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

I'm not on YouTube but there are many instructional videos there, some from the catheter manufacturers. If possible, first see a good urologist who supports self catherization as not all do. There is also lots of info in the self catherization threads here so you might want to take some time and read from the beginning. One very popular catheter here is Speedicath by Coloplast. If you have an enlarged prostate the Coude tip version is frequently prescribed. Size FR14 is good to start with and you can work down to FR12 later if you want. Self cathing can be a major life changer especially if you're currently wearing a catheter. 

Jim

The company sent me fr14, when I had ordered fr16.  I tried the  fr14, and like it alot!  Easier to insert, and very slippery.  The  fr16, is good, but I think for me the smaller catheter, feels better to use.  The only thing I was thinking was that, do you think the larger catheter {fr16}, would be better in the long run?  The larger size, would keep the prostate open with a larger opening?

Hi Dennis,

The general rule is to use the smallest size catheter that will work. In your case that would be the fr14. You might even try an FR12, and if it goes in easy, then that would be the optimum one. Like most people, I started with fr14 and then dropped down to fr12. I use Speedicath by Coloplast with the hydrophillic coating. Which one are you using?

Jim

Hi Jim,

Thanks to you and this forum, I started self cath 2 weeks ago.

I almost gave up after the earlier bloody failed attempts. Your earlier posts kept me going.

Now I self cath with almost zero failures.

I am using speedicath 10 fr straight. It does bend a little bit but went through more easily.

I can also use 12 fr straight. However, I have problem with the 12fr course.

Going past the prostate is pretty easy. The problem is at the bladder neck entrance.

It is hard to enter. I usually have to withdraw and there is blood at the tip.

I think coude tip does not work for me. Maybe it leads to a false passage.

Hank

By mistake they sent me the fr14.  It works like magic  So easy to guide in and ever so slippery. Not everyday is the same.  Some days, the catheter goes in very easily and other times, not was easy.  Self-cathing, is the best thing that I've done in years for my bladder and prostate!!!  By the way, when I withdraw the catheter, after self-cathing, I turn it side to side.  My reason for this is that it will widen the urethra, as the little coude tip, rubs back and forth as it slides out of the penis. This way, when I urinate on my own, perhaps it may be a little easier voiding.

While when in my agressive rehab stage I tried my best to keep less than 400ml in my bladder at all times, I wasn't 100% successful and did wake up some mornings with more than 400ml. So "no", I didn't schedule mid-sleep CIC's but often nature would wake me up during the night, and when it did I often would get up and perform CIC. How much are you finding in your bladder when you wake up? If it's really excessive on a regular basis then scheduling a mid-night CIC might be considered. BTW it's not uncommon for excessive overnight urine prouction as we get older (nocturnia) , which is the opposite of what happens when we are younger. You can research here and elsewhere some strategies to minimize excessive night time urination but many of us just live with it. The plus side is that more night time urination means less daytime urination which translates into less CIC's when out and about during the day. For me, it translates into zero CIC's during the day, almost all the time these days.

Jim

Your helpful responses to many in this forum are wonderful. There ought to be a special award for all the helpful info you provide! All the best to you. May you be blessed with the energy to continue doing the good work you do!

Jim H

...ditto!

I agree that you are providing an extremely valuable surface. Thanks! In general the problem seems to be more urine production overall and a gradually higher PVR. Practically no natural urination. I was previously cathing morning and evening at about 400 ml. I decided to cath because I have a PAE scheduled with Dr Bagla for the end of this month. We decided it was a good idea to try and decompress my bladder. I am cathing 4x daily. I'm finding about 550ml morning, 300 in afternoon, 300 bedtime and 650 at 4am. A little natural urination but if I don't cath there is natural urination. Kinda concerned about the increase in urine, decrease in natural urination and apparent stretching of the bladder.

Should read valuable service!

Thanks guys again for the nice words. Michael, did you do any void logs prior to CIC? Curious what was your natural urination then and what was your PVR? Assuming you had moderate natural urination before, then it's understandable that your natural void volume has decreased because a large part of that previous natural volume is now voided via catheter. It's just math. Given the numbers you provided, I don't see how you are stretching your bladder with the increase in CIC. In order to stretch the bladder you would have to have higher bladder volumes with CIC than without. And given you're close to 400ml with CIC, I doubt you were less without CIC because if you were then you probably didn't need CIC in the first place!

