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

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Hi Kevin,

I think you can do a lot better on the price.

Allegro Medical is selling a box of 30 for $89.94 USD, or $2.83 each. First Option Medical has it for $80 and $2.53 respectively. Both are US internet mail order companies, there are probably others. I believe First Option ships to Canada, not sure about Allegro. Also, most of these companies either offer free shipping for orders over a certain amount, or are constantly running free shipping specials several times a month. If you need the links or anything, just let me know and I'll try and post or PM them to you as not sure if the moderators allow commercial links.

The difference between the two is a little more than you describe. The hydrophillic catheter has a different coating which makes it more slippery than a normal catheter even with the lube.

That said, if the price is any type of hardship (my insurance pays for all my catheters) I would go with what you can easily afford. And as I mentioned before, most catheters (like the GentleCath), can be reused for up to a couple of weeks, so in that scenario the price difference between a one-use hydrophillic and a multi-use is huge.

You also might want to order samples, if so, besides the GentleCath and Speedicath, you also might want to try what they call a "red rubber" cath. Bard makes some good ones, and again, you would want it in a 14FR Coude tip.

Let me know if you have any more questions.

-- Jim

Sorry for the late reply but I haven't logged in for some time.

1) Frequency of CIC is very individual and can change with the same individual depending on any number of things. So for example, let's say you start catherizing 4 times a day. If your Post Volume Residual (PVR) is between 200-400cc then most docs would have you continue at the 4X per day schedule. However if your PVR after CIC was greater than 400cc, you would then increase to say 5 times a day to keep your PVR under 400cc. Likewise, if your PVR was under 200cc, you might try catherizing 3 times a day. If it was till under 200cc at three times a day, then you would go to 2 times a day, etc.

In your case you're starting at 1X a day. So what you will do is measure your PVR after CIC. If it's greater than 400cc, then you would speak to your doctor about increasing frequency because you do not want to have more than 400cc in your bladder at any one time. If for some reason you had less than 200cc, then I would ask the doctor why he is having you do CIC at all.

In my case, I have done CIC as many as 6 times a day and as little as no times a day. In fact, I haven't  done CIC in the past three days. With me, some of the factors that determine how many times I have to perform CIC might include fluid intake, alcohol intake, caffeine intake, amount of exercise, sexual activity and medications. And honestly, it is very hard to figure out what will decrease and what will increase my CIC frequency.

I am fairly certain that fluid volume is one definite factor. I think that if I take in too much fluid volume at once my bladder expands to the point where I cannot naturally void, ie the muscles arent't strong enough. But if I drink less, I can then void more easily naturally, and therefore at times can go for days without having to CIC. Of course you don't want to drink less to the point of dehydration. As to some of the other things, I'm not as sure what helps me to decrease the frequency of CIC.

Exercise seems to help. Caffeine seems to help. Alcohol not sure about. Sex sometimes helps but if my prostate gets inflamed from sex then it's the opposite and I have to CIC more. Lots of trial and error here.

2) If your doctor is having you CIC only once per day, I assume you are able to naturally void most of the time. By naturally void I mean without a catheter. So how it works is you naturally void as much as you can. And even before bedtime you will naturally void first, and then when you can't void any more, then you will perform CIC.

3) Sometimes I carry a spare and sometimes I don't. It depends how long I'll be away from home and what I plan to be doing. If I was going to be away for say the afternoon and joining some friends for beer, then, yes, I'd probably bring one or two along. In your case, you're only scheduled for 1 at night. If that schdule works out for you, then you probably won't need to carry one with you unless you're going to be away from home that night.

4) Not sure what meds you're on. Some people I suppose will continue to take something like Flomax and do CIC, but I think that kind of defeats the purpose. You don't need any of those types of drugs with CIC because you will be able to completely empty your badder mechanically any time you want. So who wants to deal with side effects of drugs that are designed to do the same thing but not as well?  The only drug I took while doing CIC was daily Cialis. And I only took it because I thought I could get off CIC with it. At the time I was taking it, it decreased my CIC from 4 times a day down to 2 times a day and then for a month or so I was able to stop. But it didn't last and I had to go back to CIC so I basically stopped the daily Cialis. My thinking was that if it wasn't strong enough to get me off of CIC entirely, I'd rather self cath once or more times a day xtra rather than deal with the side effects of the Daily Cialis.

