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

Hi John,

The thread is actually quite current, but the way they order things here (not in strict chronlogically order) it can be hard to figure these things out. 

I can relate to what you describe because even though our stories are quite different,  I experience similar periodic episodes of acute retention where I have to CIC. One of the triggers is too much fluid intake in too short a period of time, as is your case. I've had this happen with too much water, also alcohol (I drink beer on occasion) can sometime have a similar effect on me, probably not so much because of the quantity (usually just one beer) but because its diuretic effect dumps fluid into the bladder at a faster rate than normally. 

I have also noticed that being inactive (lying down, napping, sleeping, or even sitting for extended periods) can also cause acute retention pared with fluid intake. Conversely, I rarely have had acute retention, regardless of fluid intake, if I am being very active at the time. You therefore might experiment by walking around for ten minutes or so the next time you have an episode to see if that allows you to void naturally.

Ironic that it happened at your ultra sound test where they pump up the bladder to riduculous limits basically to save time when measuring PVR. The procedure works for normal bladders but gives very suspect readings for impaired bladders. It does give them a better look, however, but IMO PVR is much better measured with normal fluid intake.

Jim

Hi Jim,

I have thought about the being inactive. Such as sitting on a bar stool to long. I wonder if that irritates the prostate.

The night I had the episode which lead the ER visit I was pacing around the house to try to relieve the pressure. It didn't help. But thanks for the tip.

I have considered using a catheter after urinating to check for urine retention. I just may try that.

I'm glad the thread is still current.

?John

Tim,

My experience with a nurse (brutal nurse Ratchet) doing catherization was terrible. If felt like a gravel impregnated garden hose being shoved up there. There was quite a bit of pain and some blood involved.

Since learning to self cath and using the hydrophilic speedi caths, I have no pain at all when cathing. And no blood. When the catheter first touches the sphincter muscle, I feel a slight pinch or poke. But not pain. Keeping a very gentle pressure on it and waiting, allows the muscle to relax and then the catheter passes without any pain and no bleeding at all. Not at all uncomfortable or painful.

John

John,

Thanks for responding! So you would say the combo of the hydrophillic catheters plus learning to self cath on your own would lead to no pain at all? That is refreshing to hear. I've definitely never had the hydrophillic ones, only whatever the kind is that they use for urodynamics.

If you don't mind me asking, how did the change affect your sex life? I worry about painful ejaculation from constant insertion. 

Thanks for your help!

-Tim

Hi Tim,

I learned by reading everything I could find about self cathing on the internet. And I watched every movie I could find. Then talked to my urologist and his nurse. And then practiced. The coloplast speedicaths are all I'll use. I tried others and they all come up short. None are as slippery or as easy to use as the hydrophilic speedicaths.

I have noticed no change at all in my sex life from self cathing. But then I only need to do it one or twice per week at most.

Happy to help

John

Hi Tim,

I happened to be  reading your conversation with John and wanted to chime in that CIC with speedicath (with Coude tip in my case, properly oriented) is always easy and never painful. I have been doing it 6 times a day for three years.  

The few times a nurse inserted  a catheter in me, it was not as easy. 

Best,

michael

Michael, 

Thanks for your post! It seems to me after reading John and your posts that it is much more mental than physical. This is helpful. Thanks!

-Tim

Tim,  for me it hurts more if the nurse is doing it. They can't feel the catheter sliding down the urethra, and so they can't judge when to stop or when to slow down.   But when I do it, I can stop and go when I start to feel a little sting. It is painless, when I do it.  I go really slow.  It takes me from start to finish, around 4 minutes.  The key, is go slow, to avoid any discomfort.  When I was deciding on whether to go with wearing a foley, or self-cathing.  I told the nurse, that I don't think that I could self-cath.  It would be too dificult for me to insert a cathter into my sensitive penis, on a daily basis.  I am glad I tried!  It is very easy once you get used to it.  It won't take long to get used to it either.  Tim, just try it.  You will be glad that you gave it a shot.

