Self Catherization. An alternative to Turp, Greenlight, HoLEP...?
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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
jimjames
Posted
Just thought I'd annouce a personal best natural void (NV) -- 450ml
So, haven't been self cathing (CIC) for several months now with mean NV's around 250ml, sometimes a bit higher, sometimes a little lower. But the best I had measured up until today was 400ml.
Fortunately, today I voided into a measured beaker which is not my custom lately, and not only did it measure 450ml but filled up so fast that the only explanation I can think of us that I peed like the proverbial horse
I then dusted off my portable bladder scanner (hadn't used it for several weeks) to check my post void residual (PVR) and found a very acceptable PVR of 150, given that my bladder was so full.
The scan process itself is a sort of Crede Manuever (bladder pushing) so I just continued stimulating my bladder for another minute or two with the scanner probe and was able to get a second an third void which emptied me down to non-detectible on the scanner which is basically zero.
I should add that there was no sense of urgency in the second and third voids and had I not intentionally stimulated my bladder for experimental purposes and to double check the scanner, I would have been on my way.
The interesting thing was that my bladder was probably holding 600-700 ml (including my diverticulum) for the first void which is very full for me. Usually when it's this full I have difficulty getting the void started and have to walk around a bit to warm things up, and then usually end up with a smaller (say 150ml void) and then have to repeat later to empty down. But this time, it just came flowing out.
So the question is why the 450ml void today. Very hard with so many variables but I did not have any coffee since yesterday morning which is one thought. I also went to the gym which I haven't visited for some time and did a little cardio and some weights. Thinking maybe the weights since I didn't do that much cardio. I also haven't taken my bp meds and statins yet which I usually do in the morning.
Not that I've had any issues with my voiding lately, but I will try and stay off coffee tomorrow and maybe another gym visit. May also play around with what time I take my meds. Only problem is for some reason I want a cup of coffee right now!
PS To put this in context, three years ago I had a 400ml void at the urologist's office and instead of a 150ml PVR, they drained 1500ml from my bladder. Who says things don't get better with age (and CIC)
Jim
jimjames
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hank1953 jimjames
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frank74205 jimjames
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Nice going JIm ,it couldn't happen to nicer guy?
frank,
kenneth1955 jimjames
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jimjames kenneth1955
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Thanks guys! There was a bit of tongue and cheek in my first post as not exactly breaking news but I'll admit it was nice to see things going in that direction as opposed to south, especially since I'm presently off CIC, and frankly have expected some regression since my prostate is certainly not shrinking.
This morning, more typical but still good. After a full night's sleep -- no bathroom interuptions -- I voided 250 upon awakening and then another 300 about fifteen minutes later. Didn't bother using the scanner but I'm guessing I'm now down to around about 100ml in my bladder and 50 in my diverticulum. No reason to push the rest out as there is no urgency, no stretching, and no increased risk of UTI's per my history. I may stay off coffee for another day or so.
Jim
dennis47445 jimjames
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hank1953 jimjames
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Hi Jim, is this how you normally empty your bladder, with double dipping ? Hank
dennis47445 jimjames
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jimjames hank1953
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Hi Jim, is this how you normally empty your bladder, with double dipping
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No. Only use the "Constanza" method once in a while when my bladder is very full. That said, it's a valid and useful technique to get volumes down.
Jim
hank1953 jimjames
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Hi Jim,
Last weekend I went to a party and the only thing served was a '7-course beef'. So I ended up eating beef for the first time in years. I usually avoided beef and only ate chicken and fish. Few hours later I can feel that my natural urine flow was a little stronger than normal. Now I wonder if your diet may contribute to your recovery with CIC. Would you share your basic diet with us ? Do you eat any other foods besides potato chips ?
Hank
jimjames hank1953
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Hank: Do you eat any other foods besides potato chips ?
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Why would I? Is there something wrong with that?
But seriously, with so many variables it's hard to isolate a single element on a single day such as "7-course" Beef.
That said, I'm always up for guessing. One thing I do know is that higher protein/low carb diets tend to me more diuretic than vice versa. So there's that, but I certainly wouldn't trade off the heart risks of going on Atkins for a little more flow.
