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

I am assuming this is the same issue you  posted about in another thread a few weeks ago? At that time I believe you spoke to the nurse and she said not to worry for now. I think it's probably time now to insist on seeing the doctor who is hopefully a urologist as opposed to a gp, and somewhat versed with self catherization. If not, then seek out a doctor who is. Bleeding can be benign or serious but important to find out which. 

Personally, I had gross hematuria (looks like red blood, very visible) as well as microscopic hematuia (don't really see it but can turn urine slightly brown or an ice tea color). The gross hematuria was only the first few weeks I self catherized. Never since. Microscopic hematuria has perisisted to one degree or another most of the time since. I was told this is fairly normal. 

Your case sounds like gross hematuria and since you say it's in the upper area that rules out the prostate. My guess you nicked something on the way in or have created something called a "false passage" meaning the catheter is hitting a dead end tunnel, an injury created by previous catherization. If this is the case it would show up on imaging and/or a cystoscopy I believe.

If it were me, I would insist on seeing the doctor and have him examine me.  

Good luck.

Jim

Thanks for the quick reply. I have contacted my Urologist. 

Hi Michael,

Your story is very similar to mine. About the same age, self cathing for about the same amount of time, dx with hydroneprhosis, also started with reusable catheters and now using Speedicath with coude tip and presently colonized. Also following PAE but not in much of a rush as long as things stay as they are. 

As to the colonization, from what I've read, heard and experienced, not so much as a "drawback" a a benign condition like everyone's skin being colonized by bacteria. I don't have the odor you talk about but did occasionally for brief periods of time. Have you ever tried a bladder irrigation? It might get rid of the odor if it bothers you. Also, you could treat the bacteria with antibiotics and then start over again, perhaps growing a less odorous bacteria. 

In my case I started CIC six times a day but I have had periods where I only required it once or twice a day, and in fact periods for months when I didn't have to self cath at all, with near normal emptying and very low post void residual. I attribute it to my bladder regaining a significant amount of lost elasticity. It was very atonic/flaccid when I started and probably holding over a liter all the time. Now, during the times I don't cath, my PVR is almost always under 400cc, most of the time under 150cc and sometimes under 50cc. Depends on the time of day, amount of fluids, etc. 

What I have noticed over the past six months or so is that as long as I am relatively active, I do not need to self cath at all. So, for example, if I'm out and about during the day then I have no problem with normal voids. It's when am imobile for periods of time -- sitting, lying down, etc -- that's when I have problems with a natural void and have to self cath. Given my lifestyle, right now that translates into only cathing in the evening when I'm usually home. I therefore rarely carry catheters with me unless I am going to be out of town. Alternatively, I could walk around for ten minutes or so after lying down and stop probably stop cathing altogether, but it's just easier to cath than to march around in the middle of the night in my bedroom!

What size Speedicath are you using? I started with 14 and then switched to 12 which felt much gentler. Earlier this week I opened an old  pack of 14's by mistake and decided to use them and no big deal. I guess my uretha has been battle tested!

You mentioned not liking the mental side efffects of flomax, etc. Have you ever tried daily Cialis? I'm currently not using it but was thinking of going back to see if it could help with my issue of not being able to naturally urinate after inactivity. 

Glad to see that you have found a workable solution with CIC.

Jim

 

Hi Jim,

Nice to hear from you. I use speedicath FR14. I am a real  fan of coloplast, a Danish company with a fine product !

My situation is I cant urinate without a catheter. I did get tested for urodynamics, and apparently my bladder does have some tone left.

I have bladder diverticula, which adds a little extra spin to the story...

 I have gotten used used to the idea of being colonized. I had a few infections early on, but not for a year now. 

My urologist is an open minded man. He says he has patients who have been cathing 1for 10 years. 

i will inquire about bladder irrigation. The odor is quite subtle. I have to bend over to detect it at all.

you are fortunate to be able to pee if you stay active. 

​If I do go ahead with the PAE, I might have a similar situation. 

It's good to hear from someone who is in a somewhat similar situation..

Michael

Michael,

I also have a large right side bladder diverticulum. I don't talk about it much here because it really doesn't change the crux of the matter although it does add some additional issues. For example, sometimes when I cath (or naturally void) I may have to repeat in short while.That's because the diverticulum is draining into the bladder during the interim period. 

That said, I think my diverticum has either shrunk from the CIC. Via ultrasound it rarely has over 50cc after any kind of void, when a few years back, before CIC, it was always holding around 300-400 cc of fluid.

