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

Hi Neil,

Those are really promising numbers!!! You are getting close to the point where you might even start intermittedly testing/stressing your system by going off CIC for short periods of time. 

If the bleeding and burning continues you might want to have your urologist look inside. First thing that came to mind was a false passage but the blood could also be from the prostate. 

Don't know about that urge to urinate after a 250 void. Maybe if you hadn't cathed right after then you would have been able to do another natural void, ie double void? Or maybe the two are connected and whatever caused you to start bleeding stimulated you to urinate. I bet if you asked ten urologists you would get ten different answers here so only way for sure is to either look inside or table the thought unless it keeps repeating.

Jim

Hi Jim - thanks for getting back. Now for something really interesting.

I had a talk today with the IR in Houston who will do my biopsy at some point. I should first like to mention his name as he is the most exceptional caring kind doctor I have ever met. His name is Dr. Ara Karamanian. He was the one who read my mp3T MRI last November for free when the IR who perfomed my PAE and requested the MRI claimed the MRI was not performed properly. But in fact it was, and Dr. K. read all 1000+ images carefully and identified the lesion and then spent many hours on the phone educating me. So kudos to Dr. K. !

Anyway, after discussing the biopsy schedule I told him about the difficulty I have entering the bladder with the catheter. He said that he has perfomed 100s of catheter insertions and has never heard of any resistance at the internal sphincter. So while we were talking, he brought up my MRI images on his screen and zoomed in on that part of my anatomy. He said that about 7cm of my uerthra just before the internal sphincter were highly compressed by my large prostate. Also he said that that compression occurred in a natural curved region of the urethra. He added that it would be very difficult to get a catheter through that region and that that was the source of my resistance and not the internal sphincter! The guy is a diamond - what uro (or IR for that matter ) would study my images like that!

This also addresses another thing I always wondered about: once the catheter starts moving again after I apply gentle pressure for a few minutes it always travels a couple of inches before pee starts to flow. I used to think that it was just moving further inside the bladder but now it seems it really is just moving the remaining 7cm along the urethra and into the bladder with no further resistance at the internal sphincter!

So what to do? Maybe the IQ cath can navigate that region better or maybe more lubricant or maybe size 16FR?

Also if the problem region is only 7 cm long, maybe it opens me up to urolift or itind even though my prostate is huge?

So neat stuff!! I learned something new from the kind of doc we all dream about treating us.

Take care

Neil

 

Hi Neil,

I just got your more detailed post, the one that was in moderation. The doctor does really sound like a gem as you said! 

As to the current problem, definitely worth asking around if there's an easy, not too invasive fix for the stricture. If not, the IQ cath seems designed for the job, and/or larger catheters. It's possible that what is happening with the Speedicath is that it's bunching up in the 7cm corridor where a 16F or larger might not because it's stiffer. Also sounds like a straight catheter would not be the way to go as it would be likely to stick the urethra. Did you order the IQ's yet? I'd try and get both 14's and 16's, even an 18, but would run it by your IR guy or Uro before you go too big bore. 

As to fixing your overall problem through Urolift or iTind, did the IR guy tell you if this was your only obstruction point in terms of voiding, or were there others? Another procedure to consider might be FLA although not too much patient feedback on that yet. 

One thought about the bleeding. Did you tend to find blood on the catheter even those times when you couldn't get into the bladder? If so, that tends to suggest that the bleeding is also coming from the stricture area probably due to trauma as opposed to from the sphincter or bladder itself.

Jim

 

Thanks Jim - this is all very interesting stuff - I feel we are all pioneers.

My IR doctor in Houston did say that the rest of the urethra looked normal with no other strictures though of course the prostate is clamping it down as evidenced by my earlier problems in getting through the external sphincter w/o lubrication.

I should get my IQ cath samples any time but the weather has again closed down all commerce through the end of the week. I have a real interest in testing them now that I know about this stricture. They are 14FR hydrophilics but I could probably get more samples through my Ontario friend.

My contince nurse yesterday suggested I just practice urethral dilation by putting in the catheter to the inner sphincter but not entering the bladder and then bringing it back out a few times. I haven't done that yet as I was waiting for the bleeding to stop which it has now. I will watch for any blood.

