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
michael72708 jimjames
Posted
Hey Jim,
Thanks for all your advice in general. I know you put in a lot of time and thought. It is appreciated!
Thanks for clearing up meaning of "no touch". I will play around with the pushing or squeezing. I was really pleased last night to have 2 really good urinations. Seems like the PAE is having an effect. Much stronger than before the PAE. Only problem is that it was with close to 500ml residual in the middle of the night. I will take your advice and try to stay on the 4x schedule. My problem is that my nightime urination is so much higher. Not sure if its normal to only create 300 ml all day and 800 ml overnight. Definitely makes it more difficult to keep the bladder decompressed because I really don't want to wake up more than one time to cath. Thanks again for the advice
magpies03 michael72708
Posted
HI Michael and Jim
I have been using CIC since september. . I have the same problem as Michael , low volumes during day and high at night (about 300,800).
I've been trying to change this by drinking less fluid ,around 1900ml which is the recommended amount . throughout the day but so far little success. I tried drinking almost nothing after 6pm but it didnt help atall.
Then last wednesday i was on a trip away from home and only drank cups of tea etc on transit and the next morning i was below 400 suprisingly.I calculated that i had drank about 1400ml. Is there anything that explains how to achieve <400 at night without going below safe limits , is 1400 ml too low to be taking in everyday? ? I think my body stores urine throughout the day and releases at night. Is there any way of changing that?
jimjames michael72708
Posted
Michael,
Glad your natural voids are getting better.
When you woke up with "500ml residual", I'm assuming that is the volume that came out of the catheter? How much did you naturally urinate just before that if any? The total of the two would be your total bladder volume which ideally should be under 400ml although I'm sure I ran a little over at night from time to time.
I don't know if it's "normal" to urinate more at night, but it's pretty common as we get older. Right now I'm urinating more during the day, but at one point I was urinating more during the night. If you want to reverse the process a little, and I see no urgent need here, there are several things you can try including daytime naps, compression stockings and playing around with the amount of sodium in your diet. You can also experiment with diuretics taken say mid afternoon. There are also stronger medications but only if it's really interferring with your life.
Jim
jimjames magpies03
Posted
1400ml (about six 8oz glasses) of fluid should be OK if you're not overly active but you might want to check the color of your urine and/or the specific gravity of your urine via dipstick to make sure you're not dehydrated. Thirst is also a fairly reliable indicator even though the bottled water companies would have you believe it isn't.
But whatever you drink, it all doesn't have to be water. The 1400ml could be comprised of water, juice, coffee, tea, alcohol, pretty much anything liquid.
Excessive nightime urination (nocturnia) is pretty common as we get older so nothing to be overly concerned about other than the inconvenience.
Other strategies to cut increase daytime urination (and therefore cut down on nightime urination) include limited fluids after dinner, daytime naps, compression stockings. Exercise can also affect things as well as when you drink your coffee or tea, both of which are diuretics so play around with the timing. If it's really interferring with your life you could experiment with a diuretic pill taken mid afternoon to promote more urination before you go to bed.
Jim
jimjames
Posted
I forgot to add salt/sodium to the list. I sometimes found that if I ate a high sodium meal I might retain fluid for quite some time but once the sodium's effect wore off then the kidneys would really unload and I would urinate a lot. To keep things even, keep your sodium intake even and preferably low unless you want to try and time the sodium intake so you will retain fluids at night but not sure if that's very healthy.
Jim
jimjames
Posted
I posted here and there about the "dive bomb" no touch technique I use to self cath. Hopefully I will get around to consolidating things so I can point to one particular post.
The process as described on the written page seems a lot more complicated and time consuming then it really is in practice. So far I have been estimating the time but today I was doing a periodic test of my PVR so I decided to time things.
1. Open the Speedicath package, straighten out penis by pulling out and upward, open meatus with fingers of non-dominant hand, spray antiseptic into meatus, "dive bomb" catheter toward meatus until it catches about 1/16" into meatus. (22 seconds)
2. Push catheter into urethra, around prostate and into the bladder until urine starts flowing. (5 seconds)
3. Let the urine flow out of the catheter until bladder is empty, pull out catheter and dispose. (30 seconds)
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So essentially it takes me only about one minute longer than the natural urination process. In this case my PVR was 75ml following around 300ml of natural urination, and I used a Speedicath 12F. If I used a 14F I probably could have shaved off a couple off
So overall, with practice, self cathing is an easy and not very time consuming process.
