Intermittent self catheterization.

Derek,

Self cathing doesn't require the prostate to shrink or even stop growing. As long as the catheter reaches the bladder it will empty completely both protecting bladder and kidneys. There is also the possiblity for bladder rehab. If this occurs, then the rehabbed bladder can sometimes overcome an enlarged and even growing prostate producing good natural voids. This was the case with me. Four years ago I had to self cath 6x/day. Today, it's down to a couple of times a week.

Jim

Keith, I don't see how PSA can decline as a result of CIC. Hank

I think the reason the PSA declines is because you no longer are in chronic retention. All of my uro's agree that urinary retention will elevate the PSA..

Hi Keith,

I can't go that long at night without getting uncomfortable.  Can you tell me:

- how much caffeine do you have

- what's your approximate daily liquid intake?

Thanks a lot!

Its a good question.  Typically I drink @ 8 - 10 8 oz. cups of strong black coffee daily.  I know; its a habit. I grind up my coffee beans and don't use cream and sugar because I actually like the taste of good coffee.  Of course I also like the stimulant.  Sometimes I drink more water than other days; usually don't drink more than maybe 40 fl. oz; it just depends.  Of course there is water in the coffee and that goes through my system but I think that a diuretic such as strong coffee causes ones body to expel more H20 than was in the coffee so there is a net deficit if you don't replace it with water or juice or milk or something else.  I really noticed it when I used to do mail delivery and I would carry coffee with me.  If I also drank water I would have to urinate quite often; probably one way I got into the retention in the first place because I couldn't often stop.  

But I understand you are wondering about night time.  Its a little different for me because I can usually wait until I feel the urge to cath right before I go to bed because I'm not working.  If I had to sleep for 7 hours regularly in order to function well at a job, for example, on a regular basis I would probably have to get up at least once because, as you say, I often DO get "uncomfortable" lying in bed.  Not too worried about incontinence like I had before I started cic but sometimes I know its time to cath when I start rolling around in bed trying to get comfortable.   

Hi Hank- 

 

I don't have the numbers but it was my urologist's assistant that looked up my numbers from my labs (at my request) that informed me that my PSA level was "going in the right direction" now as opposed to going up over the last two tests.  I was getting some required blood tests as I was going through hep c treatment supervised by a gastroenterologist at this same time.  I don't think the psa levels were alarming although the computer had highlighted them in red to get the doctor's attention.  This has been several months ago now so I probably should get it checked to make sure its OK.  But yes; my uro docs assistant told me that the declining numbers were probably the result of my doing CIC.

There was also a creotine level that I guess indicates kidney function (?) that was also reversing and was highlighted for attention by the computer.   That level was going down after I had been doing cic for a few weeks.

Thanks for the message.

Wow - that's a lot of coffee!  I have maybe one cup a day and 50 ounces total liquid intake and still have to get up.  I guess you really have a lot of room to be able to control your symptoms.

Hydrophillics are great, but since I was reusing caths, see reply to Fred, I went with unlubricated caths, using surgilube to lubricate them.

Yes, it feels so good to relieve myself by CIC. I sleep 6-7 hours a night versus almost not sleeping before CIC. This solution seems so less invasive than TURP. I had thought about HoLeP laser, but posts on line describing the recovery process some experience drives me back to CIC.

 

"For me, if I can urinate even 30 ml with a natural void (NV) i am probably retaining @350 to 400.  I was in complete retention less than a year ago.  I had to go to get an ultrasound of my bladder when I was discovering my problem (my GP didn't have a clue) and it showed my bladder was stretched almost up to my navel."

So it's been a year and now you are NV about 30ML? I am in complete and just wondering how long it takes to get to where you are. At most, I'm my NV is about 50-10 and that's when my bladder is at 500ML or over. Were you on any medication that you felt helped. Doc is telling me to use Tamsolusin but I don't see how that will help a stretched bladder. 

I have only been on CIC fro a couple of months. Recently I started getting pain near the ribs(both sides),  not sure if that has anything to do with CIC.. Just uncomfortable, nothing that bad but I will probably schedule another apt with URO. Has anyone had this? Is this the start of UTI?