As to my "basic diet" it varies quite a lot, from very healthy to not so good. But like yourself I eat chicken and fish most of the time as opposed to red meats.
But going back to potato chips -- you knew that was coming -- it's also possible that your 7 course beef, like potato chips, had lot of sodium in it. And I have found that diet variances in sodium can effect the dymanics.
FWIW I've been on the Carbohydrates addicts Diet for the past couple of days to lose a pounds from my winter hibernation. I will tell you one thing about severly limiting carbohydrates, it's hard to think as carbs are brain food. So please take this message in that context if something doesn't make sense
Jim
hank1953 jimjames
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The 7-coursed beef was very salty. But I forgot to mention that few hours after the 7-coursed beef consumption, when I went pee, I also noticed that the tip of my penis was redder than normal. I think this indicates better blood flow, similar to when I took Viagra. I am now considering trying it again with a hamburger soon. Hank
zdzislaw jimjames
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I have a new problem: cathing 6 times/24hrs I still have strong urges very soon after cathing (but I cannot void naturally). What can I do to change this??? Cathing since December 2016.
External catheters nightly. Do you think some kind of dieting will help this??? Please, help. Zdzislaw
jimjames hank1953
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jimjames zdzislaw
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hank1953 jimjames
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jimjames hank1953
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Jim
zdzislaw jimjames
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I haven't tried to cath very soon one after another. First of all, I am scared that my bladder will close (how soon do you suggest?), then I don't know if this won't encourage my bladder to ask for cathing all the time (what do you think?). I imagine 6 is very often already, isn't it? I get some 150 - 350 ml each time and 400-500 external catheter at night. I am puzzled. At the begining cathing stopped urges for at least 2-3 hours.
frank74205 zdzislaw
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What do you think?
frank,
jimjames zdzislaw
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I've done a second CIC as soon as a minute after the first. Don't worry, you aren't going to hurt yourself. It's possible you might not get passed the bladder spincter but that would mean it's pretty empty. Or you might. But I"d try doing it when you get that urge as part of the investigation.
How long has the urgency after CIC been going on?
Jim
zdzislaw frank74205
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What your urodynamic test says? Zdzislaw
glenn77 jimjames
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Regarding "hurting yourself." Are you aware of anyone causing an injury leading to strictures? I've been dealing with that problem the last few months. I don't know if the injury happened during my Greenlight (March of 2016), the trip to the emergency department of the same hospital two days after GL when I was in acute retention and two young nurses reinserted a Foley, a Gyrus TURP (May of 2016), or one of the several cystoscopies done by my first urologist. I just know that the first urologist never mentioned strictures during my months of being under his care.
After going to the new urologist at a teaching hospital, and seeing how much better the equipment and care during the cystoscopies are, I suspect something went wrong with the 1st urologist.
jimjames glenn77
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Glen,
Not aware that self catherization can cause a stricture, but that doesn't mean it can't if CIC is very traumatic which it shouldn't be. What I do know is that self catherization is a treatment for strictures because it can help stretch the urethrea.
Sound like that Foley insertion was very traumatic and may have caused your strictures. But again, CIC can help fix that by opening up the urethra.
Yes, cystoscopy has changed with the flexible cystoscopy replacing the rigid in most cases. I had a rigid ten years ago with only numbing gel and I now know where the expression "hit the ceiling" came from. When my recent uro somewhat insisisted a rigid (under twilight) to look for bladder cancer I switched uro's and found one who uses a flexible.
I think just about all the younger uros use flex most of the time, but some of the older docs still like the rigid which they were trained on. When I told the uro who did my flex that the other doc wanted to do a rigid, he compared the rigid to shoving a railroad tie up my urethra!
Jim
glenn77 jimjames
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I'm not in need of CIC, as I'm extremely incontinent and have to have either an external catheter or Depends 24x7. The strictures are being treated by my new doctor, and I can't have an artifical sphincter implanted until that's worked out. Sorry for the thread diversion.
glenn77
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