14 all the way. It also doesn't come in a Coude model. Great catheter if you don't need a Coude and if the shorter version works and if it feels comfortable. Personally, I wouldn't start out with it because I think the Speedicath is overall easier to use but YMMV.

Jim

Thanks Jim. That would be to short then and also need that coude.

It would be nice to have caths that are more travel compact but most importantly  need them to work

Going to try now and Buy the SpeediCath hydrophilic coude in fr14 12 and 16.

Any other u recommend ?

Thanks Howard.

Got it to work this morning. Some little clots of blood came out but sounds like that’s expected.

When you say the cup you mean the guide that’s over the Cath that you keep your hand on so not to touch the Cath- correct?

My real concern is I’m going to be in Africa in a little over a month for a month and medical supplies and drs will not be near in many locations.

What’s the best approach for that.

Keith , 

Doesn’t the SpeediCath have a  cup that you can move down and hold lower without having to use your hand on the Cath ?

How many times a day do you Cath?

How large is your prostate and do u see any difference between using coupe or straight tip?

Thanks Jim. Just ordered some SpeediCaths coupe in fr14 16 and 12.

Also ordered I compact to see what it’s like. 

Coloplast FLEX Coude in same sizes. You could also try a Bard Red Rubber Coude in FR 14 and 16 as the 12 is probably too flexible. The red rubber is very different sort of catheter but worth a try. It will require external lube however. I think some here have had success with the Magic brand.

Jim

Do u know if the non powdered surgical gloves are sterile? If not do you just use the purell on it?

Just be very gentle with the Compact and don't push too hard if you hit resistance because it's not a Coude and the pointed tip could do damage against resistance.

Jim

They say "sterile" but I just bought the regular ones and then used hand cleaner on them like I would on my hands. The sterile ones cost a bit more and come individually packed.

Jim

No, speedicath doesn't have that but a couple of other brands do.  I use the "dive bomb" method that we talk about here and just hold on to the funnel and drop it in.  Once in, its pretty easy for me to get the FR12 to feed in.  Like I said, I like the Coloplast ones because they are a little stiffer than some I've tried and I like sticking with the 12 just because I want the smallest I can get away with.  I tried some sample that I had of another brand FR12 and it must have been a bit smaller because the urine was coming out around the outside of the catheter a little bit.  

I cath about 4 times a day on average; bordering on 5.  To this point I have not had a cystoscopy (or actually done anything yet with my Urologist, so I don't know the size of my prostate.  I definitely have a blockage but don't know the dimensions of it.  I can feel some blockage right before entering the bladder neck but can usually get easily through it.  Coude cath is a little easier but I don't really need it so I just use the straight. I find the coude tip to be a little sharp sometimes the few times I used them.  If I hold my penis at the right angles while inserting though it seems to go better.  I was taught to take a deep breath, hold it a couple of seconds, then let it out to relax before entering the bladder. 

Hi CJ: I also use to get some blood clots when I would CIC. That was before I added lubrication to the catheter (Surgilube) which made the catheter slide past my large prostate and not cause bleeding and irritation.

The Speedicath coudes have a green funnel at the top with a ridge to place your thumb over and keep pointed towards you as you cath. This is important because the curved tip must always be pointing up towards you so this makes it easy. Also the green funnel has a lot of grooves around it which make gripping it easy so you should never have to touch the tube part.

I use the 14fr and they are 16inches long which is just right for me. They can be a little flexible while you insert the first 4 inches or so but if you use jimjames dive bomb method and go slowly and keep your index finger over the opening of the funnel until you get near the prostate then there is no need to touch the sterile tube part. Then once you start to get resistance at the start of the prostate just gently point the catheter straight down towards the toilet and take your index finger off the funnel opening and keep pushing gently upwards till it enters the bladder. And don't forget to remove the catheter very slowly and steadily when finished by reversing all these steps. That is, remove the first few inches while still pointing down and then gradually lean back and pull it out the rest of the way straight up again in the dive bomb position. Remember to put your index finger back over the top of the funnel as you pull it out so the pee in the catheter doesn't spill all over you. Then just hold the catheter over the toilet and release your index finger so it flows out and empties.

Howard

Are there any other compact caths you recommend trying ( perferably with a coude tip)

Hello Howard

I do not find it necessary to close the end of the catheter with my thumb or finger while inserting.  Maybe I should try it.  What does that do for you?  I can see closing it while taking it out to prevent dripping but does inserting make it easier somehow.  Also, thought I'd mention that the one time I had a nurse do the catheter I was surprised at how fast she took it out.  I had been going very slow to take it out and she pulled it out in about 1 1/2 seconds.  Maybe seemed fast to me because it must have been kind of routine for her.

I  haven't found a compact catheter with a coude tip. If you find one please let me know.

Jim

Some might consider the FLEX Coude from Coloplast a compact since it rolls up nice and small. It's a bit different from a classical coude but worth trying.

Jim

Closing the funnel end on insertion seems to stiffen the catheter up a bit which in some cases means easier insertion. You can try it and see which way you prefer. You can take out the catheter fairly quickly but it's not a race. Smooth and very gentle is the way to go.   

Jim

Hi  Keith- I find putting my index finger over the cup during the first half of the insertion phase (while the catheter is still pointing up in the dive bomb position) gives me better control than holding it on the side while most of the catheter is still outside my body and can wobble from side to side because it is flexible. With my index finger over the cup and can better control the straight downward pressure on the catheter. But once I swing the catheter downward so I am now pushing up on it then I hold it on the sides of the green funnel (though my thumb is still over the ridge so the coude curve is always oriented properly). This is because my arms aren't long enough to keep my index finger over the cup and I don't need that any further because most of the catheter is now inside the urethra.

I pull the catheter out very slowly because in the past it would get stuck sometimes on the urethra tissue and if I pulled too hard I could tear the tissue and then develop an irritation which could be very painful. Since I started pulling out as slowly as I go in I haven't that problem.

Howard

Howard, I ordered the SpeediCath coude intermittent caths yesterday but the invoice says they are only 14 inches not 16 inches like you state above. Do they make a longer model ?

Jim,

Coloplast #289XX SpeediCath Flex Coude is, to all intents and purposes, a Coude even though looking at it the tip looks straight. By calling it a Coude got them into trouble with the insurance people who put it in the higher price range. The ingenuous design of the tip allows it to find its way around large prostates just as though it had a bend in it.

I have a "median" prostate (whatever that may mean) which made my evaluation exercise totally worthless, but other forum members who were already conventional Coude users found the Flex to work for them reliably. Did you perhaps hear of complaints?

Warm regards, alan86734.

Yes, CJ, the SpeediCath Flex Coude goes up to Fr 16, the largest they offer.

Warm regards, alan86734.

 

Alan, My understanding is that catheter manufacturer's can charge more money for a Coude but of course insurance companies are trying to save money so apparently they didn't buy the classification since it's not a conventional coude. But back to the user experience -- some here like the Flex, some don't. Personally, I had some issues  with it that I didn't have with the more conventional Speedicath Coude. I think people simply have to try both and see what works best for them.

