Self Catherization. An alternative to Turp, Greenlight, HoLEP...?
Posted , 82 users are following.
Since I posted a thread about self-catherization -- more formally called Clean Intermittent Catherization (CIC) -- there have been a few different discussions on the topic in various threads. I thought it might make sense to bring those discussions over to a dedicated thread. With that in mind, I will summarize and/or copy and paste some of what was said before into this thread for better continuity.
My story in a nutshell. 68 years old with BPH probably since my late 20’s. Watch n’Wait strategy with on-and-off trials of Tamsulosin (Flomax) with poor results. Symptoms were the normal retention issues resulting in frequent urination with incomplete emptying, urgency, and having to go to the bathroom at night in increasing frequencies. Near the end, two or three uti’s per year often accompanied by gross hematuria (bleeding).
Two years ago things got significantly worse and I couldn’t urinate on my own without physically pushing against my bladder (Crede Maneuver). That led to another trip to the urologist where ultrasound showed significant retention and hydronephrosis (water in the kidneys). I was told I needed an operation (this facility primarily did Turps) but first I had to rehabilitate my bladder because at the time it was too flaccid (stretched) for a good surgical outcome. I was given the choice of wearing a Foley Catheter for six weeks, or a program of self-catherization (CIC) in order to decompress the bladder. I chose CIC so I didn’t have to wear a Foley 24/7, and also because I felt it put me more in control.
Six weeks later my bladder was rehabilitated to the extent they could do a Turp, and the hydronephrosis was gone. After doing some research and a lot of thinking I decided to put off the Turp due to the potential of irreversible side effects, primarily retrograde ejaculation. Two years later, I am still doing CIC while waiting for newer procedures with better outcomes and fewer side effects.
I will detail my experiences with CIC in following posts -- but to summarize, once mastered, it’s a painless five minute procedure that allows you to empty your bladder completely any time you want. With CIC, I therefore have no retention issues, no urgency, and in most cases sleep 6-8 hours through the night without having to get up and go to the bathroom. No UTI’s in over 18 months. And because my bladder has been partially rehabilitated, I can urinate normally about 50% of the time without using the Crede maneuver. My IPSS Score (International Prostate Symptom Score) would be Zero (the best), albeit with a little mechanical assist. 
As of now, nothing that I have read about the various current procedures has tempted me to have an operation. That could, or could not change, in the future, but the nice thing about CIC is that you can stop it any time you want with no repercussions. The caveat is that CIC should be done under the supervision of a doctor who will monitor your BPH as required. Similar to seeing a doctor on a regular basis during a Watch n’ Wait BPH strategy.
I know many of you here have already had operations like Turp, and in most cases people seem pleased with the outcomes. CIC certainly isn’t’ for everyone, and I can understand why someone does not want to carry around a urinary “tool box” with them. On the other hand, with practice, it’s not the traumatic and scary procedure some think. I can honestly say right now that for me it’s about as traumatic as brushing my teeth.
I’m offering my experiences and thoughts on CIC for any of those who haven’t yet made up their mind on an operation. It even can make sense for those of you who don’t need an operation yet, but want to increase their IPSS quality of life score. In fact, wish I had done CIC earlier while on Watchful Waiting. Didn’t realize how much BPH had been affecting me for most of my adult life until I was able to empty my bladder completely.
CIC doesn’t have to be a permanent solution, it could just part of a waiting strategy like I’m on, until better surgical operations are developed with better outcomes and fewer permanent side effects.
For any number of reasons, the majority of urologists don’t seem to offer CIC as an alternative to surgery. My current urologist doesn’t as far as I know, but he’s OK with what I’m doing because it works for me. So, either you have to find a urologist you can convince to go along, or go to some of the major teaching hospitals where CIC is probably more in use and better understood. That is where I was taught, albeit not very well, but that is another story.
Jim
19 likes, 2092 replies
jimjames
Posted
Last sentence should have been " I suppose a closed system -- with sheath, bag AND INTRODUCER TIP-- would be a viable option for someone who has constant UTIs and uses a straight catheter instead of a Coude."
These catheters are available for insurance reimbursement but you need qualifying documentation from your doctor showing "x" SYMPTOMATIC UTIs within "x" months and they also ask for doctor's notes -- so it's always a good idea to make sure your doctor writes down your symptoms each time you have a UTI because often what they seem to be furiously writing down during your visits are their reimbursement codes
Jim
tim68354 jimjames
Posted
Your advice the other day re flushing urethra out etc was very informative. I have tried this using a very low % of hibiscrub diluted with water, this contains chlorhexidine which works as an antiseptic. I managed to find some historic trial data on the web re catheter use and it had some very impressive results. Fingers crossed it helps. I can actually feel a very very slight tingling, numbness after a flush which is quite reassuring in a very strange way ?! .. we will see. I’m convinced there is an answer for everyone’s problem, it’s just finding it !
jimjames tim68354
Posted
Correct. Asymptomatic bacturia aka Colonization means the presence of bacteria without symptons. Very normal in the self cath population and and in general, should not be treated with antibiotics.