Hi, Greg,

Your situation sounds similar to mine so I thought I'd share my progress. My prostate was 90cc with a large mis-shapened median lobe. I had my PAE done 7 weeks ago in Denver with Dr. Charles Nutting. He said it would take 1 to 4 months to see most of the results.

Prior to PAE I could not really pee at all. 

He also said that immediately following the PAE I would experience a window of time when the prostate shrinks away from the urethra--in my case this window lasted 8 hrs. During that time I could pee a weak stream. After that window of time, he said the prostate will swell because it's lost some of its blood source. This could last for 2 weeks or so. This also happened to me. I had been self cathing for a month or so prior to the procedure. When my prostate became swollen, it became very difficult to self cath, so my doc had a Foley catheter put in for 7 days to help me through that stage.

After the Foley was taken out, I battled a nasty UTI. The UTI inflamed my prostate and urethra. That's now gone. Suddenly about a week ago, self cathing became easier. Before I cath, I always try to void naturally. My voids have been slowly increasing. Right after the PAE they were about 30 ml. Last week they were about 90 to 100. Suddenly today, I've been peeing the strongest, longest streams yet, and my natural voids today have been about 150 ml.

Back in December 2015, I had AUR, and they drained 7 liters out. Four of 5 urologists I saw told me that my bladder function would never return. I've been following Jimjames model for rehabilitation, and I self cath 4 to 6 times a day--usually 5. My bladder is now signaling me when it's time to pee. I'm hopeful that things will continue to improve.

Hang in there! For the first 6 weeks after my PAE I started to think I'd never see much improvement, if any. I think our median lobe issue slows things down. I will post any further improvements I experience.

Stebrunner 

Hi stebrunner, 

Thanks so much for sharing your story. It's really encouraging! I wish you the best and I'll look forward to hearing about your progress as time goes on. 

Have you got any thoughts on what to do about the larger volume of urine that I'm getting in the morning after a night's sleep? I'd hate to have to wake up in the middle of the night to self-cath, but I've been having more than the 400 ml jimjames recommends as the maximum. How are you handling this? 

Glad to hear things are improving and great progress with your natural void volume! 4 to 6 times a day sounds good at this point and you really can't cath too much at this point as long as you have some natural urination some of the time. That way your bladder gets the maxium decompression/rest/recovery while your detrussor muscles still get exercised. I see you are measuring your natural voids. Do you also then measure your cath volume? I tried to keep the TOTAL (natural void plus cath volume) under 400ml whenever I could. That way I kept the bladder from stretching out most of the time and becoming lazy like it did from all the years of neglect.

Jim

Hi Greg,

I tried whenever possible to keep my total bladder volume under 400ml during the initial and more agressive rehab stage. By total volume I mean not just what I catherized out but also added to that any natural void I may have had. If you don't add in the natural void then you really aren't calculating the total bladder volume.

As to during the night, I tend to wake up during the night at least once anyway so not so much a problem although I'm sure I went over 400ml on a number of occasions. 

Whether or not to set an alarm clock at night is really a personal decision because on one hand you are doing something positive for your bladder but on the other hand you are disturbing your sleep cycle. Depends how agressive you want to be. However, if the morning volumes start to increase much more, or if your progress (natural voids, etc) start to stall, then it might make sense with the alarm.

Meanwhile, limiting fluids in the evening might help although many of us when we get older tend to urinate more at night (nocturia) irrespective of what time we take in our fluids. There are also other strategies to limit night time urination such as diuretics, compression stocking, medications, etc, but not sure you need to go there at this point.

Jim

Hi, Jim,

I don't always measure my cath volume. My NV volume and CV volume are both largest first thing in the morning. Then during the day those volumes are less. This morning my NV was 150 ml and my CV was 375.

During the night I'll wake up 2 or 3 times and do a NV. If I take too many fluids before bed and start waking up every hour, then I'll self cath durng the middle of the night so I can get better sleep.

In the daytime, I head for the toilet whenever my bladder gives me the signal. That might be once or twice in between cathings. Prior to my prostate/bladder troubles, I had the luxury of waiting until it was convenient. Ah, those were the days!