When you self catherize, do you just put in the catheter and let it drain, or do you try and use the detrusor muscles to "push out" the urine? When you do the latter, the urine will come out faster. At least initially, when I could hardly naturally void, the pushing out helped strengthen my detrussor muscles. Now they get exercised just by naturall voiding. Without exercising them, they kind of atrophy and stop working. 

I haven't done a bladder irrigation for some time but it's really very simple and you can do it at home. You get a barrel syringe (no needle) and fill it with around 30-50cc of either sterile water or some sort of antibacterial solution. Then you cath as usual, empty your bladder, and then while the catheter is still in the bladder you mate the tip of the barrel syringe into the green plastic tip of the Speedicath. They fit perfectly. Then you gently push in the fluid and leave it in for a minute or two with the plunger pushed down and then cath out the fluid as normal. Or sometimes leave it in until  the next time you cath. Various techniques for different fluids. If it's just sterile water, then what you are doing is more of a "flush" so you might repeat the process several times with the catheter stilll in. Keep repeating until the water runs clear. If you're using an anti bacterial solution, then you either only do it once or again leave the solution in until the next time you cath. Really only takes a couple of minutes and you only have to do it once in awhile. 

Jim

Forgot to add that there are a few other techniques to get the detrusor muscles moving and can stimulate a natural void in some cases when it's otherwise imposssible. The most effective for me was called "tapping" which is a light rhymic motion with the fingertips over the bladder. It helps stimulate the detrusor muscles. I rarely use it anymore but back when I started CIC  I could not begin a urine stream naturally without it. There are several other methods as well such as the crede manuever which is more of a "push" but here you have to be a little bit careful not to push so hard as to reflux urine backwards toward the kidneys. 

Jim

Jim,

this is  useful information.

yes sometimes when I cath, it seems like i have not fully voided (maybe 10% of the time) so if I pull out  the cath  a little bit,  and push it in again, and pull it out , there is quite a lot of llow that results. I attribute this to a divertculum .

It's encouraging to hear that your diverticulum has shrunk. My urologist has not spent so much tim measuring the diverticulum size. Another one did , with an ultrasound machine.

I should try to use the detrusor muscles...i don't really do that.

Once to see if the muscle was working, I stood in my shower, and tried to see how high I could pee through the catheter, and the stream went up to  the level of my navel, which according to my urologist, (who was surprised at this maneuver,) indicated that the bladder still has tone.

I know that keeping residual urine in the bladder is not good for the bladder muscle, so voiding it completely, I take to be a good thing. But using the detrusor muscle while voiding would be even better.,

My urologist has told me that to force when I can't void is not a good thing. 

regarding the irrigation technique, that is something I have not tried. Did your urologist teach you to do that? I'm a little hesitant to introduce fluid from the outside into the bladder, because I have had a few bladder infections. But a saline solution would be sterile. What proportion of salt to water do you use? 

from some readings, I gather that these bacteria that have colonized my bladder are pretty difficult to eliminate..something about how they form "biofilms" What is your experience along those lines? are you able to actually purge the colony, and do you test with urine test strips to see if the colont is gone?

Michael

Michael,

Yes, I do that sometimes myself. Pushing it in and out. Also sometimes putting my finger over the funnel hole to create a suction like effect when doing it. I think it might pull out some urine from the diverticulum or at least get the last drop out of the bladder. But like I said, my diverticulum doesn't hold a lot these days compared to the 300-400cc before I started to self cath. 

Interesting your shower experiment but you can really do similar every time you cath. Just let it flow naturally and then push out as if you were doing a natural void. If the urine comes out faster while you push, then you are using (and exercising) your detrussor muscles. You might start doing this for just a few seconds in the beginning and then work up gradually until you can do it for the entire cath process. I don't think this is the "force" your urologist is talking about because the urine is already coming out. If you try to force urination (with nothing coming out) that's another story. But do try the "tapping" also, it's very gentle, nothing forceful. 

My last urologist didn't know all that much about CIC, so the irrigation came from my own research. A lot of the info I got came from the SCI (spinal chord injury) community because CIC is very popular given their nerve damage. 

You can sterilize your own solution, but I never had. You can purchase sterile saline in 100ml bottles online. They are very inexpensive. With sterile saline and a sterile single use syringe (also inexpensive) I really don't see any issues introducing any bacteria into the system, but it can help flush the bacteria and sediment out. 