Are you doing a urethral flush, bladder flush, or both? What is your delivery mechanism for the flush. Also, if you have a link to the historic data on hibiscrub, please send it to me via private message. Thanks.
Jim
tim68354 jimjames
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kenneth1955 tim68354
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jimjames tim68354
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To the right of my name (Jimjames) there is a little symbol of an envelope. Just click on it and it should take you to the private message (PM) function. Or, you can just post the link here and it should appear in a few days after it goes through moderation.
Jim
kenneth1955 jimjames
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fred43679 jimjames
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Jim & Group,
Please bear with me here as I’m about to expose my extreme ignorance, but, what exactly is a “TURP”?
I’ve seen that mentioned numerous times on this forum.
Regards,
Fred
jimjames fred43679
Posted
Hi Fred,
TURP is short for "Transurethral resection of the prostate". Basically they go in through the urethra and bore away at your prostate so that it no longer obstructs the urine flow. It has long been considered the "gold standard" for prostate reduction procedures but today there are less invasive alternatives with faster recover and fewer sexual side effects. That said, many urologists still perform TURP or it's variations and many patients are happy with it. Just keep in mind that there is a very high incidence of permanent retrograde ejaculation after the procedure. Retrograde ejaculation is often termed a "dry orgasm" because no fluid comes out of the penis when you climax.
Jim
kenneth1955 fred43679
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fred43679 kenneth1955
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Jim & Kenneth,
?O.K., thanks. This is probably what my doctor meant when he told me he could "do a roto-rooter" on me. Scares me. Maybe I need to find a new urologist. The guy's kinda expensive anyway.
?He also told me to "stay away from all caffeine". But I have found that caffeine, when taken in moderation, seems to help me. I told him about my zinc discovery but he really didn't respond to that in anyway.
?I was taking large doses of zinc to ward off colds and flu. Some folks claims it works and some are skeptical. But I discovered that when I'd take it, it became much easier to completely void my bladder for the next 2 to 6 hours after I'd take it. I have absolutely NO idea why this works.
?On the sobering side, some studies have shown that zinc might contribute to or exacerbate Alzheimer's disease. This is GREAT news! You can take your pick. Either you can't urinate or you can lose your marbles. Sheesh! Ain't growin' older fun?
Regards,
?Fred
jimjames fred43679
Posted
Caffeine can work both ways. If it seems to help, I'd go with what your body says as opposed to your urologist. Newer studies show other benefits of caffeine, so again I wouldn't stop if it's not a problem.
Jim
kenneth1955 fred43679
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harold5217 jimjames
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Hi Jim i am having success with self catheterizing I started five times a day now i'm down to once a night. The problem i have is that usually in the afternoon i get frequent urges to void which can go on for hours What can i do to prevent this
jimjames harold5217
Posted
Hi Harold,
Have you tried to self cath as soon as you get the urge to void in the afternoon? If you have, how much comes out naturally (if anything) and how much comes out of the catheter. If you haven't, I would self cath as soon as I get the urge and write down both the volume of your catherized void as well as the volume of the natural void preceding it, if any. In fact, I'd do a 24 hour void log, writing down the time and volume of each natural and catherized void. The underlying principle is that you don't want to be carrying more than 400ml in your bladder at any one time. The 400ml would be the volume of your catherized void plus any natural void preceding it. If the total bladder volume is more than 400ml, then you want to increase your cath frequency.
Jim
hank1953 harold5217
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harold5217 hank1953
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As i have read here written by Jim i think the bladder heals itself when it's fully emptied by cathing
hank1953 harold5217
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tim68354 hank1953
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Out of interest, how long had you been SC’ing for before you managed to get down to one a day ? .. months / years etc ?
Jim,
I have tried to PM you but cannot find the email box thing ? .. OOI, now 3 weeks and no further UTI or symptoms, squirt of diluted hibi pre- cath seems to be doing the trick, albeit early days !! .. The study I read is available online if you search under google. Type in chlorohexidine catheter and in the uk it’s the third entry down beneath ads. Study from ncbi....
hank1953 tim68354
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Hank
jimjames tim68354
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Hi Tim,
Didn't find your study but did find similar.