Jim

Alan- I think CJ was referring to the length not the diameter.

Yes, Keith, you are absolutely right! It was length, not diameter.

Catheter length is my problem, too. And, viola, I found the Duette, by Poiesis Medical LLC, is longer, but it is not a Coude. Their selling point is the twin balloon feature, also a blessing, but catheter length isn't even mentioned.

I discovered the length advantage quite by chance when trying a sample. With a flaccid penis I found I had a "freeboard" (length remaining  outside the urethra) of about 2 1/2 inches with both balloons firmly inside my bladder. This is plenty for clamping and for at least a partial erection for those of us who experience this phenomenon.

I intend continuing with my search and, in the meantime, hope that the shoe industry doesn't decide to follow this one-size-fits-all strategy!

My apologies to all for the mix-up. Warm regards, alan86734.

 

Yes, I was asked length of the SpeediCath coude fr14. I order some to try. Howard’s post said they were 16 inches long. The order confirm I got said 14” long and 14” long was what I say on the website. Is there a 16 inch long model?

Is that a 1 time use cath?

Hi CJ - sorry for the delay. I just measured mine again and it is indeed 16 inches long ( the fr14 refers to the circumference which I believe is 14.4mm). They are designated Speedicath intermittent hydrophilic catheters Tiemann tip (also called Coude). You might ask them about the 16inch length as I often fine that extra 2 inches to be very helpful. Howard

Hi, CJ,

I assume you are referring to the Duette I mentioned in my post. As a general rule, any catheter that has a balloon system to keep it in place is an indwelling catheter. It is intended to stay in place for days, weeks, or eve months depending on the manufacturer's instructions and the hospital's or urologist's own rules.

The intermittent catheter is inserted to empty the bladder and removed once all the urine has been drained. Most of these will be "single use", or as you say, "a 1 time use". The indwelling catheter referred to in the preceding paragraph can be used here too, providing the retention balloon is not inflated.

Warm regards, alan86734.

Thanks Howard,

Do you have a model number. I did indeed order the SpeediCath cath u mention above but from what I see on the site of the manufacturer and the place I ordered , the length is listed at 14” ( I ordered fr 12, fr14 and fr16 to try)

Thanks.

Yes Alan I was referring to the duette. Thank you for your reply.

All Speedicaths are of identical length.

I would not even bother looking into any catheter that has a ballon in it like the duette unless you have a very specific reason why. Experimentation is good but so are limits.

Jim

Hi Jim,

I think you said that the "Speedicath Male Compact" that I use is a bit shorter.

 

Yes. Shorter than reg Speedicath and most other catheters.

Agreed.  For me, that's the only thing missing from the Speedicath Male Compact.

I wonder if the speedicaths are shorter than the magic3. The package on the magic3 say 16 inches.

Hi, Jim, CJ, and Arlington,

I have a SpeediCath Flex Coude sitting right here on my desk (unopened and therefore unused.). On the package it states quite plainly:

     Ready to use male catheter

     Length   44 cm / 17.32 In

Now, this really messes things up! I assume that the length stated is overall. The majority of catheters I have measured come out at 16 inches overall and a couple at 14 inches overall. The last mentioned have  long since been recycled and I can't even remember their brand.

so,  guys, there you have it, as the saying goes,

Warm regards. alan86734.

 

Meant to say all regular Speedicaths are the same length and all Flex are the same length.  

Hi CJ - that's funny because I thought later on I should have just given you the model number but just now got home. The number is 28494 in the US. It is 16in long not including the green funnel.

I tried the Flex catheter but it was too flexible for my big prostate and just bunched up like wet noodles and cause bleeding. This was similar to when I tried the 12fr and they just bunched up too.

When I travel I carry my catheters in a 2ft mailing tube which is very easy. I tell people it contains secret blue prints!

Once I discovered that my problem in getting in was adding a lubricating gel to the catheter then all went well. I use surgilube but any will work as long as it is bacteriostatic and you don't have an allergic reaction to it. I used to have to wait over a minute for the coude tip to pass through but with the lubricant it slides in nice and easy.

Take care

Howard

Thanks Howard ,

Do you use single use lube packets or a larger botttle.

Cj

I use a 5 oz (140gm)  squeeze tube which lasts for about 5 caths. So it costs about  75 cents per cath but is well worth it as I no longer get irritations and the catheter slips in much easier. I probably lose about half the gel each time as it flows over the catheter sleeve onto the ground so it is important to put a tissue on the floor under the catheter. Also when you pull the catheter out of the sleeve be sure to pull slowly and rotate it so the catheter gets fully and evenly coated with the gel. And don't forget to orient the ridge on the grren funnel before inserting it so it is facing you under your thumb so the curved tip is facing upwards always as you slide it in. Sounds complicated but it gets routine quickly. Howard

Oh and don't worry about the gel building up at the tip of the penis as you insert the catheter. It actually helps reduce irritation around the meatus. I just wipe the excess away afterwards with a small gauze pad.

Arlington,

A lot of the confusion is that once upon a time there was just "Speedicath". That's what I use and it's still my favorite. Later came the Speedicath Male Compact and then later the Speedicath Flex Coude. I thought the original question was if Speedicath came in different lengths and I said "no" which is correct but for clairity I should have said that all of the original Speedicaths have the same lengths. I never measured the Speedicath Flex Coude but I do know that the Speedicath Male Compact is shorter than the Speedicath. Hope this helps vs just adding to the confusion

Jim

that I forgot that some of their newer entries also are labled "speedicath" which IMO is confusing. So, we have: (1) Speedicath (the original); (2) Speedicath Compact Male (funnel design); and (3) Speedicath Flex Coude (the newest entry).

Could be wrong but I thought the original question had to do if Speedicath (the original) came in different lengths and the answer is "no". But yes, the Speedicath Compact Male and the Speedicath Flex Coude

Thank s Howard 

When you feed the catheter in and are holding your penis straight up at the ceiling; you then hit the obstruction part; you straighten out your penis to about 90 degrees or more, take a deep breath and hold for about 5 seconds, then let it out and try to relax.  It does help relax the bladder opening or something in there.  After a while it becomes second nature.  I had some bleeding at first and was alarmed but it cleared up after a few days.  At first I had some pretty big clots which I understand could have come from inside my bladder.  Then later there was just a little red tint to my urine and then it became normal in later sessions.

 I am looking at the SpeediCath coude packaging. I am used to the magic 3 where the package is transparent and you first have to press on a little package to open fluid to coat the cath before opening the main packaging.

The SpeediCath packaging is not see through . Can I open and use as is or is there a little package inside the main packaging that has to be opened somehow before I open the main packaging.

Fred,

Do you have bleeding from the large catheter, or UTIs ?

Thomas

Yes, if you have the Coloplast speedicath hydrophilic catheter then you CAN use it right out of the package.  You'll see the saline solution and the tube will be wet.  just hold the funnel and pull it out being careful not to let it touch anything and its ready to use.  