Dr. K specializes in FLA for BPH and he wants to do it on me once the lesion scare is over. He ssaid he would only focus on the 7 cm forward of the inner sphincter as that would clear up the problem for me for a few years. I would not do this laser procedure but maybe iTind or urolift might be options. For now I will just stay with CIC - there is still lots to ecperiment with in this benign procedure.

Thanks for yor advice. Take care.

Neil

Neil, that was really interesting. Thanks to your new Uro, you know what the problem is. I'm confident that soon you'll be doing better.  I used to have blood in my urine, and it freaked me out too!  As it turned out, it was a bladder stone, bouncing around in the bladder, causing bleeding.  It was an easy fix, a laser, that broke up the stones, and all is well, except for my constant need to urinate.

HI Dennis - thanks for your comments and suggestions. I tried twirling the catheter inside the bladder a few times. Do you still have a constant need to urinate? How do you deal with it now?

Take care

Neil

Hi, Neil,

Your doc in Houston is impressive! How did you find him? Keep us posted on all that you learn from him.

I think I may have found a doc to remove my bladder stones. Learned of him from an article on a new treatment for kidney stones using ultrasound. I emailed him last night with some questions, and he responded within 2 hrs! Still researching him, but I'm hopeful. Oh, and he told me there should be no reason to perform an emergency TURP during stone removal--unlike my local uro. 

I am looking forward to your report on the IQ catheters. I told my medical supply rep about them--and told him that they aren't available in the States yet. He said he'd try to get more info about them.

Are you still using your physio therapy guy? I'm still working on relaxing my sphincters and pelvic floor. For so many years I ignored my body signals for urnination and bowel movements--and then when I'd go, I'd force things. Did this a lot for work and travel, and it's been a hard habit to break. I'm making progress, though.

Stebrunner

 

Hi, Dennis,

I wanted to report back on your twirling method. It sounds like a great idea, but when I tried it, I ended up with blood in my urine. Not sure if I scatched something or moved my bladder stones. And the bleeding may not be related to the twirling at all. Decided to hold off on doing any more until after I have the stones removed.

BTW, my new personal best for reaching the bladder is now 25 seconds! Not that I'm competing with you! LOL!

Stebrunner

Most doctor want to do a trup because it earier to get to the stones.  Like you said the doctor said they should be no reason.  I would have it in writing before any doctor goes in me.  Stones removel only no turp.  Just be carefull.  Why touch the prostate if it's not giving you a problem  Take care  Ken

Hi Stebrunner,

That is good news about removing your bladder stones using u/s. I never understood why you would need a turp as part of the process. Good luck with that and keeping your uro honest.

I am told the IQ catheter samples (5) are at my local post office but I cannot get down the driveway all week due to the storms. I think most of Lake Michigan is being dumped on us here! I am really anxious to try these new catheters since I now understand the source of my difficulty cathing near the bladder and these new ones seem to be designed just for my problem. I will first try them w/o any lubrication. If they do work then the next problem is to figure out how to get them.

I have stopped my phsyio guy for now. He badly bruised my inside thighs with his massage to loosen up the muscles and the brusies are only now clearing up. I need to get to Houston asap for my lesion biopsy that showed up in my mri last November so i don't want to do anything to risk that trip for now - like the physio guy poking his finger up my anus to relax my muscles!

I found about Dr. K from another fellow on this forum who was looking for minimally invasive methods to treat his BPH. He did not want to try CIC because he was afraid of getting a uti though of course the opposite is true. Dr. K does FLA for BPH w/o going through the urethra. In fact he told me that if the lesion is cancer and he does a focal laser ablation to remove it that he would also do the tissue ablation for my BPH in that 7cm constriction near the internal sphincter -at no extra charge (20K!). But I would not do that for now anyway as I am very happy with CIC.

You can look up his website. He is devoted entirely to prostate cancer and BPH and is young and starting out. I can PM you a link to one of his recent presentations discussing his methodology if you wish.

