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
tim68354 jimjames
Posted
I use the Speedicath 10 .. suffered with infections for around a year and half and a half.
Is there a right way of inserting it ?
My main point relates to the water / liquid contained within it. Are you supposed to drain this before inserting,
or do you keep this within the catheter ?
I have started trying the latter and it has helped a lot when passing through the prostate/sphincter area. It seems to go through a little easier. Originally I drained the fluid over the loo but am now thinking that could have been part of the infection problem ?
Any thoughts welcomed. Tim
jimjames tim68354
Posted
Are you using the coude model or the straight? The coude model absolutely has a correct way of orienting the tip, with the straight nothing to align. The liquid is the hydrophillic fluid that makes it slippery. I just pull the tap and pull the catheter right out of the packaging and use it, whatever fluid is then on the catheter is there when I insert it. Some here have turned the packaging up and down a few times with the purpose of redistributing the fluid but I've never found that necessary. I am not sure what you mean by "keep this within the catheter"? Do you mean you are holding your finger over the open funnel on insertion as a few are doing? I never thought about that in terms of keeping fluid in, but the catheter does seem to stiffen a little when you insert it with a finger over the funnel. If this makes it easier by all means do it. I don't see any connection to infection, however, unless perhaps you were irritating the prostate/sphincter area more before. Got to experiment. Some here even add additional lube to the catheter but I've never felt I needed to do that.
Jim
mike588 tim68354
Posted
No don't drain the liquid, insert catheter as soon as you can after taking it out of the packaging, the longer you muck around draining or whatever you were doing the more chance you'll expose the catheter to germs.
amiller jimjames
Posted
Friends, 90% of the time if I void as much as possible before inserting the Cath, My HM14 by Cure Cath slips right in with NO resistance to void the rest of the bladder. I give the Cath a half turn and a little pull about a 1/8 of an inch when it stops flowing to drain the rest.
After many test at MD Anderson and UT Southwest with my PSA above a 10 (but no cancer yet) and 7 1/2 years of CICn, I can cath blindfolded.lol If I am having to go to a meeting, church, driving trip, I cath before I leave the house which gives me plenty of time to enjoy the outing. But it fills great to know I have those sticks packed everywhere for backup away from home. I keep them rotated in the cars due to the heat buildup during the hot days. Just don't let them touch anything else when you pull them out of the wrapper. You will get infected. I've learned so much from JimJames. Life is good and I have patients to wait on a better cure for this bump in the road. God Bless
alan86734 amiller
Posted
Dear amiller,
Right on the ball! We have trodden the same path and are enjoying the same astounding results! It's as though the catheter "was being sucked through the bladder sphincter, the neck, and into the bladder proper". This, of course, is not possible. I attribute this performance to three main factors: the catheter material, the hydrophilic coating, and the state of the urethra.
I wish you continued success. Warm regards. alan86734.
keith42667 jimjames
Posted
I went in for my yearly medicare check-up. Dr. noted that my PSA level was about a 9, up from a 5. This is the first time I've seen my GP since I started cathing regularly; he did the finger test and said the size of my prostate is not really all that impressive which is good to hear. That may mean that bladder rehab for my urinary retention is the right thing to do as opposed to taking drugs or surgery, although he seemed to think the laser surgery was also a more simple solution.
He thinks we should try and figure out why my PSA level has spiked and wants to give me a round of antibiotics. He says that the PSA spike could be due to irritating the prostate by doing CIC, but that since we don't know, he wants me to take the a/b and then see if the numbers go down. I've read JJ's comments regarding symptomatic vs. asymptomatic UTIs. Can asymptomatic UTIs cause a PSA spike? I can't say as I really am noticing any symptoms; just no appetite in the A.M. which isn't THAT unusual for me. My urine looks clear and no foul smell; no burning or stinging. Does anyone have experience taking antibiotics to lower PSA level?
mike588 keith42667
Posted
Keith my PSA also spiked after doing CIC - my Urologist was sure it's from irritating the prostate - can you go without doing CIC then redo the PSA test ? I'd like to know whether having a high PSA due to CIC is anything to worry about?
