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

Hi ZD,

Yes, the single-use Speedicath Hydrophillics can be quite expensive without insurance coverage. The best value is probably the red rubber catheters that can be reused multiple times. Even if you cath 6x/day, you could actually get by only with only 2-4 red rubber catheters a month! I also believe vinyl catheters are reusable as well. 

The important thing is that the lube is water soluable and sterile. So nothing like vaseline, etc. I used several, and they're all OK, but liked "Surgilube" a lot. They come in small tubes or individual packets. 

Jim

Where do you get Surgilub?

Hi Jim and all,

Wanted to give you an update. I went 30 hours w/o CIC - really tough. Then last night I tried again. This time I used extra lubricant. I opened up the Speedicath as usual on the wall and pulled the tab dwon 1/3 the way as usual. I then squeezed a glob of KY sterile gel on the catheter just below the green cap. After a minute it slid down out of site. So then I slowly pulled the catheter out as usual and it was nicely coated.

The insertion went much easier with little discomfort at the prostate so that was good. But I still had trouble getting into the bladder. This time instead of pushing and rushing I just applied gentle pressure and waited for a good 2 minutes. Finally it slipped in. There was still a steady stream of blood-colored urine that never did clear. And that was it.

But now I hope there is not a UTI! I have frequent peeing every 30 minutes with tons of burning - gee whiz! I used my home test kit and the leukocytes were off the chart but the nitrites were still zero. So maybe it just irritation from the trauma two days ago.

I took an azo and sat in the tub using epson salts and that really helped a lot. But an hour later all the pain and burning has returned.

During the night I was up every hour from retention. I got those new copper compreesion socks that go up to the knee but they didn't seem to help during the night. I also tried elevating my feet.

All this is a strong reality check that CIC is not for whimps and should not be taken for granted, at least for those of us in out first few months. We all seem to go up the same learning curve which is why you are so very important to all of us - thanks. Any commenst?

Neil

Hi Neil,

That makes sense with the xtra lube. It worked around the prostate but no difference getting into the bladder or with the bleeding. At least you tried. Next maybe try a red rubber and a Speedicath without the Coude. Just be very careful and gentle with the latter.

I'm wondering if no CIC for 30 hours may have precipated a UTI. You can still have one with negative nitrities. I would first go back on your regular cath schedule and increase fluids. If the burning still continues or if the bleeding increases, I would contact your doc. 

You're wearing the compression stockings during the day, not at night? They didn't work very well for me either but worth trying. Use the Azo sparingly because you don't want to mask any UTI symptons.

Have you tried the cough thing at the bladder sphincter. Someone mentioned it went in when they laughed. I used a guided relaxation technique. All these things can help get it past the sphincter. Also, maybe try the sitz bath just before cathing, probably without the Epson salts.

Jim

Hi Jim,

I found some white residue at the bottom of my pee bottle after I emptied and rinsed it well. What is it ? Does it come CIC ? Thanks.

Hank

Hi, Neil,

Glad to hear you were able to get past your prostate more easily. Coloplast has a catheter model called self-cath which comes in a coude tip with an olive head. Look it up online so you can see what it looks like. The olive tip may allow you to through the sphincter with less irritation because of its shape. The speedicath tips are more pointed than the olive tip.

You will have to lube the self-cath. The colored stripe on the side makes it easy to keep the tip correctly alligned when you're inserting.

If you're concerned about UTIs, check out a supplement called d-mannose. It helps prevent UTIs, and got a good review from the national institute of health. I bought mine at whole foods, but I'm sure its available from other outlets. I started taking it 2 times a day back in July and haven't had a UTI. When you start taking it, your urine will have a bad smell, but that clears up in a couple of days.

Hope you find some relief soon!

Stebrunner

It could be bacteria. It could be nothing. If you aren't having symptons I wouldn't worry about it. Are you drinking enough water?

