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

Curious why you're going to try Flomax at the same time you're doing CIC? One of the benefits of CIC is that you're able to empty your bladder completely any time you want, and therefore you can get off all those drugs completely as all they do is try and do the same thing but not as effectively. Yes, it's possible with Flomax or Cialis you might be able to cut down your CIC frequency a little, but unless the drugs let you completely get off CIC, I really see no benefit, only the downside of the drugs side effects. And I'm guessing you tried Flomax prior to CIC, so I just don't understand your urologist's thinking at all. 

If your frequency is currently 3X/day I assume you urinate naturally some of the time. When you do CIC, how much do you naturally urinate first, and how much on average comes out through the catheter?  The rule of thumb is that you want to keep your Post Void Residual (PVR) under 400. So, that means if your CIC volume is 400cc or more, you want to increase the frequency. And ideally, you want to keep your total bladder volume under 400, so that would mean the total of what you void naturally plus what comes out when you catherize should be under 400. 

The idea here is to decompress your bladder and give it both a rest and time to recuperate and regain lost elasticity. When I started CIC two years ago, 75% of my urine output was from the catheter. Now that my bladder has regained elasticity through CIC, most days 100% of my urine output is natural with no catherization necessary. On those days I occasionally test my PVR via catheter and it's often 50cc or less and never over 150. 

Jim

I moved to Florida three years ago, and with a new urologist came new ideas, but he also had a bladder and renal ultrasound done (neve done by previous guy) as well as a urodynamics test (perhaps the most embarassing test I've ever had).  These provided more data than former urologist had.

So, Flomax will be a new drug.

We'll see what the combination of 4x CIC plus a new med may bring.

I'd certainly never take just one urologist's view on this, though even other surgeon's would probably have the same bias.

Jim

You are doing wonderful  things here. I have started using the catheter last month and intend to follow your path and stay on it rather than have a Turps for an enlarged prostate . The Urologist offered me  this  choice. !!!

The catheter , 4 times a day,  has solved my problem  - overflow incontinence at night  and urge incontinence during day. This happened after surgery & general anaesthetic in Feb 2017 last.

I’m a bit worried by the fact that I do not void  at all or void very little  during the day when using the catheter ?? . The only time I seem to be able to void is the morning before catherization. Can you help?

Thank you for all the time you take to keep educating us about CICing. You have done the community a great service.

One question: what antiseptic spray do you use?

Thanks again. Neil

Hi Neil,

Thanks for the nice words. At various times I've used Microcyn, Puracyn, Vetericyn, and Hydrocleanse (manfactured by Microcyn). Currently using the Vetenarian formulation, Microcyn Ah as it cost less recently I think on Amazon, but basically the same. I use the spray, not the gel. I'm sure a Providone iodine spray or other antiseptic would work equally well but Providone Idoine can get messy while the other products mentioned are colorless and won't stain anything. There are also numerous wipes out there that also work well but I found nothing is faster than a quick spray into the meatus. Just don't use anything with alcohol (like a hand cleaner spray) or it will really burn and don't ask how I know  Shop around online and/or check your local drug stores to see what they have. 

Jim

Could you be more specific. Are you saying very little comes out of the catheter during the day? What is your schedule? Do you naturally void prior to each catherization? A simple log noting catheter and naturally void volumes can be helpful. That said, night time urination (nocturia) is pretty common, especially as we get older. You might just not have realized it before because perhaps things just dribbled out of a full bladder during the day and now you bladder gets emptied completely. Depending on my fluid intake and schedule, activity level, etc. I often void (either self cath or natural) in the morning and then not again until evening. I'm not retaining urine cause I've checked with the catheter, it's just the way the kidneys unload. As long as you check to make sure you're not retaining more than 400cc during the day then you should be fine. There are ways to reset things somewhat that I've mentioned elsewhere in this thread. 

Jim

Do you find it makes any difference if you self-cath standing or sitiing down?

Take care.

Neil

HI JIm Thanks for your help. After a month using the catheter i just cant pee..  I use the catheter 4 times a day and usually measure 400 in morning and 200-300 for the other three tmes. . My bladder held 71grms when i was diagnosed .and i had the condition for six months.

I think I am doing well with the catheter and hope my bladder will begin rehabilitating now. I'm also hoping that when the rebilitation proceeds I'll get to pee again ? I just hope that not peeing now is just a temporary problem? What do you think?