Anyway, you've probably started the program by the time you read this and I'm curious how its going. I'll check back more frequently if you have any more questions.

As I mentioned earlier in the thread the first few weeks, or even month, can be quite difficult for some people. It was very difficult for me. Now, it's really like brushing my teeth, that easy. Don't even think about it.

Also curious what catheter you're using. I have tried most of them and prefer the Coloplast SpeediCath Hydrophilic Catheter.  But all our anatomy's are different, and whatever works for you is the best one.

Jim

I had started to do the CIC in June. I started to do it only during the night and used to void between 400 - 500 cc. I was then told to try and do it during the mornings too, where I used to also void between 400 - 500 cc. It is quite a challenge for me to do it during the mornings in the office washroom (Mon - Fri). I had developed serious case of UTI and was given anti biotics. Now it seems the only anti biotic that will work for me is Macro-bid. My family doctors says that if I am also immune to this , then I may have to treat the infection intravenously . I am going to see my urologist in a couple of weeks. Do you have any tips on making sure that I do it right, so that I do not get infected? Do you know how the intravenous method works? I use the Coloplast speedicath Hydrophilic Catheter at home and the Speedicath compact male Catheter in the office.

When you say "used to void between 400-500cc", are you talking about how much came out of the catheter or the combined natural void and catheter volume, assuming you naturally void first? 

One rule of thumb is that if your catherized volume exceeds 400cc, then cath more often. If your catheter volume is less than 150cc, then catherize less often. If it's inbetween, continue on your current schedule. That said, a natural void volume can also be factored in, that's why I asked the question, assuming you do a natural void right before you self catherize.

Before I get into specific answers, I just want to say that you are relatively new to self cahterization (CIC). I've been doing over two years now and as I've said before the beginnig was very trying. Like yourself, the first few months were plaqued with difficult to get rid of UTIs. Flash forward two years and all those problems are way in the past. I did the International Prostate Sympton Score test the other day, and I now score borderline "Mild". Prior to CIC I was "Severe". And when I say "Mild", I mean without CIC, because of late my then flacid bladder has been rehabilitated enough through CIC that I can sometimes go weeks without having to self-catherize, while in the beginning, I needed to do it six times a day. Anyway, I digressed to give you hope looking forward, because I'm convinced that many like myself, can rehabilitate their bladder as good as -- or even better than -- by having surgery, without any of the side effects.

So back to your UTI's. First, you should be seeing a urologist right now, not waiting a couple of weeks. The average family doctor only knows how to treat simple UTI's at best, and any UTI for someone who does CIC, is a complicated UTI, sometimes requiring a different drug as well as different treatment protcol/variations. IV antibiotics are available, but my guess is that once you find yourself a knowledgeable urologist -- hopefully a urologist who is familiar with CIC patients (not all are), they will be able to cure your UTI without IV antibiotics. And if you can't find the right urologist through normal channels, try through the SCI (spinal chord injury) community. 

The SCI community uses CIC as their go to way of urinating and therefore any urologist who serves that community should be expert in CIC induced UTI's.

The other thing to keep in mind is that there is a difference between the normal symptomatic UTI and an asymptomatic UTI, often called "colonization". Colonization is very common when you do CIC, and will show up as a positive urine culture. Doctors familiar with CIC will NOT treat colonization, even with a positive urine culture unless it is quite symptomatic. To treat colonization would be counter productive. I can go into the reasons at a later date. 

As to preventing UTI's, the first will be father time. In time, you system will adjust to CIC and therefore be less traumatic. 

Second is frequency. If you're carrying around a lot of stale urine, you will get more UTI's. Therefore, the more you catherize, the fewer UTI's. Sounds counter intuitive, but it goes back to the 400cc rule. In fact, if I were treating a UTI, I would increase my CIC schedule so I had under 200cc at all times to give the antibiotics an easier hand in working. 