Jim

Maybe it is from some supplements that I am taking. I drink about 1500 ml a day. Most of the time my urine is clear. I have no other symptoms. I thought maybe it is something like leucocytes or nitrates that you and others discussed about. Thanks.

Hank

Sorry to hear you are still having a little difficulty. I started with lots of difficulty getting it into the bladder. It's a lot better now, but in thinking about it I realized its probably still taking a minute or two to get the catheter into the bladder but I've been able to relax and just wait .

I've been using the strips to check for infection every once in awhile. I would usually use them after a NV and they are usually normal. Yesterday I used them with the catheter void. Freaked me out, the colors  were maxed out for blood, leukocytes and nitrates even though the urine appeared as it usually does. I tried again with a natural void today and everything was back to normal so I guess using the strips is not accurate on the catheter void which makes sense but I never thought of it before..

Also a question for Jim or anyone who might know. When the catheter enters the bladder it quirts out like a water ballon being popped it seems to be under considerablr pressure, it this normal? I'm thinking maybe there is pressure from the bladder on the spincter which keeps it tight..

Hi JW,

The catheter void should be more accurate in terms of leucocytes and nitrities. Instead of testing on consecutive days, try testing on the same void. Proper order would be: Clean hands and meatus then: (1) mid stream catch into a clean container; (2) test with strips; (3) cath into a second clean container; (4) test with strips. If the urine is going to be sent to a lab for culture, the container should be sterile and a catherized void is preferred. 

Not sure what you mean "it squirts out....". Are you saying that urine is squirting outside the catheter all the way out the urethra? I think this has happened to me a couple of times with the 12F but not with the 14F. Trying to remember what the situation was that caused it but it might be that you're penetrating the bladder sphincter too slowly and therefore at some point it is only half open and not really closed against the catheter to prevent urine from coming out. It's been awhile since that has happened to me.

Jim

Thanks for the info on the strips I'll give it a try.

No I mean when I enter the bladder if I don't  get my finger over the green end fast enough urine will squirt all over the place which I find really surprising since I do a natural void first and I would not think there would be that much pressure on whats left...

One time when I was learning I thried with a full bladder without voiding and it squirted around the catheter too, a bit of a mess..

HI Jim - thanks for the response - there is so much to learn. I tried the stockings at night. I do cough when I get to the sphincter. It worked in the past but not now. For the past 10 days I was getting in easy but now it seems to be closed for repairs! I wonder if I forgot the angle I was using at that point?

I've taken 5 baths today in 4 inches of water with lots of epson salts. It really has helped so much with the discomfort. But now the dreaded night approaches. My NVs have been quite good all day. Every 30 minutes with about 100ml and drinking lots as you suggest.

I think I will wait till tomorrow morning to CIC again unless the night is really bad. That's a great point about checking the CIC pee with the test strips for UTIs. There is so much to learn.

Why is the coude tip harder to get past the sphincter? Do you still use the coude? I just really like this catheter and I was up and away and doing great until I rushed on Friday night and pushed through the sphincter.

Also jwrn raises an interesting point below about higher pressure in the bladder making it harder to get through. This makes sense but I find just the opposite. When I am in retention with high high bladder pressure I find that that high pressure tends to dilate everything so it is much easier for me to get past the prostate and into the bladder. My most difficult times are when I just have 100 to 200 ml to CIC.

I did order the lubricant you suggested from amazon but I had a new tube of ky here so gave it a try. I will use it next time too.

Thanks everyone.

Neil

 

Thanks stebrunner - I will check out the catheters you mention. Do you think I would have a more difficult time getting past my prostate though if the tip is more blunt than my current one?

I will go to whole foods tomorrow here and get d-mannose. I don't want utis!

I know I will master this CIC thing - it is just a big learning curve as there are so many subtle issues - but the alternatives are far worse!

All the best to you.