If you re-read all the posts I sent you they all pertain to the Speedicath hydrophilic catheter you now have and give a step by step description on how to use it from hanging it, lubricating it, taking it out of the green package, inserting it, and removing it. Howard

thanks Keith

Thanks Howard,

I missed that from your prior emails

Cj

I meant missed them from your prior posts 

Right... this message board is kinda different the way the posts show up.  This thread has a lot of the older posts at the end

Where you post shows up also depends on whether you reply to a specific post or reply to the OP. Also, how you set up the sort system at the top of the thread impacts where you will find a post. I liken it to finding a needle in a haystack that has been ordered by a sadist

Jim

Hi Howard and Keith,

Here I am again with my 2-bits, for what they are worth.

".....from hanging it, draw it out through a little more than 90 degrees to just over horizontal, in a few seconds you will see the saline solution flow around the funnel, drop it back to vertical, lubricating it, taking it out of the green package, inserting it, and removing it......"

Between "from hanging it" and "lubricating it" I have inserted three new steps (sorry I couldn't get my underscore or bold or italics to work).

Warm regards, alan86734.

 

They should put in a link on every post that would take you to the previous post that is being replied to.  That way you could easily follow a conversation.

i was going to try a speedicath fr14 today. i opened it up and put one hand on the green funnel. is that funnel/sleeve not movable? i couldnt get the cath to stop shaking long enough to put it in.

on the magic 3, you can keep one hand on the sleeve and move it lower so that you can get better control over the cath.

on the speedicath, do you have to use  your hand(or sterlie glove ) on the lower part of the cath to keep it steady so that it can go in?

jim,

if an fr 14 and an fr 12  both work fairly well, is it better to use the lower number?

It does take some getting use to. When I first started I had that problem too. The green funnel is rigidly attached to the catheter.

After I discovered jimjames dive bomb method of inserting the catheter I never had a problem again with inserting it. Jim can probably describe it better than me but basically I lean back and with my left hand thumb and index finger open the meatus and then while leaning back slowly lower the catheter into the open meatus. It is called the dive bomb method because the catheter is coming straight down into the opening. It takes a few seconds for the catheter tip to stop moving about so you just position it above the meatus and hold it till it stops moving and then lower it in.

Once it is in an inch or so (I pull the penis up a little very gently once contact is made just to secure it inside) then I slowly push it in and when it is half way in and then lower the whole setup facing downwards into the toilet and continue slowly pushing upwards until it enters the bladder.

Make sure you keep your index finger on your right hand over the funnel as that helps to stabilize it from shaking.

Also make sure your thumb is over the ridge on the green funnel so it is facing you to ensure the coude tip is always facing up.

Make sure you breath and relax through the whole thing.

I think the smaller catheter is better if you can do it ok since there is less disturbance of the urethra. But it drains much slower as well.

Good luck. Howard

 

Yes, Speedicath has no sleeve. I just hold it in one hand by the funnel and simply drop it into the open urethra by spreading the opening up with my thumb and forefinger of the other hand. So I never touch the catheter itself. If that doesn't work then either use your clean hand or a sterile glove to guide it. Or maybe you prefer the Magic 3 with a sleeve. Whatever works best for you.

Jim

Yes, always use the smallest size catheter (lower number) that works which would be fr12 in your case. Sometimes, however, a small catheter doesn't pass around the prostate because it starts bunching up and then you move up a size.

Jim

Thanks Howard . I’ll try that tomorrow . Hopefully I can get it to stop shaking.

Thanks Jim. 

The 12 worked today. Just concerned when I’m away.

If you can't "dive bomb" it in don't worry. It can sometimes take a little practice. Alternatively, the easiest way I've found is to simply guide it by holding it lower down on the catheter using some disposable non powdered rubber gloves you can find at the drug store. But like Howard said, make sure you have the coude tip lined up properly while you feed it in. I think I sent you a diagram via PM some time backbut if you're not sure let me know and I'll send it again.

Jim

Hi, Howard and JimJames,

I do it standing up and had exactly the same problem. I solved it by resting my dominant arm - the one with the hand holding the catheter by its funnel - against my hip. Hopefully you are physically able to do this!

Warm regards. alan86734.

 

Hi Alan - that's a good idea. With practice I learned to steady the catheter tip just over the penis opening and then drop it in the remaining inch. When I first started I was nervous which contributed to the shaking. But it is like learning to ride a bike to get the balance and then it is easy, In any case, it is not the end of the world if the you miss a few times and touch the outside of the meatus with the tip of the catheter since that area has been cleaned beforehand.

Take care

Howard

you guys must have good eye hand coordination. i just tried and will  take more practice.

btw, youu mentioned cleaning the tip. i use the bzk wipes. do you normally just do a quick wipe around and in the meatus area, or is there an amount of time that that needs to be cleaned for to make sure it properly cleans?

 

Not necessarily so, CJ. As I succumbed to the destructive effects of Cipro over the past couple of years, I lost my ability to write legible cursive script, the ability to sign my name clearly, and until these troubles set in I was a  reasonably competent machinist, amongst other things. However, when it comes to inserting my catheter, three or four times a day, I score a bull's eye on the first try just about every time. And that gives me at least a little satisfaction.

Warm regards. alan86734.

 

Hi, Howard,

I'm so happy to learn that you have resolved the painful issues that you were dealing with a while back. Your CIC events are now more tolerable if not actually more pleasurable. And, on top of your accomplishments you have taken the time and trouble to spread the knowledge you have gained to the rest of us, as evidenced by the many, many posts you have made. Well done and thank you! That is the very essence of our Forum.

Keep up the good work, HHoward. Warm regard alan86734.

 

I just do a quick wipe starting on the meatus and then around the tip just in case I miss the first time.

One thing I did when starting was to take a catheter for experimental purposes and wipe it clean and then just practice holding it over a penny on my desk with my thumb over the ridge in front and my index finger and middle finger around the grooves and then practice steadying it. It really was amazing the fine control you can develop on a tip 16 inches away. I got so I could make go in circles one way and then reverse the rotation and then stop it at will! Might make a great parlor game to impress your friends - at least on this thread!

Thanks Alan for the kind remarks. It is amazing how just a lot more lube and reorienting the catheter downwards has resolved all my irritation problems so I can now CIC 4 times  a day w/o issue. Jimjames always encourages us to experiment and this was a good example.

I am really sorry to hear about the side effects of Cipro. I took it a couple of times when I though I had a UTI and had similar effects. In fact it was always just irritation in the urethra from my technique so I took the Cipro needlessly at my doctor's suggestion.

My doctor switched me to Keflex which worked great but after the 2nd time I started to develop muscle weakness that was debilitating. I was worried I might have to stop CIC and submit to surgery but then I figured out this nice solution so have been ok for the past 6 months. I do hope your Cipro ailments improve over time.

Howard

Hey guys,

Cic has been going well until yesterday morning. I tried 3 times, changing the size from 14 to 16 and even changing from a magic 3 to a speed cath. I took a muscle relaxer and was able to get the 4th one to work an hour later.