When I started self cathing, I think you recommended to try to use my detrussor muscles while cathing. Each time I cath and each time I naturally void I try to use them. This seems to be helping me a lot.

Stebrunner 

Hi, Greg,

I hope you will continue to post your PAE experience, too. The men who post on this site have given me a lot of hope and a wealth of knowledge. I'm thankful I found this forum before making my treatment decisions. 

My research prior to PAE showed that men with large median lobes might not have the same results as those without. I decided to go ahead with PAE in hopes it would make self cathing easier and more comfortable. At the very least, I needed to do something to stop my prostate's growth.

My morning volumes are less than yours. For example, my natural void today was 150 ml and my cathed void was 375. So that totals 525 ml.

Last night I woke 3 times and did natural voids. Typically during the night it's once or twice, but last evening I drank lots of water because I thought I was coming down with a cold.

If my sleep is too disrupted--say I'm waking up every 1 or 1 1/2 hrs to pee. Then I will self cath so I can get better sleep.

After my big AUR last December, I had Foley catheters in for 3 months. I think this allowed my bladder to shrink back to normal size. Then I started self cathing, and soon my bladder started signalling when it was full. You may want to try self cathing during the night for awhile and see if that changes your 1st morning cath volume. 

If you can, read back through Jimjames' posts on his rehab method. He has lots of great information. Seems my urologist thinks I will tire of self cathing and opt for the series of TURPs he wants to do. He certainly wasn't supportive of PAE. But that's okay. I think this is the right treatment plan for me.

I wish you all the best with your PAE, too!

Stebrunner

Can you tell me exactly how to use the detrussor muscles while cathing?

I'm worried I can hurt myself if I'm using a catheter and trying to use a muscle. I keep trying to be very gentle and not strain when I'm using the catheter. But I'd change this strategy if it could help. 

Hi Stebrunner, 

I just read your most recent post after posting you the question on detrusser muscles. I just wanted to thank you for your help. I'll definitely continue to post progress here. 

 

I am very happy for you that it is working for you.  I am also happy that there are alot of men that are turning to CIC for there problems.  To many doctors are trying to push turp, helop and laser procedures.  Most of them that is all they know.  And of course there there going to try to talk you out of the PAE procedure because they don't make any money on that.  I'm not saying that it may help some men but there are do many side effect that men don't want to deal with.  I think that alot of the urologist forget that they are men and the sex side of it.  They alway say there will be no change but there are many. I hope you have a good outcome with your CIC and enjoy life..Ken 

Thanks jimjames,

I'm grateful for the help. 

The problem I have is that waking up in the night to self-cath would be difficult. Right now when I self cath, I have a lot of steps. How do you do this in the middle of the night half asleep, and then go back to sleep? Am I doing too many steps? With all those steps I might as well be building a model plane there! I do the following:

1. Wash my hands

2. Put on gloves

3. use iodine on my tip

4. lubricate the catheter

5. catheterize

6. dispose of everything

7. wash up again. 

I'm fearful of getting infection, so I'm taking precautions, but maybe I don't need gloves? Or the iodine? What do you think? 

It's a lot of steps when you're half asleep, and knowing myself I think I wouldn't be able fall back asleep after. This would really wake me up.  

I'm not currently getting the urge to pee strongly and definitely not at night, so that might be why I'm not waking up at night. But I seem to be improving yesterday and today, so I'm hopeful it will continue. This morning I got out 3 1/2 ounces on my own, which is a marked improvement.

I'm thinking that I'll try to drink less at night, and sleep through the night. If I stop progressing I'll get up and cath in the night, but right now I feel like I really need the sleep. 

Unless you see it differently? I'd appreciate any suggestions. 

Also - I just asked stebrunner about your suggestion to use the detrussor muscles while cathing. Can you tell me more about that? How to do it and why it helps? 

So your total volume (TV) this morning was 525, a bit higher than ideal but OK as long as during the day the TV stayed below 400. That's why it's a good idea to measure it, at least for awhile,  and no big deal as long as you're measuring your natural void volume anyway. As to the detrussor muscles, as long as you're voiding naturally on a regular basis,probably not necessary to use every time you cath, but I don't see how it can hurt.