Third is catheter choice and technique. You're using what I think is the best and least traumatic catheter in my experience, the Hydrophillic. Coloplast Speedicath. I would keep using that and dump the compact male catheter as I believe it is thicker since it has to fold up but not sure. 

Also, I'm assuming you havre an enlarged prostate, so you should be using the Speedicath with Coude (curved) tip? If not, that could be a problem right there. The Coude tip helps you navigate less traumatically around the prostate. I also believe the Speedicath Compact does not come with a Coude Tip?

Also, what size catheter are you using. Most people are giving 14F. That's how I started. But the thing with the Speedicath is that it's a relatively rigid catheter so if you use a 14F with a normal catheter, you can actully drop down to 12F with the Speedicath. The narrower size of the 12F makes an easier, less traumatic insertion, and therefore less chance of an UTI. 

Technique -- Because the Speedicath is semi-rigid, you can acutually insert it without touching the catheter itself like they show you on the videos. I hold it only at the plastic funnel with one hand. The other hand hold my penis up at at 45 degree angle and at the same time my fingers push the meatus open (from the sides) without touching it.  Then I basically drop the catheter in. Hands free, no issues with germ transference. With this technique, altough I often do, you don't even have to wash your hands because they never touch the catheter or near the meatus.  (Prior to inserting the catheter I swab the meatus with Provodine Iodine swabs or a less messy substiture)

If you go this route, I would start with the 14F coude, and then when you master the technique drop down to the 14F. The 12F, because smaller and therefore less rigid, takes a little practice to get it down without touching the catheter. 

In addition, I've also played around with urethral irrigations, but that's for another time.

But back to the UTI -- see a uroligist knowlegeable about CIC ASAP> Family doctor can be useless. And if the urologist doesn't seem to know much about CIC or treating complicated UTI's (many don't) then find one who does. 

As I said, I had a very rough time with UTI's the first four months. Primarily because my doctor didn't treat it earlier enough and long enough and with the right antibiotic. Once I got past that period, I haven't had one symptomatic UTI since. 

Find the right urologist. Get rid of that UTI. And stay the course. It will be worth it, at least it was for me.

Jim

"...drop down to the 12 F...."

Thank you so much for your advice and suggestions. Fortunately, my UTI got cured by the anti-biotic that my family doctor gave me. I live in Canada and it is easy to see a family doctor any time. However to see a urologist(Specialist), one has to make an appointment to see him and that takes weeks, depending when they have an available slot. So far I am good at the moment.

Yes I do have an enlarged prostate and I am using the 14 " coude and the 12"/14" compact catheter. However, my question to you is, do I get the UTI from the stale urine remaining in the bladder or somehow, I touch some my hands or something that is not clean and the bacteria gets transmitted somehow to the catheter and into the bladder and get the UTI. I have to use the compact catheter at the office. I cannot use the regular one at the office. I can keep it in my pocket and then wash my hands and go into the toilet cubicle. I use my hands to open and lock the cubicle. I then remove the compact catheter from my pocket and use alcohol swabs to clean the head of my penis and then insert the catheter. Its been about two months since I have been doing it and getting used to it. I only feel a slight bit of pain when I remove it, as it passes through the prostate. So pre catherization I void maybe about 70 - 100 ml and catherization will void between 400 and 500 ml. During the day, I may void a few times maybe about 50 ml.

So I am seeing my urologist next week. Jim, so please let me know what questions I should address to him.

Thanks

Daniel

The answer to your question re UTI's is "both". Stale urine can be a breeding ground for bacteria and the introduction of bacteria through the CIC procedure (hand touching, etc.) can also cause UTI's. So, the idea is to deal with both.

If you catherize 400-500 ml after you naturally urinate, then that's quite borderline and my understanding is that you probably shoul add at least one more CIC to your routtine. So if you're doing CIC twice a day, then up it to three. And if you're experiencing a UTI, I'd up it during that time period to 4 or 5 so that you have the least amount of urine stagnating which will mean the antibiotics will work better.