Tonight it just happened again. I used 1, tool a muscle relaxer waited another hour but the next one didn’t work.

Since since out of town I’m worried about running out of caths. Any other suggestions on how to get this to work ? I tried the relaxation techniques mentioned here also.

Thanks in advance

Try smaller size, 12 or even 10, if you have any. 10s never failed me. Hank

First, I would call your cath distributor and have them overnight you more so you will be under less pressure. You might try the "finger in the hole" technique which involves covering the funnel hole with your finger on insertion. Some have had success with this. Personally, I find a gentle, very slight little back and forth twist helps at the resistance point. It's always easy does it. Less is more. Let the cath find its way in, don't force it.

In an emergency you might be able to reuse the hydrophillics by washing them in soap and water, and then inserting them with a water based lube like surgilube. Disclaimer: I've never tried it.

Jim

Jim

I had some coloplast fr14 non-hydrophillic when i first started cathing.  Don''t remember why I got them because I've been using speedicath fr12 hydrophilic for a long time.  I used Surgilube with the others and for a long time tried to smear it on the tube of the catheter after washing my hands.  When a nurse did it for me when I first had it done, she put a big glob of it on the end of my penis right over the hole.  It did stay there and the catheter picked it up on the way in.  Surprised me how well that worked.  

Thanks hank. The first morning it happens I actually tried a 14, a 16 and a 12. I didn’t have a 10. Unfortunately none of them worked.

Jim,

I tried back and forth at the resistance point for about 3 minutes. I also put some lube on it. Would you continue past 3 minutes?

How critical is it that you cath right now? Are you getting any natural voids? Can you estimate how much urine you're holding in your bladder per past urine logs? If you can get by without cathing and keep your volumes say below 600ml, maybe give it a rest and try tomorrow. On the other hand, if your volumes are high and you are in acute urinary retention, then your options are either to keep trying or go to a urologist or ER and get a Foley or suprapubic. I've never personally had the kind of difficulty you describe, but several members -- Stebrunner's name sticks out -- had similar difficulties in the beginning with attempts going well over 3 minutes. That said, I can't advise you how much to push it because while Stebrunner didn't injure anything, that doesn't mean you won't. Did you try the finger over the hole? Changing the angle of the penis (while holding it taught) as it hits resistance at the prostate can also help. Sometimes I've moved it up and down slowly to find that sweet angle so it slips in. You could also try cathing lying down into a urinal or bowl. Sorry you're having these problems. Some other suggests are coughing, laughing, deep breathing, running water....

I just hand the catheter on the wall below my waist and pull the tab slowly down half way and then squeeze the Surgilube in from a height into the open sleeve and really cover the catheter. I put a tissue on the floor under it to catch any runoff. Then I pull the catheter out very slowly and twist it to make sure it gets covered with the gel. Then before inserting using the dive bomb method I make sure the coude tip is aligned properly with my thumb over the ridge. I've been doing this for 2 years now 4 times a day and it has overcome all insertion problems. I use the Speedicath 14s. Good luck. Howard

Hi CJ - please see my comment to Keith below. If you can really coat the catheter with lots of lube it should work ok if you try to relax. Also another technique which works great is that once you get the catheter in about half way using the dive bomb method with the penis still pointing upwards, then slowly reorient the penis and catheter so they are pointing straight down towards the toilet and then continue pushing UPWARDS into the bladder. I find when I do this I often can get in when I cannot get in with the catheter oriented up or horizontal. Good luck. Howard

CJ, call some uro offices and ask them if they have samples of size 10, or even 8, mine did. They have a very good chance of getting through. The problem is they will bunch up a bit so dive bomb is out. You will have to guide it by touching the hose part so make sure to have clean fingers. Hank

CJ, to be able to assist you better, will you briefly tell us your situation ? How long have you been CICing ? What procedures, if any, did you have before this ? When ? Hank

Take some alpha blocker, like Flomax or alfuzosin, if you have any. They will relax your muscles, and might make it easier for you to cath, and give you some natural void. Hank 

Hank's suggestion about getting some smaller sizes is reasonable, but if you end up ordering more, also ask for the next size up. A smaller size may work, but ironically larger sizes frequently work and are used for difficult catherizations. The concept is a bigger hammer and nail. I would try them both, nothing to lose. What works for one may not work for the other.

Jim

thanks howard

thanks hank.

i tried rapaflow for a month and didnt see much improvement. switch to flomax and felt too weird. thinking of trying one of them again, but think one of them didnt play nice with other meds im taking so really need to try and figure that out.

thanks jim. i did try a 14 (my normal), 16 and 12. none worked in that situation.

Have we ruled out temporary constipation? A fleet enema would put you on empty. Like I said, if you're doing natural voids and volumes aren't too high maybe just take a break for a day or two. But if your're filling up like a Thanksgiving Day balloon and/or in AUR, time to see a doctor or the ER.

Jim

Last night and this morning I could not get it to work again using fr14 magic 3 coude(all I have with me)

I did take a muscle relaxer and tried and hour later with extra lube and finally got it in. It took a good 4-5 minutesI won’t be back home till next Thursday and am making a drs appointment for that day.

It’s just gets stuck when it hits the last area right before the bladder. Thanks for all the suggestions but am concerned since I’ll be going out of the country for a month in about 2 weeks.

I haven’t had any constipation issues. 

I’m going to pick up some other caths to try) in Montreal right now and u don’t need prescription. Limited stock of buying by the piece but am about to see what they have. I May buy a box of the speedicarth flex( I haven’t tried yet but hoping their new technology might work.

One question, is it possible that I somehow messed up, created a clot or some sort of blockage with by cic ? If not, what else do u think it could be?

Yes, you can messed up doing CIC and ended up with urethral stricture and/or false passages, which may be or may not be what you are experiencing. However, Jim mentioned in another post that they can be easily remedied. Hank

Hank, I tried rapaflow for a month and did very little. Flomax made me feel terrible and was only on it a week.

I was thinking of trying them again, but I was having shortness of breath on both and felt chest pains right before and after came off flomax. My guess is they were from the meds and too nervous to try flomax again

Hank, 

Can you copy Jim’s post on getting past urethral structure and or false passage. I don’t see that one.

Thanks

Hey Jim,

I went to a medical supplies place in Canada and bought some speedicath 14 flex and speedicath compact. They gave me a sample to try if the flex. It was difficult but after a few minutes got it to work. No guarantee it will work again later.

The manager called a friend who was a nurse at a urologist office. She mentioned based on the little info he had given her that it could be either I’m not drinking enough water or I may have an infection. I do get blood when I try but figured that was normal due to the amount of time I’m poking around.

Could it be an infection. I have a little uncomfirtability in the urethra but again think it’s because of the number of times I’m trying.

Also what is a false passage. It was mentioned by hank you explained how to get around them. I have been trying all you guys Reccomend but hopefully did not miss that and don’t remember .