All the best. I hope your bladder stone removal goes well.

Neil

Hi stebrunner - I just sent you a long reply to your note but it got caught up in moderator net again. I don't know why but if it is not cleared soon I will you send you another one! Neil

Yes that has been going on alot.  Send im a private chat  Ken

Hi Neil,

" it got caught up in moderator net again. I don't know why"

It was because you included the website address which I've removed as per the rules for posting links/site addresses. As I have posted several times in these discussions, if anyone has any issues regarding moderation then you can send me a PM at any time.

If you do not want to wait for moderation then you can use the PM service.

Regards,

Alan

Hey Neil & Stebrunner......I have all ways heard that they do a turp to remove the stones easier.  So I looked it up.  They like to do a turp on men with a prostate size of 80 - 100g because they feel that is the cause of the stones.  But reading this article they say to remove the stones first and they do the Turp because of the bleeding.  But if they can remove the stones why do a turp. You can't be sure that the prostate is the cause.  They blame alot on the prostate. To me it don't make since.  I am glad they are other way to remove them.  Never had bladder stones but I did have kidney stones the size of jaw brakers.  I had to go 3 times to have them removed.  Thats how I got my stricture from them going in and out.  Good luck with the stone removal let us know how it goes  Take care all  Ken

Hi Neil,

Good luck with the IQ's. 

They also make a IQ Gel catheter you might try in addition to the Hydrophillic. It comes with a pack injector that really globs the gel all over the catheter. Also, while it says "single use", it's possible that the gel version is really multi-use like most vinyl catheters. If so, a multi-use IQ could at least be a short term solution until you find a supplier. You might also try larger sizes (16-18F) in either IQ or Speedicath.

Jim

 

Stebrunner,

25 seconds is pretty good! Did you ever find out what was causing the resistance early on? In Neil's case it turned out not to be the internal sphincter but urethral compression right before. Maybe his IR guy could read your images if you don't have someone else. 

Jim

Neil and Jim! I have found IQ catheters in France, quite easily.

I have found the manufacturer in UK. I tried 12 and 14, they are formidable.

No blood, less trauma. Only, beware, pulling them out may be a little painful.

At the same time my uro found inflammation in my prostate and escherizia

Coli in my urines. I am takimg antibiotic.

Jim, how do you tell the difference between colonization and bacteries

that are harmful? Is escherizia coli always harmful and should be killed?

Hi ZD,

Great that you're having good results with the IQ catheters. Not FDA approved in the U.S.A. so harder to get.  What catheters and what sizes have you been using before? How would you compare the stiffness of your previous catheters to the IQ cath. Did you get the IQ hydrophillic or the gel model? You might try some gentle twisting on the way out per the bulbous end. 

Good question regarding the difference between colonization and UTI.

On one end of the spectrum you have painful, burning urination and a fever. This is a full blown symptomatic UTI and antibiotics are required.  On the other end of the spectrum you have absoutely no symptons but some bacteria is discovered during a urinalysis and culture. For someone self cathing this is normal and you do not treat with antibiotics. The inbetween can be judgement call. 

So, since you're self cathing, it's not surprising that they found escherichia coli in your urine. The question is did your prostatic inflammation require antibiotics and/or were there other symptons? Again, a judgement call, and best made by a uro who has familiarity with CIC patients.

What antibiotic did he put you on and for how long? Next time you might want to try the supplement D-Mannose instead of an antibiotic. Some studies suggest D-Mannose equally good for UTI's caused by gram negative bacteria such as Escherichia coli.

Jim

Hi Jim,

Do you recommend D-Mannose on a regular basis like a daily supplement or just when there is irritation?

Thanks

Neil

It can be used both ways and it seems relatively harmless in terms of any side effects, etc. It only works for gram negative bacteria.

Jim

Hi, Neil,

I take D-Mannose as a supplement. The label says to take 2 x daily with a meal or glass of water. Started taking it as I battled a UTI after my PAE around July 1st. Seems to be working as I haven't had a UTI since. When I started taking it, howdy, it made my urine stink! But that only lasted a couple of days.