Urologists don't like to treat colonization for good reasons but really no harm once a year or so if you have a good reason such as trying to get rid of an odor, or in my case to clean out the system during times when I was not using the catheter at all. 

If you can get a positive culture, then you just treat for that organism. If you can't get a positive culture, then try something broad spectrum. Again, not suggesting anyone treat colonization (asymtomatic uti) without a good reason because if you do it too often then you can get bacterial resistance. 

Yes, I have used Siemens Multisitx 10G to check my urine. Same strips as a lot of urologists use. In general, you look at leucocytes and nitrites for uti's or colonization. Right now my leucocytes are negative and my nitrites are positive. I've had them both positive at times but still been symptomatic. After treating with antibiotics -- one time because of a uti and once because I just wanted to clear the system -- they both will be negative. When both negative, no UTI and no colonization. I actually kept them both negative for about six months even with daily catherization but the sterile procedure I used (including urethral irrigation) was a PITA and eventually I did get colonized. My entire cath procedure now only takes a minute with minium prep so I have chosen convenience and colonization over a more tedious sterile procedure and bacteria free urine. Haven't had a real UTI in several years now. 

Jim

Jim

Forgot to add that if you do decide to use your detrussor muscles to help push out the urine during the catherization process, consider dropping down to a 12F as opposed to the 14 you are using. It will come out a bit slower with the 12, so you can use  your detrussor muscles more effectively. It comes out pretty fast with the 14 so not as much exercise. You might also like the 12 better in terms of comfort. The 12 does have a tendency to kink a little bit more when passing the sphincter muscles and prostate, so there is a little bit more finesse involved but after a little practice should go in easy. If not, just go back to the 14.

Jim

This is great info. Thanks!

I will get some 12's and try this. Great to be sharing info. 

michael

Intereting info. I will keep it in mind . Right now there is no flow without a catheter. will try tapping.

Correction: Meant to say in the above post that currently my leukocytes are positive and my nitrites are negative. This, combined with no symptons, would be considered colonization and not a uti. Most people get colonized within a few weeks of self catherization unless great care is taken which really isn't necessary and can be time consuming. It's not necessary because colonization is asymptomatic.

Hi, Michael,

I'm new to CIC--just over 2 1/2 weeks. My 2nd week was easier than the first. For the past 3 days it's been a struggle to get past my prostate. Eventually, I hope to get that worked out. Like you I hope to eventually have a PAE done.

You mention skiiing and camping--I love to hike and snowshoe in the mountains, and I'm wondering how to make this happen with CIC. Of course, I practice "pack it in/pack it out" which will apply to catheter packaging and spent catheters. But I'm wondering how you handle your cathing while you're out. For example, does the adhesive strip on a catheter package work on tree bark or on a rock? Do you lay it on the ground?

My best success with CICing has been with the Speedicath FR 14. I hope to use the LoFric Origo for when I'm away from home as it is foldable. I think, however, that the Speedicath would fit into my backpack.

Your thoughts on this would be appreciated. Thanks!

Stebrunner

I use a fast rhythmic motion sort of kike a drum roll with four fingers. Some suggest that running water in the faucet is helpful as an auditory stimulant. Experiment. Unlike the Crede manuever, there should be no danger of refluxing the urine backwards into the kidneys because you're not manually pushing the urine out, but rather stimulating the detrussor muscles to do it for you. You can try this when you feel the urge to cath or perhaps an hour or so earlier when the bladder is not as full. Experiment. Sometimes mixing in a slight push (crede light can get the flow started. At times I have even pushed harder and no hydrophresis resulted, however probably best not to make a habit of pushing hard with an obstructive urethra. That was probably the concern of your urologist.

Stebrunner,

1) do you have a coude tip on your catheter? (also called Tiernmann) the tip turns up a little.

2) are you orienting the tip properly?

If you hold the catheter with the ridge towards you as you are inserting the catheter (which is turned up ) then the bent tip can negotiate the passage of the prostate or whatever it is that is a restriction.

3) I just take the catheter out of the packaging, when I'm ready to use it, and drop the packaging somewhere. Then pick it up afterwards and use it to carry the spent catheter. 

 

4) CIC and camping: I just pack in the catheters . you need to take some extra, in case you get an infection, in which case you will cath more frequently. You need also to have the antibiotic that works for you , with you just in case.  I use the speedicath . store it full length, and fold it if I need to carry a couple in my jacket for 6 hours. I have plastic garbage  bags to store the used catheters until I get to a garbage bin. 