The post that Jim mentioned that it can be easily remedied is on this very same discussion (thread), posted 2 months ago. He did not mention how to remedy it, instead referring to his other earlier discussions. I would best leave it to Jim.

  My personal experience at the early days, I thought I experienced false passages, in which the catheter refused to go any further, will bunch up and will cause bleeding if I insisted. I got around it by switching from Coloplast 12fr coude to 12fr straight. And when occasionally I had problem with the straight, I just rotated it 180 degrees and reinserted. The tip now coming with a downward bend and it usually got through. I think I avoided the entry to the false passage this way. Remember you should not rotate a coude. 

  Talking about the 12fr flex, I tried 10 of them and they all worked well. To me, the tip is more like a straight than a coude. And it is more flexible and less stiff, so less chance of causing damage. Maybe it's what you really need. 

  It's just my experience. Don't ask for Internet medical references. Hank 

What was your cath volume when you finally were able to do it? If it wasn't too much, maybe give yourself a rest fo a coupe of days. Anything is possible, but from other experiences here, it's probably just your prostate being stubborn. That said, if you keep having problems, let your urologist know and he can look inside. And as long as you are going to pick up more caths, again try one size up with plenty of lube. Plenty. BTW are you using Coude (bent tip) caheters? If not, that would be my first suggestion.

Jim

The flex is a form of coude tip. So if the flex worked, my guess is that the regular Speedicath with Coude tip would work as well. Have you tried it? It's the one in the green package with the hydrophillic coating. Get it in FR14 an FR16 and start with the 14 first. Just remember the tip has to be oriented properly. I can send you a diagram if you need it. A false passage is like a little side street off the urethra with a dead end. I don't think that's it. If you hit a false passage you won't be able to get into the bladder at all, but you did. The only way to "get around" a false passage is not to let the catheter slip into them. With a coude (bent) tip, less of a chance to form a false passage, and less of a chance to slip into one.

Jim

Just because I don't think its a false passage, I don't want to minimize the fact that it might be. That's why I suggest you hold off CIC unless you really have to. Retrograde urethrography, a voiding cystourethrogram and cystoscopy are all tests and procedures your urologist can use to diagnose false passages and strictures. The treatment is usually antibiotics and a short term of stenting often with a Foley. Then you're as good as new!

Jim

Voiding volume was 350 this morning when I finally got it to work. Yesterday it was 450, after a 100 natural void.

I have been using coude ( bard magic 3 fr14)  but have gone up and down fr12 and fr 16 but not helped when I had issues.

What’s the max that I can hold in the bladder without damage ?

Thanks hank.

Do u ever try a fr14? 

Also I see u mention it the straight doesn’t go in u take it out and rotate it 180 degrees. Would the straight top be the sam no matter how u put it in?

OK. So your cath volume was 350 this morning. Any natural void just before that? And when was the last time you cathed and had a natural void before that? Trying to figure out what your total bladder volume would be if you don't CIC at all, or maybe you know?

Jim

Jim I did 90 right before the cic of 350 and 2 hours earlier when I tried and failed cic I did 2 voids totaling 110.

Yes, I tried 14fr's before. They are generally more difficult to use, and they usually leave my prostate irritated, sometimes even for hours afterward. You can tell if you rotate a straight by observing the marker on the funnel at the end. 

Before insertion, the catheter shape is straight line. However, after a failed insertion and being taken out, it will have its tip bent pointing toward you, about 1 or 2 cm. after you rotate it 180 degrees, it will point away from you. I used this bending characteristic to guide the tip away from the path of the previous failed insertion. Hank

When did you start CIC and how much were you retaining then? What is the longest time you have gone between caths recently? What I'm trying to figure out is how much urine your bladder will hold if you don't self cath at all. If it's not too high, then taking some time off from CIC may be the best thing.

Jim

Wow I didn’t know that on the straight.

Thanks for the tip. 

When you reinsert it to you add more lube?

 I think around-240. But my cic has been has high as 450.

I have a question to anyone using the speedicath flex. I tried it this morning and got it to work ( took a while) but i Don’t think it hit very far into the prostate. I pushed it as far as a could but do the design I think it’s shorter than I have been using. I feel it left a decent amount in there. Does anyone have similar experiences

I used the flex several times and unlike the Compact model, found it long enough. You only need to push in an inch or so after the urine starts to flow. How much came out of the catheter. You still haven't answered my question, or maybe I'm not asking it clearly enough. If you never cathed at all, how much would be in your bladder? You could base this on voids and PVRs in your urologists office  prior to self catherization or you could base it on a urine log if there were gaps of say 24 hours between CICs. The reason I'm asking is because if your total bladder volumes, without CIC, are 600 ml, possibly even a little more, than you could probably safely stop CIC for a short while to sort things out with your doc and/or until things heal.

Jim

Jim

I use hydrophilic catheter. Before reinsert, I dip it back into the sleeve to wet it again. Applying more lubricant may be better but I am lazy. Hank

Hank,

That’s another genius suggestion. Thank you.

Sorry jim, I thought I answered it above. 

I was somewhere between 240 and 300 ml the last time I went into my doctors office as what he measured on the sonogram after I had went to the restroom. That was in the morning.

But that was a day after coming off a month of rapaflow and a week of Flomax. Prior to that 3 months earlier it was low 200’s.

So if I didn’t cic for a day, are you saying my left over should only be in the 200’s even though I was as I did a cic of 450 2 days ago?

Ok. So here's what I would do, and something you might seriously consider. If your PVR is 240-300 on average, than the CIC is arguably optional. And your bladder certainly will not be harmed if you take some time off. So instead of driving yourelf crazy trying every catheter and technique in the book, why don't you just stop CIC for a week or two and hopefully things will heal and calm down. If they don't, then go see your urologist and he'll take a look to see if there are strictures or a false passage, etc, and if so it will be easily fixed. Yes, you will have more frequency without CIC, but you won't be unecessarily irritating your urethra and prostate. I know you're on a mission here, but sometimes it's best to take time out. It would be a different story if you were holding 1000cc or were in acute urinary retention, but you're not. So enjoy a catheter free vacation. My two cents.

Jim

Just,

You mentioned that you have used the flex. Did you find it somewhat difficult to use compared to standard cath.

When I use a stand cath, you have one hand on the penis and the other on the cath. With the flex , it looks like you need two hand on the flex so I find it more difficult to use.

 Same advice even if your  PVR goes up to 450ml, like the other day, assuming you're not having extremely large natural voids. Yes, it's a tradeoff, but I don't like what you're doing to your urethra when it might not be necessary.

Jim

Yes, the flex takes a couple of times to get used to because you have to feed it in, instead of dive bombing. I never liked it as much as the regular Speedicath but we are all different. What I did like about it was that the sheath seemed more protective of germs in say pubic bathrooms but I haven't cathed in a public bathroom for a few years now.

Jim

Jim,

I think I understand what your saying but Since I only cic 2 times a day after many natural voids thooughout the day( morning and before bed) wouldn’t  my volume be at least 350 or 450 after the first time I don’t cic and if I wait a day to cic, possibly over 1 k?