In my case, I almost had no natural void when I started CIC. Gradually, and I mean gradually, the natural void volume increased. Over two years later almost all of my voids are natural and only CIC on occasion. 

Unfortunately, most doc's -- and I guess I will include yours -- see CIC as mostly a stop gap measure, alternative to a Foley, or as a short-term rehab prior to surgery. They also seem to grossly underestimate the improvement the bladder can have with time if you keep it decompressed. 

My urologist, head of a well known teaching hospital, told me that after six months or so I should see no more improvement with CIC and that forget totally about ever rehabbing your bladder enough to throw away the catheters unless you have an operation. 

Well, at least in my case he was wrong. Very little data seems to exist for longer term CIC and BPH in part because there is no commerical interest in pursuing that line of research.

Jim

Jim

Probably should add to my last response that during the period of time when I was doing CIC 6x/day and naturally voiding very little -- during that time I made it a point to exercise my detrussor muscles -- on occasion -- by pushing the urine out through the catheter using the same muscles that I would use to naturally urinate. Don't know how important this is but I can't see how it can hurt. 

Jim

Jim, I agree, unfortunately if there is not much monetary reward in a certain procedure, the medical establishment, is not that interested...human nature. As my young little neighbors would say:  Too bad, so sad!

Jim, most recently, say up to a month ago, I was having very little natural urination and cathing almost always 400 ml morning and night. Then it started to creep up to between 5-600ml. I just started cathing 4x daily but last night at 4 in the morning I retained almost 600 ml and at 8 in the morning about 550. I'm convinced my total urine production has increased. Yesterday I had kidney function test results that were in the normal range. The only thing top of range was glucose which was 140 nonfasting which is just barely ok. Was trying to figure out a cause for urine increase. Previously (cathing 2x) I was collecting 800 ml total. Now I'm collecting about 1400 ml total with virtually no natural urination at all. If anything I'm having more natural urination now with the 4x cathing which would make the 1400ml even higher. So I have an increase in urine production and the issue that within a few hors of going to bed I already am retaining more than 500 ml and waking up once (around 4) doesen't seem enough to deal with it. I do not have logs but since there is very little natural urination I have a pretty good handle from measuring the cathing total. Thanks for helping to try figure this out.

PS:Good advice about bearing down. I wondered if so much cathing would possibly atrophy muscles etc. Did you find that cathing 6x irritated your urethra at all? I'm using the same catheter as you. I'm more or less resigned to trying to cath 2x during sleep hours. Usually I wake up a bit at 4 anyway but I'm going to try at 2 (with an alarm) and 4. I'm pretty motivated since I have a PAE lined up for Nov24. Would love to have the same outcome as you but my prostate is 90-100 so don't know if that precludes it but we'll see!

Excessive urination and high glucose makes one wonder if diabetes is at play. I have son whose Diabetes was discovered through those symptoms. 

This from Mayo Clinic website:  

Excessive thirst and increased urination 

Excessive thirst (also called polydipsia) and increased urination (also known as polyuria) are classic diabetes symptoms.

When you have diabetes, excess sugar (glucose) builds up in your blood. Your kidneys are forced to work overtime to filter and absorb the excess sugar. If your kidneys can't keep up, the excess sugar is excreted into your urine, dragging along fluids from your tissues. This triggers more frequent urination, which may leave you dehydrated. As you drink more fluids to quench your thirst, you'll urinate even more.

Michael, 

Fluctuations in urine production can be difficult to figure out as there can be so many factors involved such as fluid intake, overall diet, sodium intake, exercise, amount (and timing) of sleep, etc. Also, it's not unusual for urine production to increase after CIC because with CIC there is now no or less back pressure (reflux) with the kidneys so they can unload more freely. This is a good thing. 

Personally, I've seen my urine production go up and down, looked for clues here and there, but eventually stopped focusing on it because of the so many variables. So unless your production is eally high, say over 4,000 ml, or really low -- say 500ml, I wouldn't worry, as long as other health markers remain normal such as general check ups, general blood and kidney function tests, urinanalysis, etc. 

Your retention does not seem that high but it seems now to be over 400m maybe more than ideal for maxium bladder rehab. Six times a day is a pretty normal schedule for someone with very little natural urination and you might try that to cut down on what your bladder holds. I was doing CIC six times a day for quite some time until I was able to empty my bladder better naturally.