Neil

Hi jwrhn,

There is a lot of elastic energy stored in the bladder wall when it is filled.  properly functioning detrusor muscle would close down and expel all the fluid when called upon by the brain. But our detrusors are only working partially so they only contract so far with the result that the pee that is left in is under pressure from the compression of the bladder wall. The more pee the greater the inward pressure from the bladder wall on the residual pee. So when we pierce the sphincter with the catheter we relieve this pressure and the higher the pressure ( i.e. the greater the residual pee - PVR) the greater the speed it comes out. The driving force is the stored elastic energy in the bladder wall and not the detrusor muscle bein activated. Hopefully we can all rehab our detrusors like Jim has done so our PVRs will be driven to low values by normal detrusor contraction.

But I've noticed that when I have a PVR of 600ml it is much easier to get through the sphincter compared to wehn the PVR is 100ml. I think that is because the higher pressure dilates the sphincter and bladder neck more so it is easier to get in (like having a baby) even though as you say it is more intuitive to think that the higher pressure in the bladder would make it harder to get in.

Take care

Neil

 

Oh. If you're doing it over the toilet, you just have to time it better when to lower the funnel toward the toilet. At least that works for me. The only time I put my finger over the funnel is when I pull the catheter out so that the urine in the catheter doesn't drip all over me. Then I release my finger when the catheter is pointed toward the toilet.

You said: But I've noticed that when I have a PVR of 600ml it is much easier to get through the sphincter compared to wehn the PVR is 100ml. 

--------------------------------------

Way back I noticed that. In fact, if I emptied my bladder completely with CIC, and then tried to cath right away it was sometimes impossible to get past the bladder sphincter the second time as the empty bladder shut the door so to speak. For some reason today I have no problem getting through the bladder sphincter whether my bladder is full or empty. Not sure why. Maybe my body is just used/conditioned to the process (here it comes, let's open )  or maybe my sphicter has widened from the self cathing or maybe I have gained some voluntary control over the sphicter. Hard to say.

Jim

Jim

The funnel is pointed up and the urine will squirt straight up a foot or two, I need to quickly put my finger on  the funnel to stop the water works. It's not like siphoning gas and relying on gravity this is like poking a bag...

The last was 180 NV and 120 PRV and it still squirted out ...so it dosent seem related to real high volumes. I seem to remember reading something about high and low pressure nuerogenic bladder maybe I better revisit that...

I understand what you're doing. But in my case, even though I drop the catheter into the meatus with the penis pointing straight up, by the time I pierce the bladder sphincter it is facing straight down into the toilet therefore no need to put my finger on the funnel. My process is so quick (5 seconds until urine flows) that I will have to slow it down a little to see at what point I actually drop the penis toward the toilet. My guess is right before it pierces the sphincter but it could be right after but before it starts draining. The volume thing is another issue and relates not to squirting but to ease of penetrating the sphincter.

Jim

Hi, Neil,

So here's some helpful info from a medical supply web site--since we can't post links I copied it over:

A Coude Tip Catheter has a slight curve at the end of the

catheter to assist in passing enlarged prostates and urethral strictures. The Olive Tip Catheter has a small bulb at the end of the curve to assist in

 negotiating restrictions in the urethra.  Each Manufacturer product has

 different lengths and thicknesses of the coude tip and olive bulbs and one

may work better for you than another.

There is also a Tiemann Tip Coude catheter that has a much skinnier,

longer, and more flexible tip to help find the smallest of openings in your

urethra and guide the catheter through.

When I started CIC, my uro's office started me off with the self-cath FR16 with a combination olive-coude tip. I likened it to using a snowplow! The FR16 factor kind of roughed up my urethra, but I kept some around for awhile--for those days when my prostate got stubborn!

I did try the Tiemann tip but found it too sharp and uncomfortable. Had the same problem with Speedicaths and ended up using LoFric Origo FR14s. Since my PAE, I've been able to use Speedicath FR12s, but some days those end up pinching me too much so I alternate between these and the Origos.

You might find that a Tiemann tip will work well with your architecture. As Jimjames says it's good to experiment. I tried several different tip styles and sizes.