Stebrunner

Hi, Jim,

I think my resistance early was due to inflamation from a UTI, diet and a tense pelvic floor. My time of 25 seconds came while using a Speedicath FR12. The weird thing is that for the previous 4 days, I couldn't get a Speedicath through to save my soul. Had to use my Origo FR14. Then suddenly the Speedicath worked. Not sure why that happens. Sometimes the Speedicaths will work great for a while--then stop. Then I use the Origos for a while--and then they stop. But, hey, I'm thankful that one works when the other doesn't!

Stebrunner

Hi Jim and stebrunner - thanks for the info on D-Mannose. I gave up on the car and just strapped on snow shoes and trecked the mile and a half to the post office and picked up the IQ cath samples today. There are 4 of them.

Jim - for the past few days I have been doing really well with the Speedicaths: cathing 3 times a day with good results and no problems. I am reluctant to try anything new right now as I am waiting for a break in the weather so I can get to Houston for  my biopsy. Do you think I might cause a probelm with the IQ caths and should wait until after my biopsy? I am itching (not literally) to try one but don't wamt to rock the boat.

Thanks

Neil

Thanks Alan for explaining that - I will remember for next time.

Take care

Neil

Looking at a pic of the IQ the end looks quite blunt so I don't think you would hurt yourself, the issue might be if the flex end will pass through the stricture although apparently that is what it was designed for. I'll leave it up to you whether to leave well enough alone or as the Star Trek movie suggest -- go where no man (here) has gone before

Curious, which ones did they send you. Size(s)? Hydrophillic or gel?

Jim

Hi Stebrunner,

I asked because of all the speculation regarding Neil's obstruction and then, Voila, one look at an MRI seems to have solved the issue. I understand you're doing better but a look inside might give more definitive answers as to the resistance you feel sometimes and sometimes not so much. Based on my experience, others here, and what I've read, both your CIC experience and Neil's are outside the norm in terms of getting resistance. I believe most people get through to the bladder with only momentary resistance at the prostate and bladder sphincter.

Jim

I have no UTI symptoms, certainly not full blown!!! I will certainly look into D Mannose. I will be on antibiotics for a week. As you once wrote, every doctor panics on seing bacteries in the urine...

I have IQ caths 12 and 14, don't see a big difference. I believe they are simply lubricated. Half of such a catheter is relatively stiff. They are packed in such a way that you hold them in the middle, protected by a piece of their envelope. The other half is elastic. I have no problems getting in, but I had TURP and no obstruction whatsoever from the prostate. My uro says I have a royal tract there. Only my bladder is incredibly lazy and doesn't have any tonus. 

I would have never gotten through this without you!  It is scary at first.

And no information is to be found on French forums. God bless you!

I will probably switch between Compact Speedicaths of Coloplast and

IQ. I like things being compact...

HI Jim,

I requested (through my Canuck friend) to be sent the 14FR hydrophilic model. I figured I would try these first w/o my usual added gel and if it worked fine and if not I could l always add my gel. I think I will sit on them (not literally) unless I have another problem or until after my biopsy. I feel selfish having them as I know you all also want to give them a try. They are curious looking though - like the old tickler condoms from a previous life! Thanks. Neil

Neil,

If anyone deserves to have them on hand it's you, considering past difficulties. There are two models, a hydrophilic and a gel model. I believe the hydrophillic comes with a water pouch and perhaps a syringe which you inject. This is unlike Speedicath where the water comes with the catheter. If you have the hydrophillic, I would start with that before adding any gel. They also make a gel model btw. You will find demo videos for both models on youtube. Yes, they do look a little like that

Jim

Jim, what exactly is hydrophilic? I understand the meaning of the word

but not its practical sense. My IQ caths are in a saline solution. Are

they hydrophilic??? And Speedicaths Compact, what are they?

Hydrophillic catheters come pre-lubricated or sometimes with a lubricating packet that you break. Speedicath Compacts are hydrophillic. 