Jim

If you are voiding naturally on a regular basis, then you are using the detrussor muscles so probably not so important to use them while you cath. In any event, what you do is basically push out the same way you do when you do a natural void. It can be a gentle push or a moderate one. You will see the urine come out of the catheter faster when you do this.  When you stop pushing, the urine will come out slower. I don't see how it can hurt anything but I'm not a doctor. Being "gentle" is important with cath technique but I've never had an issue with using the detrussor muscles back when I wasn't voiding naturally very much.

Jim

My steps:

1. Open meatus with one hand and spray in a disinfectant with a pump bottle nearby.

2. Catherise using "no touch" technique described elsewhere

3. Dispose. 

Takes about 60 seonds from beginning to end.  Note that there is no hand washing because the catheter never touches my hands. There is no lubricant step because the Speedicaths come pre-lubricated. More in next post...

Jim

This is a continuation of my previous post detailing my cath procedure. 

There is nothing wrong with your procedure and at various times I have done many of the steps you have done, even more. But over time I started to eliminate steps to speed the process along and have not had a real UTi for at least a year even with my minimal prep that I described. That said, I do understand you valueing not getting up during the night and certainly that should be taken into consideration especially if you are careful to keep the total volume below 400 during the day. But it's kind of a two edged sword -- the reason you don't wake up is because your bladder is flaccid and needs rehab. If it had more tone and normal feedback, you probably would be getting up during the night at least once, but the important thing is that you see progress.

Jim

The above is minimal. I hardly ever cath outside the house anymore but when I do I carry some alcohol based hand cleaner but that's more for sanitary reasons then because of UTI risk. I also have a pump alcohol based hand cleaner on my sink which I also use if not half asleep. Takes another 10-15 seconds or so. Just make sure you don't get that hand cleaner on the meatus. Tried it once as a meatus disinfectant and how do you say STING!!!

Jim

Thanks Jim!

If I can do what you do, I might be able to do that in the middle of the night. Can you tell me:

1. What disinfectant you use?

2. I looked in this forum for the "no touch" technique but couldn't find it. When I looked on the web I saw there are types of catheters that are no touch. Is that what you meant? If so, can you tell me what "no touch" brand and style of catheter you use?

Lastly, I will need a catheter that I can take with me when I go out on jobs, so I'd appreciate any suggestions you have for that. What brand and style would you recommend?  

1. Currently I use MicrocynAH, a formulation of Microcyn marketed to the Vetinary market. Basically same product but less expensive. Occulus also makes something similar called Hydrocleanse. You can also check out Vetericyn, Vetericyn VF an Puracyn. All these products are similar and come in spray bottles. The formulation is probably no better than Providone Iodine but doesn't stain or make a mess to clean up. They also don't sting like alcohol based disinfectants.

2. I use a hydrophilic catheter by Coloplast called Speedicath. It's rigid enough that you can hold it by the plastic funnel with one hand and basically "dive bomb" it in if you gently open up the meatus with the fingers on the other hand. So first you open the meatus, then spray, then dive bomb in the catheter. Your hands never touch the catheter. I use FR12 but FR14 might be easier to use initially because it is a little more rigid and less prone to kinking up when feeding it in by the funnel. 

Jim

Jim and Stebrunner, 

Do you guys work? Or do you go out much for a full day or even a long evening? If so, I'd appreciate any tips on handling this when you're out and about. 

Currently, I only need to cath in the evenings (if at all) so as a general rule don't carry catheters or supplies with me when I leave the house. When I did carry them, I threw some of the Speedicaths in a back pack. If I was concerned they would get bent (they bend easily) I would pack two or three of them in one of those card board tubes you can get a stationery store. Then I would throw the tube into the back pack. Same should work with a brief case, etc. As to being discrete, if you don't want to bring a back pack, briefcase, bag etc, into the washroom, you can stick one or two catheters into your socks and hide them under your pants. I'm sure there are many other ways to be stealth about it if you give it some thought. 