As to technique, I talked about my "no-touch" technique in the previous post and would be happy to go over it again if you have questions. Also, try some 12F catheters and I think you will like them better with practice. They will not hurt as much pulling them out and with less trauma, less chance of UTI.

Also, your pocket cath I don't believre has a coude tip? If I'm correct, try and use your Speedicath instead. For concealment, if that is an issue at work, you can bend the Speedicath in two and it should work for a couple of hours. Or, you can simply stick it in your sock (under your pants) and walk in and out of the bathroom with no one the wiser!

Questions to urologist: 1. Discuss your UTI situation and ask what his threshold for antibiotics is. In other words does he treat asymptomatic bacturia (colonization) -- he shouldn't -- or does he only treat positive cultures when certain symptons present themselves. 2. Again, ask for an rx for some 12F to try them out. 3. Discuss upping your CiC frequency based on the measured PVR (post volume residual). 4. Come up with a protocol should you get a future symptomatic UTI, where you won't have to wait several weeks to see him -- maybe he can give you xtra RX's for urine cultures that you can use at a lab that reports back to him and then he can prescribe an antibiotic on the phone if needed. 5. Don't let him talk you into an operation unless you feel it's right for you. Almost all urologists I have seen view CIC as  temporaty phase prior to being operated on. I disagree and feel that it is an alternative option to surgery for those who weigh the pros and cons of each. As I've mentioned before, after two years my bladder has healed enough due to the rest given to it by CIC, that I'm only cathing every week or so, and the rest of the time everything works pretty normal. 

Jim

Well I went to see my urologist and everything is going fine with the CIC. Voiding around 300cc and getting better day by day.  I wish I had done this years ago. My urine has been clear of any UTI's for now. However, I have a few questions and would like your advise. My uro had prescribed me with Finestride which I took for about 7 months and my prostate shrunk from 52 cc to 44 cc.  But still have a lot of retention and hence the CIC.  I was having terrible side effects from taking the drug. He told me that since I am now doing CIC I can stop taking the drug. But ever since taking the drug my sex drive libido has gone down. My erections are like 80% of what used they used to be, but I can have sex successfully. I used to wake up with an erection every morning, but not anymore. He has prescribed me Ciallis, which he said will help me with my erections as well as the BPH.  I know you have taken and stopped take taking it. My fear is that will I have to take it for life? If I stop taking it, will I be able to get erections? I am 55 years.. and just worried of taking this drug. I haven't started taking it yet.  Any advise would be greatly appreciated.

Glad things are going fine with the CIC. When you say you void 300cc, are you talking about the catherized volume or the volume of your natural void? The recommended procedure is to first try and naturally void and then do CIC right after. If you feel the urge (or if your on a schedule) and you cannot naturally void the you just do the CIC. I found it useful in the beginning to log all my voids by time and volumes including what was a natural void and what was by CIC.

Finasteride can have sexually side effects and I agree with your doctor that now that you're doing CIC you should go off of it. Are you on any other meds like Flomax (tamsulosin)? If so, they can also have adverse sexual side effects and you don't need them either. 

How long have you been off Finasteride? You might want to wait a month or so after stopping, before trying Cialis,  and see if your erections improve. 

Did he proscribe Daily Cialis (5mg/day). That is the recommeded schedule ad dosage for men with BPH. However, since you are doing CIC you really don't need it to increase your flow. Therefore, since you will bre taking it just for better erections you really have a choice between the higher "weekend" dose and the lower daily dose. Each has it's pros and cons with efficacy data in terms of better erections mixed and therefore individual. Of course with the daily dose you will have the spontaneity factor but you will also will have side effects more of the time, which may or may not bother you, again an individual thing.

Other than the side effects which vary and you may get used to (dizziness and a few others) I don't see any long term issues with Cialis. If you decide you don't like it, just stop and you will be back to where you were before, no worse. In fact, there is some anecdotal data that you may be a little better off when you stop since you've had increased blood flow while on it. 

But again, I'd probably wait until you see how you do without the Finestride before introducing something new into the equation.

Jim

Jim