Hi Jim,Have you tryed the sure grip catheter by Bart? They have a packet which you break thats supposed to lubricate catheter. I don't know if its me or the catheter thats causing the catheter to come out with pain and does not have much lubrication.I wish the speedy cath came with a sure grip,this would be ideal. Jim ,what a great catheter this would make. I bet this one would be great on the market,Jim make one and patten it ,i would be your first customer.

frank,

I think that's Bard's Magic 3 hydrophillic you're talking about? I've tried it but prefer the Speedicath because of the shape of Speedicath's coude (bent) tip. That said, all prostates are different so what is comfortable for me may not be comfortable for you and vice versa. 

It's unfortunate the Speedicath doesn't come with a sleeve but you could try surgical gloves instead of do as I do which is to hold it only by the plastic funnel and just drop it in while holding open the urethra with the thumb and forefinger of the other hand being careful not to touch where the catheter enters.

Jim

Frank,

I love the new "sliding grip" on my "Magic 3s" Keeps my hands off he tube totally and make insertions so much easier,  I usually do not have issues with the lub on it. If you void what you can before you insert the cath, make sure your cover the whole cath in that lube, because it seems to have more resistance since you have voided before using the cath. 

Hi amiller, I also love the sure grip on Magisc 3s".however i can only void with CIC, no NV. When you say cover the whole cath in that lube,break the pouch ,turn it side to side about 5 times,this has sterile solution. Is this the one you use?I find that insertion is ok,however taking it out seem very dry and more difficult ,not enough lubrication. Do you have this trouble?

Thanks

frank,

Yes, I do.  But because of self-cathing, I am able to manage it better.  Now, I can at least empty my bladder completely whenever I choose. I do notice, and I don't think I am imagining it, but I can urinate better {nv}.  It's a subtle improvement, but I believe my bladder is getting stronger. A couple of days ago, I did a self-cathing, and as I was pulling out the catheter, I tried pushing it back into the bladder....couldn't!  I was a bit concerned, but then I figured, the bladder must have clampped down, and was forceful enough, where I couldn't squeeze a cathered through it. Strength in the bladder?  That's my guess.  I am also drinking the watermelon tea every morning, I don't know if that's helping, but I'll continue to drink all five pounds, till it's gone.  I'll keep you updated, if I see any progress on the watermelon tea.

Hi Dennis,

CIC certainly can help your NV's if you do it enough to keep your bladder volume under 400ml. More important, it can improve your NV/PVR ratio. 

When I started CIC, my NVs were around 100 with PVRs over 400ml. Today, my NVs are 250-350 with PVRs often under 50ml. 

As to the resistance you feel when trying to push the catheter back into the bladder, that's your internal sphincter you're bumping up against. The internal sphincter is designed to shut close when the bladder empties. So if you empty your bladder via CIC, pull the catheter out a bit, and then try and push it back in, very often you can't. That's normal and different from bladder muscles/tone although to be honest I can't remember if my sphincter shut down as well when I first started CIC, but my recollection is that it did. 

Jim

Hi Jim,Is my math right?Out put 300ml divide by 30 =10 ounces.

Is this right? 10 ounces of lquid doesn't seem like very much output?

Is this right JIm?

frank,

Hi, Frank,

You are correct.  300ml = 10 ounces.

Steve

Frank,

Yes, 300ml equals around 10 ounces which is around 1.25 cups. I would say that falls within the normal range for a single normal void. 

Jim

Frank, 

I make a "V" shape out of the cath package and go back and forth from the bottom to the top several times like you but keep it where the lub can flow in a puddle, in that dip ("V", all over the cath. I make sure it is rubbed into the tube good. It seems to really soften up the cath. Be carefull pulling the cath out of the container, not to wipe all the lub off. And yes, it's more restricted when pulling it out especailly if I void some of the urine beforr cathing. BUT, I do want to void before if at all possible to rinse the penis out so I don't push any bad stuff back into the bladder. I don't drink enough water like I should, so I get UTIs easy if not careful. Can't count the time I have to go give samples to get pills to kill infections.

Hi amiller,That is interesting. Do you use a Magic 3 hydrillic catheter with the sure grip? The sure grip ,you don't touch the catheter ,this might stop the uti? What kind fo uou use?

frank,