Taking antibiotics to lower PSA sounds illogical to me.
keith42667 mike588
Posted
No, I can't go a whole day without doing cic. If I do my bladder will begin retaining over 400ml again. The Dr. wants to check me in 3 weeks after I take the round of doxycycline.
So, what did you do? Is your PSA not high enough to worry and you decided to live with it? I'm in my middle 60s. I have had a bit of stomach upset from the last round of a/b that I took before I started doing cic. I did have a pretty intense case of prostatitis. I think that it was mainly from months, maybe years, of retaining stale urine. I took Cipro and that finally seems to clear it. I just don't like to take a/b if I don't have to.
keith42667
Posted
My GP said that taking the a/b to see if the PSA level drops is the most "up front" way to deal with it. He said that after the PSA level gets to 10 or above they begin to worry about prostate cancer beginning to spread. So if I don't try the a/b we should do a needle biopsy. I'd rather do the antibiotics and after 3 weeks hope my level drops. It was dropping; went down to 5 from 7 I beleive right after I started cic but now is up to 9 on my last blood test.
mike588 keith42667
Posted
Of course you don't want to take antibiotics if you don't need to, that is why I commented. My Urologist thought the PSA of about 9 was not enough to worry given that I am doing CIC. She did not think a high PSA alone is going to cause cancer. I'd like to find out more about it.
High PSA can also be caused by a lot of sexual activity, so before next PSA abstain for about a week or more.
I just do CIC when I think I need to - I kind of know when I start urinating more frequently or feel urgency it's time. I'm 62 and otherwise in pretty good health.
How much is your PVR when you CIC and how much do you natural void just before that? Have you tried natural void, then wait ten minutes and natural void again? You might see the PVR is acceptable then.
keith42667 mike588
Posted
Yes - and thanks for the reply - I have been doing the double-void wait thing. Doesn't sound like I'm where your at yet. My PVRs are much lower than at first. I haven't used my beaker lately but I would guess after I have a NV of about 30ml I have 300-350ml. I need to check it more now. I've been doing this about a year now and are already getting results that I think are positive. Very slow. I've had a couple of natural voids that were closer to the 100ml probably. Then if I cath I may get out 200. Something like that. But the urges can get annoying if I wait too long to cath. Usually way below the 400 I'm shooting to stay under though.
mike588 keith42667
Posted
Yeh NV of 30 is not enough - I think when my bladder has over 400 I get very strong urges.
Let me know if you find out more about PSA.- right now I'm not too concerned, and I don't think a high PSA alone is something to worry about.
keith42667 mike588
Posted
kenneth1955 keith42667
Posted
keith42667 kenneth1955
Posted
They took blood at 9:00 A.M. I did wake up just in time to make it in the the office for the blood draw. No sex before hand. I've looked at my labs from about a year ago and I can't identify on there where it lists the PSA level. They must call it something else or it wasn't on the print-out. But I think normal for me is more like 4 or 5 . I'm gonna go ahead and get the doxycycline. The Pharmacist said it doesn't upset the stomach as bad as does Cipro. Seems like I've heard JJ say on this forum that it isn't bad once a year to take some antibiotics if you're doing CIC... maybe not in this context as I'm dealing with. Oh well... Drs orders. I certainly want to avoid the needle biopsy which my GP sort of threatened me with if I didn't do the a/b.
jimjames keith42667
Posted
Never heard of taking antibiotics to lower PSA. Sounds more diagnostic than anything else and not sure I'd use antibiotics that way. If you don't have a symptomatic UTI the rule is not to treat and save the antibiotics for the real thing as you don't want to build up resistance. PSA is an unreliable marker but I have no idea if a CIC irritated prostate could cause a spike. Anything possible. Personally, I'd talk to a well versed urologist first before taking antibiotics for a spiked PSA. BTW how old are you? The newer guidelines are telling a lot of follks to stop PSA testing.