Jim

I can only talk from personal experience and non-professional opinions. That said, when I first started self cathing, my natural voids were either very small or non-existant. Today, I can go for days just naturally voiding with very acceptable residuals. As long as you're not holding more than 400cc in your bladder at any one time, I don't see a problem now whether you are naturally voiding or simply cathing. Some people will never naturally void, some will to some extent, and some will to a greater extent like me. 

In time, hopefully your bladder will rehab some and you will start to urinate naturally at least part of the time but no reason to worry.  Meanwhile, until you are able to void naturally, try "pushing" out gently while you self cath to exercise the detrussor muscles a little. You will know if you're using them because you will see the stream coming out of the catheter get more forceful. You don't have to do this all the time, or very hard. 

Jim

Hydrogen peroxide should work as long as it doesn't burn, irritate or sting. If it does, maybe try a more diluted formulation or something else. 

Jim

Hi Jin - thanks for your reply - helpful as always.

I have another strange question for you.

A few weeks after I started to self-cath once a day I was sitting on the toilet and suddenly I felt  my scrotum hit the water - it really shocked me! Then I saw that my "balls had dropped" quite noticeablly and all of a sudden. I knwo this happens as we get older but do you think self-cathing had anything to do with it? I cannot imagine so and  I guess it is a stupid question but thought I would ask you - any way it is humorous. Neil

Thats brilliant . Many Thanks

Magoies03

Neil,  I'm with you.  Jim, has helped many on this forum.  To you Jim, if you have the time, a video on You Tube, would be very helpful to anyone that wants to learn about CIC's.  Before videotaping, perhaps you could outline a format, then proceed with the videotaping.  You could help men, that are unaware of this forum, but are browsing around on You Tube.  Just a thought.

Jim , Thanks again for your help and support. I am now voiding  small amounts using peeing and cic , day and night. Nightime i get up at 2am and 4am and rise at 6am  with a total amount cic and pee of 750 , none over 400 , nearly all 300 or less. So I think i am progressing well.

However I get a sore tip of penis when peeing and most worrying a threat of pain when I come near orgasm when i am helping myself.. My wife and I havent restarted yet.  Is this because of the bladder in which case I'm hoping it comes right as my bladder recovers? Or is it my Prostate which was enlarged . In any case do you think it will  cure itself if I continue on the path of keeping less than 400ml  in my bladder all the time. ?

Hi Magpies,

Sounds like you're progressing well. It's good that you are keeping total volumes under 400ml, but as I mentioned before it's normal as we get older to retain fluid during the day and therefore urinate more at night. So, while under 400ml at night is ideal, don't go crazy if you're alittle over at night (or first thing in the morning) as long as you try and keep it under 400ml the other times. I certainly don't want you to get dehydrated. 

Hard to say why you're feeling soreness at the tip of your penis when peeing. Maybe you can describe it a little more. Do you feel the pain just prior to the urine coming out, or do you only feel the pain when the urine passes? And how long does it last? Also, do you feel the pain near orgasm or are you just worried that you will? I can only guess at this point, but it could be something physical, possibly from the catheter, and if so, your urologist should be able to see it. Or, it could simply be referred pain from the prostate. I happen to get that from time to time when I try and initiate a natural void but I don't get any pain associated with orgasm. 

If you're asking if your bladder will cure itself if you continue with CIC and keep volumes low, the best answer I can give is "maybe".

For me it has, for some others it hasn't although it has improved things. Also keep in mind it took me two years for the real breakthough.

Very little in the literature on this, but to over simplify things, the physics of the matter are whether or not the bladder muscles are strong and elastic enough to push though whatever obstruction (enlarged prostate) you may have.

So the two variables are: (1) the bladder and; (2) the prostatic obstruction. That ratio will be different in different people but a normal emptying will only occur when the bladder overcomes the obstruction or vice versa.

This is why some people still can't urinate after surgery and others, like myself, can now have normal voids without surgery. In the former, the obstruction might have been removed but the bladder still wasn't elastic enough to empty properly. In my case, the obstruction remained the same -- possibly grew -- but the bladder rehabbed enough to overcome the obstruction. Had my obstruction been greater, and/or had my bladder been in worse shape when I started, then my results would not have been as good. 

Anyway, it's been what, less than six months for you on CIC, so I would be patient in terms of any progress. A good mindset with CIC is that you should do it because it works better for you than other solutions and not because you think that one day you will be able to throw away the catheters. If that happens, like it essentially has with me, well that is a bonus. 

Jim

Ill start with the ejaculation because it’s the one I’m most worried about re resuming sex. I   feel pain coming as I feel ejaculation coming. I usually stay away from the ejaculation I know is coming. However when I continue and the ejaculation happens  it is a pain at the top of my penis and alongside the inside of my thighs sharp and intense but lasts short time. Then it goes quickly.

