Self Catherization. An alternative to Turp, Greenlight, HoLEP...?

By age 85, 85% of men will have BPH.  If your dad got BPH by 60, then there is a good chance that you will also. As we get older, like everything else that lives, our parts wear out (regardless of how much sex we have, or don't have).

As for your nocturia problem, have you tried not eating or drinking between 6pm and 6am?  If not, it's probably worth a try.  It's worked for me. As far as TURP being the "gold standard", it's the gold standard for the docs and hospitals that receive your gold. For those who go under the knife, not so much.

Hi John, 

Try my best to answer your questions. 

Yes, you can feel both sphincters when inserting the catheter, but less and less as you learn to relax and as your body gets used to the process. After awhile, it becomes an automatic, painless kind of procedure like brushing your teeth. That said, in the beginning there can be issues depending on the person. In my case I had bleeding, false urgencies, some pain, and developed a UTI. Many others have it easier

As to relaxing the sphinter, again it comes with time. In the beginning CIC was very tense and stressful for me, so of course my sphincters were tight. Later, things loosed up .Now, I make a concerted effort to relax the whole area, along with slow breathing during the process,  in a similar way you do yoga relaxatio exercises. I also read somewhere that the void process is 80% relaxation of the sphincter and only 20% pushing with the detrussor muscles. With me it's probably 90/10, as most of my concentration during a void is on relaxing the sphincter. As far as navigation goes, I start with the penis at straight up toward the sky, but as soon as the catheter gets to where it will go around the prostate, I drop the angle so the penis is parallel to the floor. I find this makes insertion easier, at least from the standing position, which is the only position I have ever used.

As to your question if coude catheters hurt, I have only used coudes so I can't give a comparison. You would really need to speak to someone who has used both, but most here seem to have only used one or the other. But as I said before, I don't have any pain during CIC, so my coude doesn't hurt. The purpose of the coude is to be able to navigate more easily around the enlarged prostate without snagging it and also to avoid sticking the urethra and creating a false passage. They also apparently help if you have any type of urethral abnormality.

In my opinion a topical anaesthetic is unecessary because there is no pain, however maybe that would have helped me the first couple of weeks. However, you have to be careful of what you use is water soluable and not something in a petroleum base like vaseline. Also, if you use a hydrophillic catheter like I do, the hydrophillic coating might not work as well if you have some sort of numbing gel inside. Probably not a problem with a more traditional catheter that requires the use of a lubricant gel. 

If you think you want to give CIC a try, I would go for it and not worry about your doctor's reaction. If he resists, you can find another one hopefully although not sure how that works in Canada. There are also studies out there that suggest a six to twelve week trial of CIC prior to TURP will improve TURP outcomes. You might try that approach with him. 

So let us know how things work out, or if you have any more questions. 

Jim

 

Just to clarify, when I was talking about 80/20 and 90/10 in terms of relaxing the sphicter versus pushing with the detrusor -- I was talking about a natural void of which basically is all I do now as I'm pretty much off CIC. During the CIC process you don't need to use your detrussor's at all, however in the beginning when I was doing CIC at almost every void, I did push with the detrusor's sometimes -- again not because I had to, but because I wanted to give them some exercise. The result was just the urine came out faster.

Jim

John.......First of all don't let a doctor talk you into anything.  It is your body and you have the right to pick what procedure you like to go with. Sometime a turp is the only thing they know because they have been doing it for years.  Retro orgasm sucks.  Had them when I was on a pill.  They hurt my bladder.  At 60 I'm not looking to have anymore kids but I felt incomplete after.  Had a Uro-lift and it worked great for me.  Has for a coude catheter it's the only one I can use.  Had a bad time last year in the hospital they tryed 3 diffrent ones and they all hurt never got it in the bladder. They will never do it again.   My urologist found a stricture that I can't use a reg catheter.  Had one put in when I had my uro-lift.  He put it in when I was alseep  So don't know if it hurt going in but coming out it was fine. Just make sure you get all the information you can.  A turp or a laser will give you retro orgasm.  Anytime they cut away at the prostate you will have them.  Take care and good luck  Ken

Hey John,

Thanks for the info about the  Fouad Aoun article on LUTS and minimally invasive therapies. Really up to date. What intrigued me there was not the Rezum but the PEMF. It was not prominently featured but it got me to an animal and human studies using some of the footnotes and a couple of mentions in the main article. Seems like the Parsemus Foundation funds studies of minimlly invasive overlooked therapies and they funded one on Pulsed Electromagnetic Fields on dogs prostates and it resulted in a 57% reduction in size with absolutely no side effects. There have been previously published human studies. This is a therapy used to mend bones and other current applications. I'm using CIC/SC while waiting for this type of really minimally invasive therapy.

A couple of weeks back, after reading this blog, I sent away for, and received my first catheters (I had been suffering from such severe urine retention, causing many sleepless nights that gave rise to depression, that I had signed up for a PAE procedure). However, I have yet to open the shipping package full of catheters and have cancelled the PAE procedure.  Because, after trying everything that was non-prescription, including zinc, saw palmetto, beta sitosterol, stinging nettles, and pygeum, with sometimes horrible results, I have finally found what, for me, has been a game changer.  

I read that both peppermint and spearmint leaves were effective anti androgens. A pound these dried leaves from Amazon cost me only slightly north of $14 each.  A pound of mint leaves is a large quantity, so, even if the leaves didn't work, I figured they would make great tasting tea and that my cost would be next to nothing. 