Jim

No issues with urethra when I did CIC 6x/day. The 12F Speedicath is pretty small, if that is what you're using, but even with the 14F I don't think that would be an issue. As I mentioned previously in the thread, my major breakthrough didn't come (I'd have to check my notes to be exact) for about a year after starting CIC. And it didn't come until I got more agressive with my CIC schedule. That didn't mean that every day I was agressive, but as soon as I noticed a decline in natural urination and an increase in retention, I would up the schedule. 

This past year I sometimes go a week or so without CIC but a couple of times I felt more retention and went on a 6x/day schedule for a couple of days. That seemed to do the trick and then I was able to go  back to no CIC at all for most of the time. Sort of like a tune up

Jim

Jim

Always good to have tests run, but I don't think 1400ml of urine in 24 hours would be considered excessive urination (polyuria).

Jim

Hi Jim - I wanted to ask you about the use of the detrusssor muscles while peeing, either during self-cathing or w/o cathing. Is that the same as pushing while peeing to get more pee out? Or do you just let the pee flow out on its own without pushing? I am not sure when I am actually using the detrusor muscles. I have been told not to push while peeing but doesn't pushing exercise the detrussor muscles which is important. I find it confusing!

Thanks as always

Neil

Hi Michael - I had PAE 2 months ago now with Dr, Isaacson at UNC. My prostate was nearly 300gm but I was considered an ideal candidate since I had no median lobe or other issues. I was cathing twice a day thanks to help from jimjames. Anyway after 2 months there has been no imrpovement even thought he PAE was a big technical success. I still cath twice a day and my retention worsens. I am thinking of trying PAE again in the spring with Dr. Bagla so please keep us informed. I wish you all the best and a better outcome than mine. Neil

Interesting you were told "not to push" when peeing (naturally). It's beyond my pay grade as a non-professional, but "not pushing" may not be the same thing as not using your detrusor muscles. My guess is that even when you don't push at all, the detrussor muscles are being activated during natural urination. As an aside, I have found that during natural urination I can sometimes empty better but concentrating more on relaxing all the involved muscles as opposed to "pushing". 

With CIC, however, I did "push" on occasion, my theory being that because CIC doesn't use the detrussor muscles at all, they could weaken over time. The type of "push" I have done is not vigorous but akin to what you might do (or have done in the past) when you are naturally urinating and in a bit of a hurry. The way you will know if it's working is if the urine comes out of the catheter faster than when you just let it drain. 

I didn't do this all the time, or even for the entire time the urine was flowing out, but I did used to do this intermittedly to keep the muscles in tone. I don't do this anymore when I occasionally CIC, because my urination is natural most of the time and therefore my detrussors are being exercised to one degree or another every day. 

Again, these are just my thoughts and observations and not based on any studies, etc, however a lot of what many urologists tell their patients are also not based on any studies, etc, and just their opinions, often on topics they have little experience in.  I'm sure a lot of you have found that out, I surely have!

Jim

Thanks for the wise counsel Jim about the urine production.  I also use a 12 Spedicath hydrophillic plus the microcyn. Plus the no touch so to speak. Makes it a breeze. Out of curiousity, do you know how large your prostate was? Could it be that BPH is as much a bladder issue as prostate issue? I would love to avoid the PAE through aggressive CIC but I know there are no guarantees but I intend to try since I've come this far!

Thanks Jim. I came across an old Russian paper a while back that had the first recorded diganosis of BPH. It had a diagram of a man with advanced enlarged prostate problems. The diagram showed enlarged muscular "love handles|" which they attributed to constant pushing to pee. The paper then discussed the progression of the disease which involved bladder failure, then kidney failure. I think the paper was from the 18th century. The only treatment offered in the paper was prostate removal!

To michael's point below, it is intertesting that the AUA now identifies LUTS with bladder problems independent of whether the patient has BPH or not. LUTS use to be considered secondary to BPH.

Thanks for your response. I've noticed too that if I take a deep breath and relax all my muscles I pee better than if I try to push.

Take care

Neil

Don't have my notes handy but will check on prostate size and get back. It wasn't too large but not normal either. The doc that did a recent cystoscopy said I had an enlarged median lobe which could be as much a factor with bph as size itself. You probably know that some men with quite large prostates have no bph symptons while some men with smaller prostates have symptons. So it's just not about size here. 