Your anxiety about upcoming CIC tonight is understandable. I've been there myself plenty of times. Remember that you've been having great NVs. That's a huge plus! I hope your CIC tonight goes well!

Stebrunner

 

I have the same problem as you. When the catheter enters the bladder, I better have my finger covering the green plastic funnel, or urine will squirt out of the funnel end.

makes sense to me!

 

JIm,  today, it took me 15 seconds to reach the bladder.  It's the fastest so far for me. I could have gone a little faster, but I could feel a little stinging sensation, so I slowed down to where there was no pain at all, even though it was minimal.  I am using   FR14. coude tip Coloplast.

 

Neil,  The last time I was at the drug store, the pharmacist told me that KY is not sterile lubricant.  He told me to use another type of lubricant, it's called surgilube.  I don't use it now, because I am using FR 14 Coloplast, which is already lubricated.  I was using a straight tip, at the time, but now, I'm on the coude tip, which I like a lot. Sounds like you are having trouble entering the bladder, with the catheter.  You may want to try taking Doxazosin that you can get by prescription from your Uro.  It relaxes the muscle by the prostate, so perhaps, it may  help with getting that catheter through?  I am still taking Doxazosin, but since my TURP, I am only taking half a dose.  What I do is break the pill in half. I can feel the difference in the amount of urine and the ease at which it exist the body. In the beginning many years ago, after taking Doxazosin, I  would immediately have a stuffy nose.  I guess my body got used to the drug, and so now, no problem with stuffy nose.  As I told JimJames, I can do it in 15 seconds from beginning to I reach the bladder.  This is only if conditions are right and there's no resistance as the catheter travels through the urethra.  When I first started around 3 months ago, it took me around 2 minutes to reach the bladder.  It must be frustrating not being able to enter the bladder easily. My guess is that if you continue doing the CIC, then eventually your bladder will ease up, and penetrating the entrance to the bladder, will become easier, like what happened to JimJames.  Good luck!

Hi Dennis,

That's great. How long did it used to take? Not that you are, but please don't be tempted to go fast just to go fast. It's not that I'm worried about my 5 second record (actually just under) being broken it's that going faster than the catheter naturally travels could result in a bad outcome such as a unecessary trauma or even a false passage. I'm using FR12 Coloplast Speedicath Hydrophillic with Coude tip. Are you using the Speedicath Hydrophillic as well?

Jim

Hi stebrunner, jim and dennis,

Thanks so much for all your help and good wishes.

Dennis - are you in training for when CIC becomes an Olympic event (hoepfully not televised!) ?

The 4 tub soaks with epson salts really helped me a lot yesterday. Today all the burning and pain is gone so that is good.

I tried holding off from CIC last night to give the sphincter a rest but by 5 am I was in such agony I had to do it. I was up every hour before that passing about 50 to 100ml with some effort but not too much.

Anyway, the passage through the prostate was much easier with the glob of KY (thanks Dennis - I have the surgilube on order from amazon). I would say the burning is reduced by 2/3 from just putting a glob at the top of the open package and letting it slide down.

But again I had a hard time at the sphincter. I thought it might be easier because of the high PVR (650ml) but it wasn't. Seems that every time things are different. So I held light pressure waiting for the door to open. I tried coughing and moving the tip up and back an inch and turning it from side to side. Finally after several minutes it slipped in with not much pain and out came a gusher.

First there was just a little blood but then the flow cleared to a normal yellow. I was happy about that.

But then right at the end just as the flow was ending the yellow turned to bright red blood and lots of clots came out. Iw oudl say maybe a tabelspoon of fresh blood. The catheter was also filled with fresh blood when I got it out ( I keep my finger over the funnel to avoid a mess). When I released the my finger all the fresh blood drained into the toilet along with many clots. They were thin, stringy and elongated. I was very discouraged by that. I had been doing so nicely for 10 days w/o any bleeding. Be careful Dennis not to rush which is what got me back in thsi problem.