The sensation in my penis when peeing is more soreness  and a bit burning. It occurs at start of pee for a second and then resumes when half way through getting more sore as I pee to end. And that’s it – no pain/soreness afterwards .

I remember I had a less strong version of both of these from before I started the catheter . The Urologist said the pain on my penis was from the bladder. I didn’t ask about the ejaculation.

I  have booked a GP appointment for a fortnights time. Maybe he’ll use anti-biotics. My urologist discharged me so I cant go direct to him.  I have been assuming it will eventually go away when my bladder

recovers.

Magpies03

Neither the GP nor the Urologist seem to know more about the CIC .

When I first looked at my bladder was described as “large volumn bladder residual 77cc due to enlarged prostate. (61grms) “.

Good morning Mag.  Are you sure you don't have a prostate infection.  When I had a prostate infection my orgasm was very painful and the pain in my groin lasted for about 1/2 hours. No pain in the penis that I no of .  Now I am deal with Chronic Prostatitis. My doctor told me that it is stress related.  I will see him in 2 weeks.  Maybe you need to go see another urologist  Take care  Ken

Hi Magpies,

Those types of pains can be hard to diagnose. I still can't get a straight answer from a urologist regarding the pain I sometimes get when I try and initiate a natural void.

In my case, I think it’s referred pain from the prostate, related to prostatitis, but it could be from the bladder. In your case, it could be either as well. Same I suppose with the pain you feel with ejaculation, although I have never had that. Might try hot sitz baths which can sooth the prostate.

Assuming you don’t have a UTI (you should be checked) sometimes a long round of antibiotics is given for prostatitis. If you’re not seeing your urologist, hopefully your GP has some experience here because if you do take antibiotics, you want to do that right.

Lastly, if things don’t go away, or get worse, a look inside can’t hurt in case it’s something physical.

Since your problem is incontinence versus retention (a PVR of 77cc is pretty low and even normal for seniors) you should be looking at kegels and other ways to strengthen the pelvic floor, if you aren’t already. 

Jim

Thanks Jim thats very helpful

I'll start with the GP and maybe try urologist after..

I dont quiet understand your last sentence?

Magpie03

Thanks Kenneth.

Your  history with Prostatitis may be a key. I'm starting with the GP , maybe anti-biotics, and then try the Urologist..

Magpies03

My understanding is that you have incontinence (leakage) and not retention. Is that correct? If so, Kegel and other pelvic floor exercises are often prescribed for incontinence.

Jim

Jim, I had incontinence to begin with but since using the cic i have had no problem with incontinence but have retention which is reducing. I pee quiet a lot now and my retention amount has been gradually reducing - ie cic quantity small.

. I'm going to the GP soon and i ask for an investigation  by the GP or referred back to the urologist. I'll let you and others here  know.

Thanks for your help

thanks for this info,

frank

Hi Frank, I also had total retention.. probably did not realize it was happening until Acute Retention sent me to the ER last summer. Then after a week on Foley cath, and switching to Self cath.. I'm in Chronic Retention, not able to go, more than a few drops.

Doc approached it from the BPH side, I just had UroLift done ten days ago and while now I can dribble, still need CIC to void. Was hoping the UroLift would fix everything and could resume normal function. Still on CIC so its frustrating.. - Ron

TURP I still cannot void. No uro checked my bladder before the operation

Give it a little time. Hopefully, things will start to improve.

Jim

I'm afraid that is the way urologist think.  If they can't find a answer for the problem they assume that it is the prostate.  They talk you into a GL or a Turp and they say that will fix the problem But all they do is cause more.  It turns out to be the bladder.  So you have had surgery and all that does is cause more problem  Take care  Ken   

Exactly, Ken! And to think that I wasn't exaggerately trustful..What they do to trustful patients with PCa is a crime. And to these young (under 50) people who post here...Take care too!

Let's hope...

Hi Frank74205

Yes I had complete retention which meant I peed in my sleep a few times a night. This happened after an operation on my mouth under general anaestetic for a bit of cancer .

Since using the CIC  7/8 months I have gradually got better able to pee , from a very slow start and my retention is nopw around 100ml. So I now use cic at bedtime and morning and pee many times a day.. My pee and my pee+cic  is always under 400ml - I measure it just in case. However sometimes when I rise in the morning I get  >400ml , , some 500ml and  600 ml once. It doesnt seem to be a setback to the rest of the days.. .  I usually wake at 2am plus in the morning and pee.  Drinkwise I take about 1800 mls a day  Hope this helps.I wrote and still do write to JImJames a number of times to get his help - that's been brilliant.