There are some catheters that fold more easily than Speedicath but so far have never found one that I liked therefore the regimen above. Red Rubber catheters, for example, can be coiled and put into your pocket but I personally don't use them anymore. There is also a "compact" version by Coloplast but at this point it doesn't come in a coude (bent) tip plus it's a bit too short for me plus I'm told there can be insurance issues with that catheter if you're on Medicare. However, if you don't have any of those issues or concerns you could look into that catheter. 

Jim

Hi Greg. I tried to post a link to a nice carry case I bought on Amazon for carrying my catheters and other supplies out and about. But a mod deleted it. The name of the item is Bluetech Extra Long, Hard Storage Case for Cards Against Humanity Card Game, Green. The speedicaths fit inside perfectly. I sit on the toilet, insert the catheter and void. I very seldom need to do that (only once so far) but it works. I've tried more flexible catheters and found they don't work nearly as good at the speedicaths.

Hi, Greg,

I use the LoFric Origo hydrophilic catheter with the coude tip--FR 14. When I'm out or traveling, I store some of them in a cardboard mailing tube--like Jimjames does. The Origos are bendable, but I don't keep them bent long; otherwise cathing can be tricky as they can get warped when bent.

For example, before I go into a restaurant, I will pull out a catheter from the tube, fold it and put it in a bum bag (or fanny pack). Also in the pack I have some Wet Ones antibacterial wipes, a paper towel, and a plastic bag to dispose things in. I know the bum bag might look a bit dorky, but it works fine. Sometimes in a public restroom, there is no toilet tank to place your gear on. Sometimes restrooms will have double toilet paper dispensers, and those work great. Sometimes there is a single roll dispenser.

Wet Ones come in bulk packs or in individual packs. I use the bulk packs at home, and the individual packs when away from home.

Many hydrophilic catheters have an adhesive strip that allows you to stick the catheter package to the side of a toilet stall. When traveling I have discovered that some bathroom stall walls have been given a coating to discourage graffiti, and the catheter adhesive strips won't stick. Then you have to be creative and hang the catheter off the toilet paper dispenser or the grab rail.

A lot of guys on this thread prefer using Speedicaths, and they're a good product. The Origo is more comfortable for me. It comes with a sleeve to help guide the catheter in without touching it. I take off the sleeve and use Jimjames' method of holding the catheter by the funnel while inserting it. This gives me more control.

There are some negatives with LoFric products. Many times the funnel marker isn't lined up with the coude tip, so I make a mental note of where the marker is. So if it's off by a 1/4 turn to the right, I try to keep it that way while inserting. I always visually inspect the tip of a catheter before inserting as sometimes there is some "gunk" on the tip. The gunk can cause pain while inserting the catheter. If that happens, I pull it out and try a new one.

Before I traveled out of town for the first time with catheters, I practiced a couple of times at local restaurants. You'll soon become an expert problem solver!

Stebrunner

Thanks John, I'll check it out. I appreciate the help. 

 

Thanks jim and stebrunner. Here's a new problem that just arrived. 

Has anyone here had excessive urine output or polyuria post PAE? It's been about 3 weeks since my PAE and all of a sudden since last night I'm putting out a huge volume of urine. 

Tonight after 4 hours since my last void, I had like 1300 ml come out. 

I do have a UTI and I started on cipro this morning, but I had this problem last night before I got on the cipro so it can't be a side effect. I also don't see UTI's linked to this problem. 

Polynocturia (excessive nightime urination) is fairly common as we get older for many reasons. It's then possible that what you're seeing is the natural evolution of things now that your prostate is shrinking and letting the urine flow more freely. It could also be a temporary unloading of the kidneys again due to years of obstruction. Time will tell but I would not be too concerned other than ironically it might mean more versus less bathroom trips at nght. 