1. Did you use 2 or 4% chlorohexidine?
2. How did you administer it? Did you just squirt it on the penis head and meatus or did you irrigate the meatus? If the latter, how did you get it in the meatus?
3. Does it stain at all like providone iodine? Does it have to be washed off?
THanks.
Jim
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alan86734 jimjames
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I am also interested in your views on bladder and/or urethral flushing, but I’m not sure of the protocol to follow. Is it O.K. for you to send me a copy of your response? Should I also PM my request to Tim68354?
I had my flexible cystoscopy over a year ago in my urologist‘s office. The cystoscope was a closed circuit instrument which maintained a constant flow of saline through my bladder. I was surprised by the cloud of detritus churned up by the flow, just like the “snow storm” one sees in those little glass desk ornaments when you turn them upside down.
My uro reassured me that this was borderline and did not require flushing or washouts as long as the urine exiting the catheter during my CIC sessions remained clear, which it has. But, if the urine clouded up excessively then we would have to address the problem.
I would like to take this opportunity to wish you, and family and Patient associates the season’s greeting and best wishes to you all for a great 2018!
P.S. I have searched everywhere for a longer indwelling catheter that would fulfill my needs but to no avail. The only real solution would be a suprapubic device. Then my delightfully creative, but somewhat evil mind turned to the possibility of having more than one hole bored to allow a plurality of catheters to be placed side-by-side. I could win just about every p*****g contest, hands down!!!
P.P.S. The latter comment is just light humor to ease the burden of life; do not attempt at home.
Warm regards alan86734.
jimjames alan86734
Posted
Hi Alan,
When you say "indwelling" catheter, are you referring to a Foley? Why are you using a Foley as opposed to self cathing (CIC)? And why isn't a Foley long enough?
I've tried bladder irrigation maybe a dozen times using either Microcyn or its veterinary counterpart. I've also irrigated with sterile saline only and a few times with a mix of sterile saline and Microcyn. I will have to check my notes to be sure, but basically I first introduced a straight catheter into my bladder. Then, using a syringe barrel that I pre-filled with around 100ml of solution, I mated the barrel point to the plastic funnel of the catheter and injected the solution into my bladder. Most of the time I let it wash around a bit with a gentle back and forth motion on the syringe and then extracted the solution by cathing. Once I left the solution in until the next time I cathed. If you search the internet you will different variations of what I did using different solutions. At some point I stopped because I was concerned about the long term effects of various solutions in my bladder (other than sterile saline), plus its a little time consuming.
What I did more often was urethral irrigation which I have also described in the self cath threads. Here, I just used a squeeze bottle and gently introduced either sterile water or an antiseptic into the urethra.
I haven't done either type of irrigation for over a year now.
Jim
alan86734 jimjames
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My urethra has an overall length, when flaccid, of 50mm (2.0 inches) greater than the standard of 16 ins. overall. This is confirmed for the umpteenth time by my experiences evaluating the Cure straight catheter. This comes with a cute little insertion sleeve which measures 3.00 ins. When I insert the catheter fully – flaccid penis, first appearance of urine – the sleeve is forced onto the external part of the funnel for its full length and, even then, only one eyelet seems to be active in most cases.
This marked the beginning of my urinary woes some 20 odd years ago when undergoing spinal laminectomy. No sooner had the anesthetist begun to administer the spinal block that I went into shock with acute cardiac fibrillation. The attendant crew resuscitated me O.K. and whisked me up to ICU where I was routinely cathed with a Foley. Something went terribly wrong here as well but I was only half conscious and in no position to help. I was told later that difficulties were due to “operator lack of training”. It was some 20 years later when I started to self-cath that I realized that I was the problem and that, years before, the Foley balloon had probably been inflated when it was still in my prostate. The resulting rupture led to scar tissue which ultimately began to cause my urine retention. It was two years before I got someone to write me prescription to enable me to CIC.
All this has changed for the better, I’m happy to say. When I was learning to fly I understood the importance of the walk-around and the same applied when I was driving an 18-wheeler in central and northern Argentina. Same precautionary measures apply here. I am no longer mobile (succumbed to the infamous Fluoroquinolone Toxicity Syndrome) so, should I go downhill any further I would probably end up in our local hospital and would like to know what my options would be ahead of time.
You have given me much valuable information already so if you include me in your list that would be great. Many thanks, Jim, you have been a great source of help and support!
Warm regards, alan86734.
jimjames alan86734
Posted
Alan,
Check out the The Cure Medical M14XL Extra Long Pocket Catheter. It's 25" long. I've also seen other catheters not quite as long but longer than the standard 16".
Jim