Magpies03

Best wishes 

#Magpies03

Hi Ron, I don;t know if age has something to do with not being able to NV after proccedure like uro lift ,GL or Turp?I just had a urodynamics test waiting for results. Did you have this test done before you had this proceedure?'How old are you Ron?

I'm 87.i will post my results from this test as soon as i know. i am still in retention.

frank,

frank

I almost never have pain. I wonder why do you have it.

What kind of cathether do you use ?

Alex

Can you describe the type of pain you feel a little bit more? Dull? Sharp? On scale of 10? Where exactly do you feel it? 

--Jim

Hi Hank, 

I'll ask you what I asked ZD. 

"Can you describe the type of pain you feel a little bit more? Dull? Sharp? On scale of 10? Where exactly do you feel it?" 

-- Jim

Dull, I cannot sit down. I don't know for the scale...bearable, sth like 6? 

It is localized in the perineum and scrotum. 

Like you suggested, sounds more like prostate related irritation/inflammation rather than urethral trauma. Do you have a lot of difficulty passing around the prostate? What catheter and size are you using? Coude tip? I use Coloplast Speedicath, 12F with Coude tip. Personally, found that to be the gentlest of the stiffer catheters. I have sometimes gotten what I would surmise to be a mild urethral irritation (1 or 2 on scale of 10) but nothing like you describe. You could also experiment with a softer cath like the red rubber coudes. What works for one person may not for another.

-- Jim

Hi Hank,

ZD's sounded like a prostate pain, not sure about yours. The list of suspects are urethra, prostate and bladder, and in your case could be any of the three since pain can be referred from one area to another. Another question, which I don't have an answer for,  is the pain from the actual act of CIC or from the bladder being emptied? If the former, maybe try a different or smaller catheter. If the latter, maybe try drinking a glass of water right after CIC and see if that brings any relief. 

Jim

Jim, thanks! I admit I have got very attached to Compact Speedicaths. As you told us once, they are telescopic, so quite big in size. No coude tip. I haven't quite understood what the purpose of coude tip was? 

I have tried many different kinds, including IQ. I don't deal well with soft catheters, they bend. The red rubber version scares me.

Somehow this telescopic shape is the easiest for me. Do you think I should really insist on getting used to, say, IQ 12? 

I have no NV at all except sometimes at night if I put an external catheter on. 

What do you think about taking Ibuprofen and just ignoring the pain? 

How is it possible to tell whether this is chronic prostatitis (no fever) or just

understandable irritation? Zdz

PS I don't have much difficulty passing around the prostate, probably because of TURP?

Hi ZD,

I just thought prostate related pain based on what you posted earlier, but just a guess. There is so much referred pain down there that it's not easy to know where what originates from where! Unless you uro finds something, which they hardly do, it's trial and error, and sometimes just time. 

Have you had a recent urinalsysis and culture? Epididymitis should also be ruled out. Not common with CIC, but not rare either. Is one of your testes larger than the other? That's one of the early signs along with soreness. I had a bad case three years ago and the urologist pointed out that one of my testes was three times the size of the other. I guess I don't look in the mirror down there enough!

Then there's trauma which began the discussion about trying different types of catheters. Not saying the compact isn't good for you, just saying that if you think the pain is from CIC then experimenting with another type or size is reasonable.

Coude tips are primarily to navigate around large or swollen prostates, sometimes to push through strictures. When you look at curve at the end, it doesn't make sense at first. But think of a straight catheter as a sort of a sharp sword. If your canal is open and no prostate in the way, then that's great. But if the prostate is pinching the urethra, then the sword can stick in to the prostate. Happens to me almost every time I've tried a straight catheter. Conversely, when you use a coude, the catheter leads with a curve, so there is nothing to stick in. It just sort of bounces around the corner if that makes sense. 

Ibuprofen might help with inflammation, but not sure I'd ignore a "6" pain in that area, so you don't want to cover it up for too long. What does your doc think?

Jim

I agree TURP would probably make CIC easier, and probably then no reason for a coude tip although if your experimenting can't hurt to try one.

Well, I doubt it most doctors think very much, so I rarely consult....My wife says my testes are equal size...Maybe 6 on the scale was exaggerated,

I am not used to estimate the pain...Taking into account that I can ignore it if I don't sit down for a longish period of time...Anyway, I feel best when I walk. 

You are right, I should give my urine to analyse...I am taking D-mannose all the time, as prevention. Maybe all this is just mechanical...Thanks! Zdz