It was right around memorial day in 2017 when I was in complete retention... but that was sort of a temporary state.  I live 50 miles from any hospital or emergency room; I was scheduled for an ultrasound of my bladder and was to drink several ozs of water before I drove down there.  I had noticed that having to "hold it", especially sitting or in a car would make it much harder to pee when I finally got somewhere I could do it.  Not too long after I began CIC regularly and was keeping a log of my NV (natural voids) and the amount I subsequently got out with the catheter was when I noticed that 400 cc was about the limit of my non-feeling or lack of urge.  At first, I was going by the clock more than using urges.  I would say that after about 4 months I began to get more urges.  

I HAVE had some of the minor pains that you described at times.  I think it may be some of the feeling coming back into my detrusser muscles in my bladder.  I don't push a lot when I'm trying to get the flow started but I do tense up my muscles at times which is sort of like pushing.  I have to say that I DO notice some very gradual improvement and I am becoming a believer that a big part of this problem - at least for me - is the bladder rehab part.  Its obvious that I have a blockage but this is at least a two-fold problem.  The only drug I've taken is saw pamento... hard for me to tell if its helping.  Sometimes I think yes, even if only a little.  My NVs are still pretty pitiful but I always try before doing CIC.  I usually sleep on average about 5 or 6 hours before having to get up and then I usually have no urge.  I give myself a little while; drink a cup of coffee; and if I don't feel any urge I go ahead and cath knowing that its been several hours and my frequency when awake is usually no more than 5 hours apart.  Hope this helps; I didn't mean to give the wrong impression about my full retention.  As I said, my NVs are so small that its almost the same as.  I think without these easy to use catheters and my medigap insurance that I might have to go for an operation.  Like JJ says, there's just nothing yet that sounds feasible that is offered around here.  

Thanks Keith. It seems as though I am on the same routine as you except that I can go to about 500MLbefore feeling I need to go.My prostate was not that enlarged but was diagnosed with some obstructions. I did start taking saw palmetto but didn't stay on too long to give it a chance. I know the CIC will help the Bladder rehab (hopefully) but wasn't sure what I needed to do to lessen the obstruction. And at this point I don't know that I trust the doc enough to believe there is an obstruction. It could be his way to help me get the insurance to pay for a TURP as he recommended.

I also follow the same routine, cup of coffee in the morning before CIC and chose to forgo the second cup as I believed it was hurting rather than helping my bladder. Looking forward to getting to where you are at with 30ml of NV, just seems far away at this time.

Let's beat this!

Tom,

Check out my story here and in the "on/off strategy" CIC thread. 30ml is a lot better than no NV, but over a 3 year period, I went from almost no NVs to a mean of 250ml, with up to 400ml voids at times. The key for me was keeping total bladder volumes below 400ml as well as alternating stress and rest periods for the detrussor muscles.

Jim

Hi Jim, Did you keep on a CIC schedule? like every 4 hours Or what?

frank,

The overriding principle is that you don't want your bladder holding any more than 400ml at any one time. This would be the amount of your catheterized volume plus the volume of any natural void just preceding it. If you don't have any natural voids, then your bladder volume is the same as the amount that comes out of the catheter.

In general, this comes out to a schedule or around 6x/day if you either have no natural voids or very little natural voids. Spreading out the six catherizations over let's say your 16 awake hours is a good start. That would be a schedule of cathing around every three hours. But that's just a good starting schedule. You might find that your kidneys don't produce urine evenly throughout the day and therefore you might modify the schedule to accomodate the 400ml rule. A written void log will be helpful here.

Often the first morning void is the largest, and if it's a little over the 400ml, not to worry. However, if you find you're holding much over 600ml in the morning, you might consider cathing during the night.

400ml comes from amount of urine an average, normal bladder holds. If you consistently stretch it too much beyond that, then the bladder can remain stretched and not function as well. By keeping bladder volumes under the 400ml thereshold, you decompress the bladder and give it time to heal and function better.

Jim

Jim