But you just said that your PVR was only 240-300 in your uro's office when you weren't doing CIC. And you also said it was only 450 the other day after no CIC. So how do you get over 1000CCC? If you're concerned, why don't you just stop cathing for 24 hours and then make a local appointment with a uro or clinic to get a bladder scan. If your total bladder volume is under say 600-700ml, I'd leave things alone till you get home and get things looked at.

Jim

If you aren't already, you might want to take some Flomax, or similar,  till things get sorted out.

Looking ahead, you might be a good candidate for having your own portable bladder scanner. Avoids unecessary catherizations.

Jim,

First thank you for all your help and advice. since I started cic and have much higher pvr, I am assuming that it just adds up over a day.  That if my pvr after cic inthe morning is say 400, and if The next time I cic in the evening and the pvr is 300, then If did not cic that day , then my pvr would be 700 total left in me that evening and continue to add up in my bladder. Am I thinking this wrong?

Maybe, maybe not. You may cut that down with more frequent natural voids. You might be able to tell by how full your bladder feels but the best wsy wld be to stop for 34 hours and then get a pvr at a doctors office. Just hate to needlessly see you irritate and possibly harm yourself.  Advice her is limited by distance and credentials. This is what doctors are for. Use them!!!  Jim

Thanks Jim. I got an appointment for Thursday. 

I’m going to mention that my last few times trying to cic either produces failure or mulitiple times to get in to the bladder.  

I going to ask if it could be a blockage, false passage or hematoma. Anything else I should ask?

Would the best test be to ask for a cystocopy?

Anything else I should bring up . 

Culture, cystoscopy and/or imaging. The urologist should know what to do. Could just be an inflammation or UTI.  Glad you're getting things looked at. As I mentioned before, you might want to gives things a rest. You also now have an opportunity to see how much PVR you have if you don't cath. So consider not cathing 24 hours before the appointment and then have him do a bladder scan in the office. Now you will know what your PVR is without CIC.

Jim

Jim

Jim,

Is it normal to have so many problems after a month doing cic. 

I figured after the first time at the drs office which was miserable and took 3 times, the it would get easier.

I had started cic 2 times a day and probably had once a week where I had to do it at least twice to get in . The last few days had been real terrible. Wasn’t going in and bloody.  ( I stopped yesterday).

Shouldn’t it be easier?

I'd say most take to it fairly easy, some don't. I had a very rough time the first five or six weeks. Pain,bleedng, false urgencies and two UTIs including epidydimitis. But I was always able to get it in without the kind of difficult you are having. That said, we have had a few members with similar or even more difficulties to yours, Stebrunner comes to mind. But after a period of time, it became easy for him. There's a good chance that a month from now you'll wonder what all the fuss was about, but meanwhile you have to attend to the issues you're having. Good luck with your doctor's appointment.

Jim

"real terrible" is not good.  I'm not jimjames, but I can answer your question; yes, it should be easier. 

CIC is a a good option if it can be made to work with minimum discomfort or risk; what you are describing sounds like something that needs professional attention.

I hope things improve for you-

S

 

Thanks Stan and Jim .

How hard was it for some of you to find the perfect cath and size?. Did u find  having to get prescriptions a real pain. I have ordered a few singles online based on Jim’s suggestion but wasn’t able to find the right one.

When in Canada the other day, I bought a box of the speedcasr flex since they let me try it in store and it worked the next day also, but then couldn’t get it to work again. 

What methods did u guys use.?

I settled on a speedicath FR12 hydrophilic straight tip.  I tried an FR12 that was made by Cure I think it was... that one wasn't stiff enough.  Some kind of difference in materials or something.  One time I ordered Coloplast FR12.  I didn't ask for "speedicath".  The ones I got were in a package but you had to tear them open, add water, and then let the catheter soak for a few seconds to get lubed.  I sent them back because what I wanted were the speedicath hydrophilic.  I didn't even know Coloplast made these. Byram Health Care were nice about it.  There are so many different kinds and its not too hard to get samples.  I tried an FR10 as I recall because I kind of thought the smaller the better because I was afraid  of hurting myself.  It didn't work.  I was able to get it into my bladder but some of the urine was coming out from around the catheter and getting on my hand.  I've also tried the one I'm using with a coude tip but I can get into my bladder without it and don't have to worry so much about keeping it lined up correctly.  At first I did what the nurse taught me... to insert the catheter until you feel some resistance... then take a deep breath and hold it for about 3 seconds... then let it out, relax and finish inserting it.  This method DOES relax something in there.  I don't have to do that now that I've gotten better at it.

I just order mine on line, currently using coloplast fr14 straight.  This is my second course of CIC, first one was two years ago, before having a TURP and two BNIs.  My first round, insertion was easier and flow was better; this time it's very subtle, finding the exact spot where the flow starts and holding it there.  Definitely takes patience, and too much force is not helpful. Sometimes rotating the cath side to side produces some flow.  But  mine is very slow now, sometimes takes 15 mins to get 400ml.  Much better than leaving it in there though.

Stan,

First time I've heard of this. Once the catheter is in the bladder, it should empty in no more than a minute or two because unlike with natural voiding, the catheter itself simulates an open urthera. The convention is that once the flow starts to insert the catheter about one inch more. Then, when the urine stops flowing to slowly back it out to drain bottom of bladder. Are you noticing strong flow in the beginning and then it peters out. If so, your job is done when the strong flow stops. If you leave a catheter in for 15 minutes you may be picking up new urine coming out of the kidneys which isn't what you want. Another thought is the catheter clogging due do clots or something. Lastly, do you have a bladder diverticulum by any chance. The anatomy or a bladder diverticulum could account for slow drain rates.

Jim

Keith,

Did you need a prescription to get samples? 

I’ve tried some that work one day and don’t work the next. Have you had that happen to you?

Jim,

I noticed in a different thread that you mentioned  also had a hematoma early on. Did you stop catching for a while for it to heal? 

No, you don't need a prescription for samples.  Use a search engine and look for catheters and you'll probably see samples.  Some of the suppliers such as Byram or 180 medical will send you some as will the manufacturers like Coloplast or Cure.  Ask for some different ones.  I can use a range of sizes if I have to.  They all work for me; its just that some work better or easier than others.  I like the hydrophilic and since I'm on medicare and I have medigap insurance the cost to me is the same.  

The same model catheter always works the same.  This isn't rocket science although they are pretty amazing the way they work to drain the bladder.  

You need an rx to get free samples however sometimes it's easier just to pay for one or two of each online. There are some websites that do not require an rx to purchase.

Jim

Keith,

Maybe it's semantics, but if you don't have an rx on file, distributors such as 180 Medical will NOT send you samples. Nor will the manufacturer. They used to but not any more. And in fact, even if you do have an rx on file, if you don't have an rx that covers a specific catheter, they may not send it to you. For example, say your rx specifies a straight catheter but you want a sample of a coude or a closed system (with bag). They may require an additional rx or an amended rx from your doctor. This is not speculation but from personal experience. The workaround is to find an online seller who will sell you one or two catheters without an rx. There are a couple of online sellers like this and it can save both paperwork and time.