I cold brewed them, using a 1/4 cup of leaves to every quart of water.  I leave them in the fridge for at least 12 hours.  At first I drank the tea hot, using vanilla flavored non-dairy creamer.  Great taste, and even a greater after taste.  Now, I drink the mint teas cold with nothing added.  I've grown to enjoy them.

Before I started drinking this mint tea, there was no way I could urinate after 8pm.  My daytime urination was weak at best.  Now I've got some serious streams during the daytime, and decent streams in the evening before going to bed.  I sleep the night through, and no longer feel like I am sleeping on a urine filled bladder.  It's great waking up in the morning after 6 to 8 hours sleep.  It's been years since I've been able to do this consistently.  I hope this is not an anomaly, because I seem to be getting better everyday.  

I've made many other lifestyle changes, that I believe I wrote about in previous posts.  I hope this info helps others who suffer from BPH urine retention. 

 

Hi Rich,

First, very happy that you found something that is working! 

My understanding is that mint is a strong diuretic, which is probably what is helping you. In my case, I've found both coffee and beer to be helpful in regard to increasing the stream and better bladder emptying. Both are diuretics. And while many articles on bph advise against the two, I 've personally found them helpful and also found some articles in  support of coffee. Lastly, years ago I was on high protein, low carb diet. Don't think it was Atkins, possibly the Zone diet. In any event, one thing I noticed was that my urine stream was very strong on the diet. Turns out that higher protein diets also have a diuretic effect. 

I have also read that some suggest thiazide "water pills" Hydrochlorothiazide. These pills should probably be taken no later than early afternoon or you may end up with too much night time urination. They are also used for lowering blood pressure so should not be taken unless under medical guidance taking into consideration all your health needs.

Lots of things to experiment with if motivated. 

But back to mint tea. One thing to note is that while mint is supposedly good for stomach upsets it can be a very strong trigger for reflux and GERD. So, if you have either of those two conditions, tread very cautiously with any type of mint, tea or otherwise. 

Richard 

It was probably the Atkins diet, because the Zone is not high protein. The Atkins diet puts one in a state of ketosis, which can be hard on the kidneys.  Coffee and caffeinated tea make my symptoms worse.  They also dehydrate me.  Mint tea, on the other hand, really is an anti androgen.  In fact, women with acne and post pregnancy hirsutism have been known to see relief of those symptoms by adding mint tea to their diets.  

After so many disappointments, I'm happily surprised that the mint tea is working.  I can only hope that it continues to work as I continue to age. One other positive side effect is that I no longer have a pre-ejaculatory fluid retention problem after having sex.

It's possible that it was the Atkins diet but the Zone diet is considered relatively high protein/low carb as compared to let's say the Mediterranean diet or even what most Americans eat which is generally very high carb and high fat. One day I should go on the Zone diet for a few days and see what happens. 

I understand that many report worseing symptons with coffee, but for me the opposite. The study I was talking about had to do with a group of post operative patients who were routinely catherized I think because of the anathesia used. What they found was that if they gave them a couple of cups of coffee, in most cases the urine started to flow without the catherzation, plus their urination threshold was lowered meaning their bladder didn't fill as much resulting in less retention. This seems to be similar to what I experience but it's really hard to draw generalizations from anecdotal experiences.

I wish I could try the Mint tea, but unfortuntely I do suffer from reflux/GERD if I'm not careful with my food, and the last time I had peppermint tea I paid for it in not a good way. 

Can you expand a little on your last sentence. I assume you mean "post-ejaculatory" fluid retention and not "pre-ejaculatory"?  Are you saying that after you ejaculate, you don't urinate for awhile?

 

I just want to add that the overall idea is that diuretics may be helpful to some people with BPH. It seems to help both with urine flow and emptying, and if timed correctly should help with nocturnia. On an individual basis, I think experimentation is the key because what works for me may not work for you and in fact may have the opposite effect. 

It does happen post ejaculation, but the substance is pre-ejaculatory fluid. I don't believe that, other than for some kind of bactorial discharge, that there is such a thing as post ejaculatory fluid.  And yes, the fluid made it difficult to urinate afterward.  

Sorry the mint won't work for you, and sorry the coffee won't work for me, because I like coffee (and love the caffeine for working out) even more than I like the mint.

One other thing that has worked for me, as far as getting a good night's sleep, but can be problematic for others, is melatonin.

I use a 2.5 cup (600 ml)  Pyrex measuring cup that you can find in any household store. If you are urinating (or retaining) more than 600 ml, then use a bigger container. 

So I simply urinate into the measuring cup and write down how much came out. Let's call this volume "NV" for Natural Void. 

Then I empty the cup and caterize into the same cup. Again, mark down how much came out. Let's call this volume "CV" for Catherized Volume. 

In the beginning do this every time you urinate or self-catherize noting volume, date and time. If you want a complete diary, you can do the same thing for fluid intake.

In general, your CV should never be more than 400ml. If it is, then you should catherize more often. If your CV volume falls below 150 or so, then you should catherize less often. 

A stricter forumula, however, is that the total volume (TV) your bladder holds at any one time (NV plus CV) should never exceed 400ml. That way you will insure that the bladder will start to decompress. So, in this case, if your TV is more than 400ml, then catherize more often to bring it down to 400ml or less. 

Of course run all this by your doctor and nurse as they might want more modest goals initially given that you drained 7 liters which is more than I drained at any one time. 

In any event, these logs will be helpful both to you and your doctors in terms of monitoring progress and making decisions moving forward as to frequency of self-catherization. 

Jim