What I do is car camping, with daily excursions. 

I would not go backpacking out in the wilderness on foot for  days , in case I were to get an infecrtion (Although I haven't had one for a year)

you always want to have  spare catheters on hand. In case your luggage is lost on a flight etc...In an emergency, the reuseable catheters would serve longer, as they can last days. I don't use them anymore otherwise.   

I hope these points help. feel free to ask for clarification.'

Michael

I bought some of the Speedicath compacts, for use at work, on airplanes, on my motorcycle rids, etc. They are small enough to fit in your pants pocket, jacket pocket, etc. These allowed me to get out and about, and are discreet. 

Hope I never need to use them again, that was really lifestyle changing for me and wanting to stay active.

Coloplast has the foldable one as you say. It would go in my pants as well, but needed to carry the little lube packets. 

The Speedicath compacts are a neat idea but unfortunately they don't come with the Coude (curved) tip that many of us use. The other thing witth the compacts is that while you might order say a size 14F, the actual size of the catheter at its widest point is probably closer to 18F because of the way they retract. This could be an issue with some. 

Jim

the compacts sound interesting, 

last I looked they were not available where i live

also I got the impression that they do not have a coudr tip, which really makes a difference for me . Note the Speedicath standard are foldable for a day. 

Just wanted to add to Michael's post that when I did carry the Speedicath's around with me, I usually put them in cardboard tubes that you can find in stationary stores like Staples. They have caps on both ends that prevent the catheter from falling out and they are rigid enough so the catheter will not bend like it might if you just put them in your backpack. They also act as a discreet carrying case as well as a receptacle to put your used catheters. The diameter I liked (I think it fit 3 catheters) was a little long so I just cut it down to better fit in the back pack. 

Jim

A bit of English Victorian history for you although American gentlemen possibly did the same. The men used  to carry their catheters ready for use  rolled up inside their top hats.

Within months most succumbed to a fatal infection. Just as well that we live in a throw away use once age.

I bought the compacts out of Canada. I live in the USA. But I never claimed them on my insurance either. 

No they did not have the coude tips, but they are smaller at the end anyway. Just thought I would pass something on that worked, and get you out of the house. I cannot imagine packing those long catheters into bathrooms on airplanes, public restrooms, etc. At home, yeah, that is what I used as well.

about packing the long catheters into bathrooms on airplanes, public restrooms etc: They can be folded in 2 and fit in a front pants pocket.

I also use a small size fanny pack to store them folded. Folding them seems to be OK for a while, the mild kink that results has not been a problem for me. (but you should test it for yourself) .

I would not store them longer than 4 to 8 hrs in a folded position. 

Michaelmike,

LOL at folding a Speedicath and putting it in your pants pocket! You must have some big pants.

I recommend every person cathing have some of the compacts in their inventory. Not for every day use, but for what I described earlier, getting out and about.

But to each their own. Glad I don't have to do it any longer.

Hi, Michael,

Thanks for your input! I am using the coude tip and orienting it properly. My problem is that I order Speedicath FR 16s. They are quite ridgid, and don't seem to "make the bend" up through my prostate. The FR 14s are more flexible and allow me to finesse my way past so I'll be ordering those next week. In the meantime, I'm using Coloplast Self-Cath FR 18s that I have on hand. They are the kind you have to lube, but they are a bit more flexible than the Speedicaths. BTW, are you folding Speedicath FR 14s or 12s? The 14s seem pretty unfoldable.

Really like your idea of packing along extras. I don't do overnight backpacking trips, just daily excursions. However, most trails around here don't have restroom facilities at the trailhead. Once I gain mastery over my CICing, I'll take a few short trips out to see how this will work.

Not a fan of catheters I have to lube, but I know I can use them if there's no other option. And I can see how they could be easy to pack along in a backpack. Jimjames suggested cardboard tubes to hold catheters, which sounds like a good idea.

When I first found out that I would probably be CICing for the rest of my life, I tried to research ways to continue an active lifestyle via my uro's staff and online. Found very little info until I stumbled across this forum. It's been a great help as I adjust to my new normal.

Stebrunner

Hi, Jim,

This is a great idea! I could easily put the cardboard tube into my backpack or even strap on to the side. I'll look for some this weekend.