Jim

Hi Greg,

I had my PAE at UNC last Tuesday with no adverse side effects like pain or discomfort. But I haven't noticed any improvement yet in my peeing. It is still slow. Mt rpostate was /is 300 gms but with no bladder neck obstructions so I am hoping for great things soon. Where did you get yours done? Jimjames taught me to self-cath through this forum but I was hoping to hang it up after the PAE but now I am not so hopeful and have the speedicaths ready to go on the bathroom wall. Neil

Hi Jim,

Do you think that self cathing could damage the inner sphincter muscle over time? Normally it opens in synch with the detrussor muscles so when we push through it from the outside with the catheter it seems that would be an unnatural thing to do. Should I worry about it? Thanks for all your patience and help. Neil

Hi Neil, I talked to my urologist and his nurse both about this. They agreed that if I was gentle and used the correct proceedure, there would be no damage to the spincter. The proceedure, which I've found works extrememly well, is to stop pushing when I feel the pinch or tingle sensation when the catheter bumps the spincter. I then hold a very gentle inward pressure against the muscle until it fatiques and opens. The catheter then advances easily into the bladder. Since doing it this way I haven't had as much as a drop of blood like I saw before using this technique.

John

Thanks John for responding - thta puts my mind at ease. I view learning to self-cath as learning an important new life skill that gives me control over my bladder for the rest of my life and takes that control away from emergency nurses and uros. I hope my PAE works but regardless self-cathing is important for all men to learn as we age. I will master it! Thanks again to you and Jim. Neil

Hi Neil, Sorry for not posting sooner. I had my PAE done at University of Miami on July 26th. My prostate was huge with a large median lobe. I was having lots of trouble voiding about 2 weeks before the procedure, and as a matter of fact they catherized me to start the procedure, and they removed more than 2 liters of urine! They went through my groin for the prodecure, and I came out with a foley catheter and had lots of pain and blood in my urine.  I kept the foley in for almost 2 weeks, which  I hope I never need to do again. At least I can sit at my desk and work again!! After I removed the foley, I was not able to naturally void at all. So I chose the self cath. JimJames was a big help! I also went to my urologist ofice and they gave me a lesson.  Now I'm able to naturally void intermittently (sometimes I do, sometimes I don't) But I do feel it's improving. I'm self cathing around 4 times a day. I'm currently back on Cipro for a UTI. 

Hi Greg - I am sorry to hear about your problems but hopefully as the prostate shrinks things will improve. I read that when there is a large median lobe the IR guys can usually find the artery feeding it and then embolize it along with the side lobe arteries so I hope this works for you. Do you know if they identified the medain lobe artery? Are you still peeing huge amounts at night? Thanks for writing back. How big was your prostate? Let's follow each other's progress here. Take care. Neil

Never thought about it but personally haven't had any problems in that regard nor heard of any. The catheter is pretty small so I doubt it but I'm not really quallified to say one way or another.

Jim

Hi Jim - I am sure you have written about this before but I just wanted to ask you about the position you place the penis in as you insert the catheter. First: do you extend the penis out by pulling on it?

Then: do you orient the penis facing up and drip the catheter in or do you orient it horizontal or pointing downwards and insert the catheter upwards?

Thanks again for your help.

Neil

Yes, first extend penis by pulling it out and up toward the ceiling. The urethral opening therefore is very visible which I widen a little using the thumb and forefinger of the hand not holding the catheter. I am careful not to touch the opening itself because I want to keep that as sterile as possible. Then I literally drop in the catheter into the open urethra. It goes in just a tiny amount by gravity but just enough so that it doesn't slip out. Then I push it in holding the catheter only by the plastic funnel. If I miss the urethral opening (not very often) and the catheter slips down the head of the penis, I throw the catheter away and start over. This technique requires a catheter with a moderate degree of stiffness. I find the Coloplast Speedicath works fine in either fr14 or fr12 (which I currently use), although with fr12 it takes a little more practice because its more flexible.

Jim

Forgot to add that once the catheter is in, and as I start to snake it on down, I start to pull the penis downward so by the time I hit the prostate the penis is now facing the wall opposite me as opposed to the ceiling. You can play with the angles here to see what works best for you, probably no one right angle or technique.

Jim

Thanks Jim. Do you keep the penis pointing upwards during the whole catheter insertion process until it enters the bladder or do you orient it horizontal or downwards once it securely enters the urethra?

Thanks again. Neil

Thanks again - you just answered the other question I jusr sent you. Great information for me. Neil