Jim

 

Thanks for that correction.  Hope changejobs sees it.  I know that once you begin with regular monthly orders the supply houses want a confirmation from the doctor.  I had to see my Uro just to make a change to change my monthly order from 120 per month to 150 of the same catheter.  I was suprised that my Uro office that time said they were fine with my doing CIC if I was willing to live with that.

The manufacturers must have changed their policies just in this last year because Coloplast sent me several samples just about 10 months ago.  

You might have had an old rx on file with them. The last time I asked Coloplast for samples they told me I needed an Rx. Wasn't always like that. A good distributor handles all the paperwork and rx confirmations. When I wanted a change, I just let them handle it with my doc. Finally, after not seeing my uro for two years he wouldn't renew the rx, so I just had the distributor call my GP and tell him what to order as most GPs aren't very knowlegeable with CIC.

My rx reads something like this: "2oo catheters a month, Straight or Coude tip, sizes 12F, 14F, 16F, Hydrophillic or with external lube". So this covers just about anything I want except for closed systems which have pre-qualification requirements. I don't actually order 200 catheters a month, just order what I need from the distribuor, but in case I do need them, I don't have to get the rx changed.

Jim

Thank Keith.

Jim,

That’s outstanding how it’s written.

Do u take the copy of the prescription and send it to different retailers or just 1?

Which online retailer do you or Keith order from ? 

I wrote it myself and dictated it to my urologist I also asked him to email me the rx but I've probably lost it by now. The fact is that it's on file with the urologist and the different distributors can contact the doctor to get it, no need to send anything to them yourself nor am I sure they would even accept an rx for you. I'll send you a PM soon regarding distributors.

Jim

Thanks Jim.  Yes, what you describe is exactly what my first experience with CIC was.  But this time it's very slow, though it does seem to begin at that specific point.  No apparent problem with clots or bleeding/blockage. My sense is massive amounts of scar tissue.I do have a large diverticulum, so maybe that has something to do with muscle tone in the bladder--things are just all stretched out in there.  I'm hoping  that keeping the volume down with CIC might address that, give the smooth muscle a chance to recover at least a little.

Stretched and scar tissue re common amoung the CIC population, I don't think it's that. It could very well be that it's the diverticulum that's accounting for much of that 400ml. A diverticulum, depending on it's location can take a long time to empty because of catheter access and other factors. I also have a diverticulum and those times when I want to bother emptying it via CIC (I usually don't bother) it can also take a long time but my bladder itself only takes a minute or so. The only way to know would be to do video urodynamics or get your uroligst to take multiple scans at different  points of your self cath. In other words, stopping it  mid cath for pictures. Good luck on that one! I know how  my diverticulum works in conjuction with both bladder and CIC because I have a portable real time bladder scanner at home. And this was one of the reasons I got one.

Jim

The other point with a large diverticulum is that you may not be retaining as much in your bladder as you think and the typical office 3-D Verathon Bladder Scanner can mistake the diverticulum for the bladder giving you a false reading. I corrected my last urologist on that one. My scanner is a 2-D with real time imaging, the same type of imaging you get on the larger scanners used for bladder/kidney studies. I'm at a loss why more urologists don't use these real time units because they don't cost any more than the point and shoot 3-D models designed for ease of use and saving time at the expense of diagnositic value.  Diverticulum's by the way have no detrussor muscles.

I recently found out that the catheters are not covered under my insurance. I have been using the Coloplast Coudle FR14 Hydropholic disposable ones and I'm looking for less expensive ones. I have tried straight tip and that might be an option. I think a box of 30 is costing me about $90 and that was a pretty good price when I compared it to other websites. I have not had a UTI so I am concerned with not using the Hydropholic and trying to self lubricate. Any recommendations?

The least expensive way would be to use non-hydrophilic catheters. You use them, clean them, and re-se them. I've read that you can use a single red rubber catheter for a week or more. I imagine the same thing with plastic ones. I would call Coloplast and ask which of their non-hydrophillics is the most similar to the disposable hydrophillic you are using. Just keep in mind that the catheter manufacturers and distributors will tell you not to re-use any catheter, but consider where they are coming from. People re-use catheters all the time but it's an individual decision. If you go this route, a box of 30 should last you many months, so maybe try some samples first and see what you like before ordering a whole box.

Jim

Some people here report re-using hydrophillic catheters but I have no experience with that and it might just be easier to use a non-hydrophillic for re-use. The only catheters I re-used were the red rubbers when I first started out. No big deal. I just alternated two or three, that I washed in soap and water each night and hung out to dry. Then I put them in a zip lock bag. When I realized my insurance paid for 200 a month I became lazy and just use them once.

Jim

Come to think of it, I might have been alternating more than 3, since I was cathing six times a day back then, but you get the idea.

Thanks Jim....Ok, I will call Coloplast and see what they recommend and ask about eh red rubber tips. I thought the color represents the size(Ie: Green = FR14) but I will ask a few more questions once I get them on the line. One of the things that I didn't have to worry about with the hydrophilic was lubricating the catheter. Is there a certain type that you would recommend? And is it mixed with water or do you just lubricate?

You may not like the red rubbers. It's not just the tip, the entire catheter is made out of rubber. Some like them, but many prefer the stiffer plastic ones like you've been using. Go ahead and try a few red rubbers, but I would also try some plastic catheters just like the Speedicath, but without the hydrophillic coating. Ask Coloplast which one of their non-hydrophillics is the closest to what you are using. I used "surgilube" in the individual single use packets, but there are a number of options. Just make sure it's water soluble and intended for CIC. You do not want to use anything petroleum based like vaseline.

Jim

I've had good success with Cure Ultra catheters and Cure Hydrophilic catheters.  The Ultras are pre-lubed with a viscous coating.  The Hydrophilics contain a water pouch that you break before using.  They're both a lot cheaper than the Speedicaths.  I paid $1.88 each for the Hydrophilics and $1.28 each for the Ultras.

One weird and slightly frightening thing about their Hydrophilics: they go in easy but then, for me anyway, they take a lot of effort to remove.  The first time I thought it was just stuck, but found with enough pulling it came out.

The Ultras go in a bit slower than the Hydrophilics, but come out easier.  I found their lube stung a bit at first, but after a while I didn't notice that anymore.

Both types come with sleeves, which I like.  They help me guide them in without bending.

Hi, George,

How much time do you spend cathing (insertion to removal)? I'm using these same Hydrophilic catheters but, if I spend more than a minute, I begin to notice this sticking effect that you report.

Also, make quite sure that all the water is squeezed out of the sachet and that the catheter is properly wetted.

Changing the subject a little, I too suffered stinging a few minutes after my cathing session. It turned out that it was the bacteriostat in the lube that was affecting me. Changed lube, and problem solved.

Finally, yes, the sleeve is a wizard idea! However, I thought its primary  purpose was to keep the user from touching the catheter proper, thus preventing contamination from non-sterile hands.