It seems I am still causing the sphincter to bleed when I enter it and that this blood pools at the base of the trigone area which gets drained at the end of the cath. This morning I had several NVs. The first one was fresh blood and the sencond one was brown and now the last one was clear.

Do you think I will continue to injure the sphincter every time I CIC or will it clear up over time even though I cath every day? I got past my roiginal bleeding but now I seem to be back where I started.

Thanks everyone. All the best.

Neil

Have you searched to see if an internet search will find you an E-commerce provider in Europe who can ship them to you.  Just search on [surgilub] or something.  In the US, I found a box of 144 for about $20 US.  I've also found 4.25 oz tubes for about $3.75.  The tubes are easier to use, but you need to maintain the sterility of the jell.

I'm not familiar with the degree of E commerce in Europe, but here in the US, I find that I can have just about anything shipped to me within a few days.  

Was 650ml your PVR at 5am after  holding off CIC? Was there a natural void preceding it? Don't have to mention that high PVRs can not only stretch the bladder and cause reflux into the kidneys (hydronephrosis) but they it can also set you up for UTIs. So to answer your question, I would continue to self cath daily unless things get worse. 

At the same time, I would continue with the hot baths (you only really need a shallow bath that covers the prostate and maybe nix the epson salts which could be an irritant if they get into the urethra). That and experiment with different types of catheters such as the ones Stebrunner and myself suggested. Also, if you can find someone qualified, consider some bodywork/massage of the pelvic floor area to loosen the sphincter. Lastly, you might experiment with a muscle relaxant like Valium and see if that makes any difference in loosening the bladder sphicter. I wouldn't use valium long term, but if it works then you could switch to other more appropriate muscle relaxants.

Jim

 

I believe I saw surgilube on French Amazon. It's certainly on U.S. Amazon. While that's what I used, there are other suitable alternatives out there for a water based sterile lube.

Thanks, Glenn, yes I did. No Surgilube outside Europe. Jim mentioned KY

jelly but is this sterile??? ZD

I'm not certain, and I couldn't find any definitive  answer.  There are some other brands, such as McKesson Sterile Lubricating Jelly Lube.  You might ask a pharmacist or a medical supply house to see if they know of others.  I did read that KY was originally used for surgical purposes, but the company doesn't use "sterile" in their marketing.

Hi ZD and Glenn,

Surgilube is availble on Amazon in the U.S.A. both in tubes and individual packets.

BTW I never mentioned "KY" unless you are referring to another "Jim"? 

Jim

Sorry, it wasn't you about KY but I don't remember who it was 😁

HI jim, my PVR has been 550 ml Not always,.Do you think this reason is the intake of food and liquids?

Thanks  JIM,

Just guessing around 2 minutes.  I used to go really slow. Now because I'm very used to it, I can move along at a pretty quick pace.  Yes, I am being careful, because I don't want to injure myself, just to see how fast I can do it.

Yes, I am using the FR 14 coude tip from Coloplast. That thing is so slippery, that I have a hard time holding on to it if I'm holding on to the part that is inserted in the penis. I wish I started CIC back 10 years ago.  It feels great to have an empty bladder! Now when my wife and I go to a restaurant, I don't have to use the restroom, right before leaving the restaurant to go home.  In the old days, before CIC, I always made sure to use the restroom before leaving the restaurant, just in case we ran into traffic before reaching home. I wonder, say...100 years ago, before they invented catheters, what did men do then?  Did they just suffer and eventually die from urine retention?

Glenn, It's called Surgilube...you were very close.  Here in Hawaii, it cost me around 35 dollars for the same amount, if I remember correctly. I don't use it anymore because I am using the Coloplast FR 14 self-lubricated catheters.

Hi Frank,

I replied to your question in this new thread here:

https://patient.info/forums/discuss/issues-and-problems-with-self-cathing-cic--552686