Jim
kenneth1955 keith42667
Posted
Good evening all. I did a look see on the internet to see if I could fine any information on this. I found one done at the Saga University of Medicine. It was done with 25 men ( ages 35 - 85 ) who required CIC because of a voiding dysfunction. The effects of urethral catheterization on PSA levels are controversial. The blood samples were taken for the serum PSA levels. The time from the last CIC was determined. The correlation between the serum PSA levels and other clinical factors were analyzed using Spearman's rank correlation coefficient. They found that there was no significant correlations between serum PSA levels and age, CIC duration, presence of urinary tract infection, daily CIC frequency, and the time from the last CIC. They also said that if CIC affects serum PSA levels Then they would not be able to use it to diagnose prostate cancer early and accurately. They found that there was correlation between the serum PSA level and the prostate volume. I hope this help. Ken. PS They also said at one time they thought a DRE exam would raise the serum PSA level. This study has shown not to alter the serum PSA levels.
mike588 kenneth1955
Posted
kenneth1955 mike588
Posted
It's no problem I printed it and I will put it in my file. If I need it I will have it. Take care Ken
keith42667 jimjames
Posted
Hi JJ
I'm 66. My GP is doing this for diagnostic purposes. He said he is going to call me in 3 weeks and have me do another blood sample to see if my PSA level is going down with the treatment. His solution for my nearly complete urinary retention a year ago was also antibiotics. I DID have prostatitis and the Cipro he had me take did clear that up. I did have symptoms that time. Haven't had any symptoms now except this PSA spike in my yearly medicare check up. We also talked about drugs for BPH and he prescriped me 640mg of saw pimento. I've been taking 320mg a day. He said my prostate was "not that impressive" (large).
steve05114 keith42667
Posted
Saw pimento is b.s. Studied with placebos have shown that. If the GP recommends it, then see another doctor, preferably a real urologist. I had the same b.s. with a former GP when I had bad BPH and retention at my annual exam. A few months later, I passed kidney stones and reality hit really hard. I am now with another GP who immediately recognized the severity of the problem and properly addressed it with flomax, a bladder ultrasound and such. I am now with a urologist too.
Steve
jimjames keith42667
Posted
Keith,
If you haven't started it already, I'd run it by your urologist. Seems an inexact and unorthodox method to verify your PSA results using what may be unnecessary antibiotics. Saw Pimento shouldn't do any harm but studies suggest it won't help so again may a uro is the one to consult re your prostate and not your GP.
Jim
Light1 keith42667
Posted
I have been taking Saw Palmetto (about 360 mg per day) for about a year, along with pygeum. I haven't noticed a reduction in size of my prostate, however when I stopped taking it for a couple of months my PSA went up significantly, and it went back down when I started taking again. Also, less burning with urination.
keith42667 Light1
Posted
That's interesting. Thanks for that. Did your Urologist make the connection between your rise in PSA level and the saw pimento? Your doctor didn't seem concerned when you saw the significant rise in PSA?
Its pretty subtle but I do think the saw pimento is doing some good. Whether its shrinking my prostate, I don't know. I am having larger NV volumes at more frequent urge sensations but its hard to say what to attribute that to. I think mainly its very gradual bladder rehab from doing CIC.
I'm not having any burning with urination. My PSA level of 9 up from 5 last November is the only worrisome thing. I have a call into my Urologist office and will probably make an appointment rather than start on the Doxycillin.
steve05114 keith42667
Posted
As you noted, that is do to bladder recovery from CIC and not saw palmetto. If you want anymore saw palmetto, I can send you what i have left over. I found it to be worthless as have the placebo studies. Good luck on your PSA levels. Mine have always been low but had a minor spike when I had prostatitis years ago.
Steve
keith42667
Posted
kenneth1955 keith42667
Posted
That's good to know. At least he won't over kill the antibiotics. Good luck and the nest PSA Ken