Wishing you all the best, alan86734.

 

Hi Alan -

It probably takes me about two minutes from insertion to removal.  I'm guessing the water coating on the hydrophilics is getting absorbed into the urethra leaving no lubrication left for the extraction.  I just ordered some Surgilube and I'll use that on those hydrophilics I have left.

The stinging with the Ultras seems to have gone away for me, and they're cheap and easy to use, so I'll probably stick with them going forward.

And yes, I think the sleeve is to prevent touching with non-sterile hands.  I can use it to support the cath and keep it from bending when I run into a point of resistance while inserting.  Or in the case of the Ultras, since they're not as slippery as the hydrophilics, I use the sleeve to push with, instead of pushing from the funnel end.

Thank you for all the great info you've posted here, Alan.  It's been very helpful.

George

I also add some Surgilube to the catheter (mine is Speedicath 14 coude hydrophilics) to keep it from sticking on the way out as it takes me about 3 minutes total. It really makes a big difference.

Hi Howard -

Yes, I ordered the Surgilube after reading one of your posts about it.  Thanks!

George

i didnt know that speedicath made a hydrophillics. i always got the one that was pre- lubed. the thing that i didnt like on the speedicath was it did not have the sleeve. the bard i bought had that and made it easier to hold.

Yes - I hang the green package that contains the Speedicath on the side of the bathroom counter and then pull the sleeve half way down and squeeze in some Surgilube. It mixes nicely with the saline solution and gives the catheter a nice coating that keeps it slippery for the 3 minutes that I cath. I've done over 2000 now this way and it gets me past my 240gm prostate ok!

Chagejobs, Speedicath is a model name for a hydrophillic catheter made by Coloplast. A hydrophillic catheter is pre-lubed by definition. Because Speedicath's are relatively stiff, many of us cath by holding the catheter only on the plastic funnel making a sleeve unnecessary. I have termed it the "dive bomb" technique where you stretch the penis with the non dominant hand while opening the meatus with your thumb and forefinger. Then you simply drop in the catheter with your dominant hand without needing a sleeve to thread it in.

Jim

If I remember correctly the speedicath does not have lube for about 3 inches away from the funnel.  So it can be held in that area and that area does not go inside anyway.  It gives a little more control than holding by the funnel.

Thomas

Jim,

It still would shake when I held it, so hard to get directly into Penis without hitting the top of the penis

My Speedicaths 14fr coudes are 16 inches long and when fully inserted I use the whole length right up to the green funnel. So first I hang the catheter on the wall and then pull down the green sleeve half way and then squeeze some lube into the sleeve being careful not to touch the exposed catheter. When I pull out the catheter from the sleeve the lower half gets coated with lube which makes insertion easy. Since some of the lube accumulates at the tip of the penis during insertion of the lower half it then coats the upper half as it goes in so I get a fully coated catheter which really makes a big difference for my large prostate.

Two years ago I found jimjames dive bomb method and have now done 2300 catheters without an issue. I was scheduled for prostate removal at that time due to kidney damage. But thanks to jimjames I am good to go today. I always say "thanks jim" after each catheter!

 

As long as you clean the top of the penis with a good wipe it is ok if you miss the opening once in  a while and then maneuver around to where you get into it ok. I still miss sometimes and then just lift it up a inch and try again with no ill effects. But use the wipes jim recommends. It is like learning to ride a bike - you will get the hang of it eventually.

Works for me.  Even the FR 12 I find perfect in the Coloplast hydrophiliic as it is stiff enough to hold by the plastic funnel and once in the opening I'm able to thread it down.  Definitely helps though to pull the penis straight up and even stretching it a bit... at least until the catheter reaches some resistance.  Then lower the penis and gently work it in.until the flow starts.  

Dear Howard,

If you normally insert your catheter right to the funnel, and presumably with a flaccid penis, then I believe you have an unusually long urethra, just as I have. I was blissfully unaware of this fact until I started self-cathing and became aware of the situation when I saw the funnel trying to disappear down my meatus when the tip of the catheter had just passed through the bladder sphincter.

This explained the prostate rupture I suffered twenty-plus years earlier when a Foley catheter was placed in me and its retention balloon was inflated while still in my prostatic urethra. This event was at least partially responsible for my urinary troubles that followed years later.

If this is of concern to you please let me know. I will send you all the relevant information I have. I'll do this as a Private Message to get it past the Moderator.

Warm regards. alan86734.

 

If you feel like experimenting, you might check out the manfred sauer website. They have a "third hand" device which might allow you to guide the catheter with both hands.

Jim

Howard: have now done 2300 catheters without an issue....But thanks to jimjames I am good to go today. I always say "thanks jim" after each catheter!

---------------------

I realize I'm a bit behind, numerical wise, but "you're welcome" and glad things are working out for you.

Jim

Yes, pulling up and stretching a bit helps. Also holding the meatus wide open with thumb and forefinger to widen the target. For me at least, the catheter gets "caught" and anchored a mm or so into the meatus. Once it's anchored I now can make whatever adjustments with my dominant hand to start pushing it in the rest of the way. Lately I've been putting my finger over the funnel which seems to stiffen it up a bit.

Jim

Alan: If you normally insert your catheter right to the funnel, and presumably with a flaccid penis, then I believe you have an unusually long urethra, just as I have.

------------------

Or simply an enlarged prostate which means the catheter has to travel further to get into the bladder. It's not uncommon to go right down the funnel.

Jim

 

Jim, I think you may well be right!  Thanks for the correction.

Warm regards. alan86734

You re very welcome - more than you will ever know!

Are you back to doing CIC?

I've tried the on-off cycle a couple of times but I couldn't seem to gain any traction - maybe in the future. I do CIC 4 times per 24 hr period and my totals (NV+PVR) are between 400 and 500ml except at 3am when my PVR is very large (500 to 700ml). But if I remember my pinch of salt before bed then that is reduced to 300 to 500ml.

Cheers

My CIC shedule these days varies from weeks without CIC to several times a day. A lot depends on my activity level, how vertical versus horizontal I am during the day, whether I nap or not, fluid intake and the condition of my prostate which can vary at times.  Lately, I'll sometimes self cath even when not needed just to empty completely before bed. More regular cathing also seems to condition my urethra in that if I only cath say once a week I might feel a little sting but if I cath once or more a day I feel nothing at all.

I saw significant improvements even after the 2 year mark but we all react differently. I've always viewed bladder rehab as a bonus with the major and very attainable benefit for most being a very easy way to empty your bladder completely any time you want therefore protecting both bladder and kidneys and often eliminating almost all bph symptons such as hesitancy, urgency, etc.

Jim

hi Howard- I am a newbie to CIC (have not started but going to ask my urologist about it at next visit)- can you please describe the divebomb method of the guru jimjames, for those of us who would like to know. Also how to decide on best catheter to use?

any insights are appreciated.

Steve

I am 62 - have a 190+gm prostate (size of a baseball they tell me) and have trouble especially at night. Last night i as up every 45 min