As to "avoiding the PAE through agressive CIC", that's a personal decision but I see no harm as long as you keep your bladder relatively decompressed by limiting total volume to 400ml or under whenever you can. PAE will always be there as a choice, but once you have a procedure you can't go back. So if you're on the fence, maybe wait a few more months and see how things are then?

Factoring into the decision I think would be how much of a lifestyle inconvenience is CIC, but of course you may have to end up doing it after PAE for some time as well. For me, CIC has become almost a non-factor in my life so I pretty much stopped actively looking into other procedures although I do follow them with interest.

Wasn't always like that though and in fact the first four months or so were very uncomfortable with pain, false urgencies, UTI's, some bleeding and a very bad bout of epididymitis. Part of my problem was simply adjusting to the process but the other part was that my medical team dropped the ball and failed to treat the initial UTI which just ballooned into a bigger one and then finally the epidymitis. Fortunately I found another urologist who might not have known much about CIC, but did know enough to treat my symptons. 

From there gradually smoother sailing. In the few years since, only 1 -- possibly 2, symptomatic UTI's which I can easily live with. And I think I probably could have avoided the recent one if I had been a little more careful with my technique. With no utis for so long, started to get a bit cavalier and a couple of times at night when I missed the "target", and therefore contaminated the catheter, instead of throwing it away and starting over I just re-inserted it. Pretty sure that is what did it but you never know. 

Jim

Hello Michael - I've been pretty much down the same road as you and would be happy to share my experience with you. I was in AUR and various uros wanted to do immediate surgeries on my large prostate like Holep, robotic simple prostatectomy, Green light, Turp. But I was lucky to find jimjames and his column so I started self-cathing to buy time and then decided on PAE 2 months ago. Anyway if you wish I can share my decision-making with you. Good luck. Neil

JimJames,  I've been self-cathing for 43 days now.  What are the symptoms of UTI's?  I just want to be informed, in case it happens to me.  Can you tell me a little about it?

Hey Jim,

A couple of clarifications. Just approximately how long did it take from 6x per day until basic recovery. 

Also, when you say below 400 do you mean all 6 x or an average. For example now at night I'm producing about 5-600 and in the day 2-300.

Thanks again for all the help!

Michael

Dennis,

Short answer because a lot of gray area here. 

If urination becomes painful, if the toilet bowl turns red from blood, if urgency suddenly increases, if your urine smells foul, and especially if you run a fever along with one or more of these symptons, then you should see your doctor to figure out what is going on.

Very important here that you see a urologist, hopefully one with CIC experience, because the average doctor would do a urinalysis and culture and nine out of ten times start you on antibiotics right away.

A good urologist knows that some of these symptons (not fever) are normal when you start self cathing and they also know that a positive urinalysis and culture does not mean you need antibiotics since most people who self cath colonize their system with non-harmful bacteria within two week and this bacteria will show up as a positive urine culture. 

To overly simplify, if you self cath, then you only treat symptomatic uti's, you don't treat colonization, even though under the microscope they look the same. As to what symptons require antibiotics, it's a judgement call best made with an experienced urologist. 

So on one hand you don't want to start a course of antibiotics with every little sympton because you will build up resistance. On the other hand, you don't want to wait till you're really in pain and suffering. 

The latter happened to me (a lot of pain and suffering), even under the supervision of a urologist experienced in self cathing, so the last bit of advice is not to dimiss your instincts. If things really feel bad and your urologist won't treat, question him or her again, or even seek a second opinion. Or, if you think your urologist is handing out antibiotics like candy every time you have a positive urinalysis, again question what they are doing or seek a second opinion.

Jim

 

Hi Michael,

My notes aren't as good as they should be, but it was probably at least a year before things got to the point where I didn't have to cath every day and still had acceptable post void residuals. 

Ideally, you don't want more than 400ml in your bladder at any one time. So, if you're cathing less than 6x/day and are carrying around 500-600ml of urine, then I would increase frequency. And again, the amount of urine in your bladder is not just what comes out of the catheter but is the sum of what comes out of the catheter and what comes out naturally just prior, assuming you are able to have some natural urination.

This is not to say that I always kept it under 400ml. It can be difficult, even with 6x/day because the kidneys don't always cooperate and unload urine evenly throughout the day at night. But there were also times when I kept up the 6x/day even though I was only carrying around 200-300ml or urine. I probably could have decreased frequency but felt that the smaller volumes would give my bladder even more rest and rehab. 

Jim