Jim
kenneth1955 jimjames
Posted
michael72708 jimjames
Posted
So you no longer use any antiseptic wipes around the meatus. I still do that although it would only seem to help if you're aim was off a little
jimjames michael72708
Posted
The Vetericyn spray stream I use is somewhat diffuse so while I aim into the open meatus it covers the head of the penis. That said, if I do miss (which happens once in awhile) and the cath starts slipping on my penis head, I throw the cath away and start over. I can't really vouch for how antiseptic my technique is compared to something like providone swab stick wipes, but it is certainly faster. As mentioned before, only about 30 seconds from opening the package to when the urine starts to flow out the catheter, and that includes spray the meatus. I am pretty colonized lately, however, which is pretty normal so one day I may try going back to the providone iodine or some less messy wipe. Are you colonized?
Jim
frank74205 jimjames
Posted
Hi Jim, I like your system. I wash with soap and water,then use antibacterial wipes .I then open coloplast package catheter.I don't lilke to touch catheter ,however it is difficult to insert without touching. Have you tryed the magic 3 hydroyllic sure grip sleeve? I would appreciate knowing if you have tryed them?Company is Bard care.
jimjames frank74205
Posted
Hi Frank,
What kind of difficulty are you having inserting the Speedicath's without touching them?
Yes, I've tried the Magic with the sure grip sleeve, in fact tried about every hydrophillic on the market. It is supposed to be a good catheter and if it works for you fine. With the sure grip sleeve you don't have to touch the catheter although I find the sleeve method a lot slower than the "nose dive" method I use with the Speedicath. If I remember correctly, the coude tip on the Magic seemed to snag (cut into) my prostate a little while the coude tip of the Speedicath slips right by. I had the same issue with the Lofrix Origa catheter (snagging on the prostated) as well. But that's just me and we all have a different anatomy.
Jim
Howard31850 jimjames
Posted
frank74205 jimjames
Posted
hi Jim, i hold the funnel end of catheter,it is now straight up vertical with my penis. I'm using a fr14 and at times it slides out if i don't hold catheter below the funnel.Now i touch the catheter and thats not good ? Is that right?
Is their a better way of doing this?
Thanks Jim,
frank74205
Posted
jimjames frank74205
Posted
Hi Frank,
Try opening up the meatus wider with the thumb and forefinger of your other hand to give yourself a bigger target, if you aren't already. With me, while the "dive bomb" part only takes around 5 seconds, I do stop for a second or so when the coude tip bypasses the meatus and catches about 1/16 inch into the urethra. Once it catches, then I push it in.
I think it's just practice and tweaking things a bit, however if you can't do it that way then touching the catheter is an option just make sure your hands are well washed or probably better use a non-powered surgical glove. When I used gloves, they weren't usually labled "sterile" so what I did was put on the glove and then I covered the gloves with an alcohol based hand cleaner. I found the catheter a bit slippery to touch but never reallly practiced that much. They also have some hydrophillics with a "sleeve" which means you can feed the catheter in with the sleeve without actually touching it.
Jim
jimjames frank74205
Posted
I believe I discuss it more in length in the self cath thread, but basically it just means that with my penis gently stretched and the head facing the ceiling, I gently open up the meatus with thumb and forefinger of one hand, while gently dropping (nose dive) the catheter into the meatus holding it only by the plastic funnel. It's all very slow and gentle. Not painful at all.
Jim
frank74205 jimjames
Posted
Hi Jim, Thanks for this. I do have trouble droping the catheter in this way. I going to get some sterile gloves and try it again. I don't know if this is quite right. When i use a fr12 the output is less than fr14, do you find ot this way also?
jimjames frank74205
Posted
Do you measure the output in a measuring cup or are you just estimating? The output should be the same. How much of a difference are you finding? Real sterile gloves cost more than non-sterile ones. I used the non-sterile gloves and just rubbed some hand cleaner over them, but the dry sterile gloves migh offer more grip if you are going touch the catheter with them. Just don't get the powered ones.
Jim
frank74205 jimjames
Posted