I can see I made a mistake by ordering the Speedicath FR 16s. They are just too rigid (I think) to make it around the bend past my prostate. I'll reorder and get the FR 14s as they are more flexible--and more comfortable. In the meantime I have to use the Coloplast Self-Caths FR 18s. Even though they are larger, they have more flex than the Speedicath FR 16s. At some point, I'll try the Speedicath FR 12.

The Speedicath Compact has its appeal. My understanding is that it is a FR 12 at the tip and FR 18 at the base with a standard tip. Might try that once to see if the FR 12 straight tip can past the prostate. If it will work, it could also be an away from home option.

Stebrunner

Hi Stebrunner,

I fold the Speedicath 14 s quite often. Just do it...it turns out not to be a problem.  I have a small fanny pack in which they fit folded in half (approx 9 inch long ). Some of my pants will take 9" in the front pocket too.   I would not keep them folded more than 4 to 8 hours. they do get a little kink if bent, which you can reduce by bending it the other way. (while still in the package). 

And you may have read JimJames' description of how to use a Sppedicath without touching anything any part of the catheter  except the green plastic piece. the "nose dive " technique. 

Michael

Thinking about it, when I fold the Speedicath, I usually bend it around several fingers, or a pill bottle, just to make the bend less tight. that may help  in not kinking it too much.

I keep two in a Ziploc bag, always ready to go; while they are not - technically - folded, they are curled, but I have no problem using them even after being like that for weeks at a time.

Hi, Jim,

My request is a little off-topic and I apologize for taking up your time.

Within the "Patient" site, how do I pick up or otherwise gain access to threads that are outside the one I am following?

I am , registered as a Patient and based in the USA.  While I find this site absolutely incredible, I would not call it the most user-friendly. Perhps my web page is not set up correctly?

If you could point me to where I can learn how to search for and pick up any thread (my most important need) or how I can go about getting tech support or find User help, I would be very grateful indeed.

Warm regards, and thank you for all your posts!

Alan

Hi Alan,

This is a GREAT forum but site navigation is a NIGHTMARE!!! At least for me. My biggest problem is that unlike almost every other forum I've participated in, the posts are not in chronlogical order. 

To answer your specific question. 

1. Scroll up to the very top of the page.

2. Click on "Forums"

3. Enter "Prostate Problems" in the search bar.

4. Click on "Prostate Problems/forums group"

5. Scroll down and you will see all the prostate group threads.

6. Click on a forum you want to follow.

7. Now click on "follow this discussion"

  

You should now get email alerts (you may have to set this up) every time someone posts in a forum you want to follow. There is also a way to organize the posts you view at the top but really a nightmare. Good luck.

Jim

PS Easier to learn how to self cath than to find a post.

HINT: If you are searching for a particular post, use the "search" function in Windows (if you have a Windows computer) to search for a key word and it should take you to the post. Assuming that page of posts is loaded.

Hi, Jim, Many thanks for your reply and useful tips!  Thought it was myself; you put my mind at rest!

Alan

At top right under your user name is My Groups and My Discussions.

Click on My Groups and select the group you want and it will take you to all conversations in that group going back forever.

I started a post on this in the general forum a while back. Only seven responses. Go figure!  

https://patient.info/forums/discuss/great-fourm-very-confusing-posting-structure--338031

Address it to the Moderator. He is always very helpful.

Hi Alan/Jim,

There is an FAQ section inked at the bottom of every page in the forums to

https://patient.uservoice.com/knowledgebase/topics/59133-discussion-forums

Re ordering of posts - replies to the original post are in chronological order and these are the posts that are sorted using the filters at the top of the page. The nested comments under the main replies will always be in time/date order, oldest first. 

As Derek says you have a user panel and profile page where you can see all of the groups you are in and discussions you are following. You can also see all of your activity, replies and notifications. The notifications are basically a list of all of the emails you would have received so you can use these to go straight to relevant comments.

The FAQ with more detail on these is here:

https://patient.uservoice.com/knowledgebase/articles/398360-user-panel-functionality

We are in the process of improving the search function to make finding individual terms better. If you want to find another group you are not in there is an A-Z listing of groups on the forums homepage.

If you have any issues or need more advice you can contact me at any time.

Regards,

Alan

Dear Alan,

Many thanks for your very welcome note! This is to acknowledge receipt of same. I will be writing to you within a day or two describing my concerns in more detail. BTW, nothing illegal involved; just sraight, down to earth controversy.

Warm regards,

Alan E.