Self Catherization. An alternative to Turp, Greenlight, HoLEP...?
Posted , 82 users are following.
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
frank74205 jimjames
Posted
i havent had this done in 11 months ,since i started doing CIC.Do you think i should see my uro about this?
Thanks Jim
frank
jimjames frank74205
Posted
Hi Frank,
No set formula, but I was seeing my uro every six months. Probably once a year is OK if you aren't having problems. They are all different. What does your uro suggest?
Jim
frank74205 jimjames
Posted
Jim,I was the one who asked when i should see him again he said in 6 months. I don't see any reason to see him now ,so i canceled appoint ,made it 1 year from now. I"m not having any problems . What is the reason for this exaim?What does he do? Does he run more tests?
Thanks JIm,
frank
jimjames frank74205
Posted
You would have to ask him. It's like an annual check up. Why only once a year? Why every year? Nothing in stone.
Jim
frank74205 jimjames
Posted
JIm My Uro did not suggest a follow up. I asked him ,he said 6 months. I see no reason to see him now ,so i rescheduled for another 6 months. I can't figure out what this follow up exaim would be?Do you know what he would do?
Thanks
frank,
tim68354 jimjames
Posted
Hi Jimjames. I'm a newbie here so please forgive me if this already been covered off.
I was diagnosed by a Uro with a distended bladder in Jan 2017, this followed UTI's every year or so since the age of 16 (now late 40's).
I've been on speedi cath 12's since then and really struggled, 4 times a day. Doesn't appear to have made a noticeable difference in residuals yet, however told it can take upto 2 years.
I was dreading the CIC however it really is very straightforward. My biggest issue has been ongoing UTI's, or so I thought UTI's. One week on, one week off, tried various antib's, profo antis as well. Nothing has really helped.
So much so referred back to uro for I/v. Discovered during the referral that my UTI's were not in fact UTI's. Samples had come back blank. He was at a bit of a loss until I grabbed my crutch to demonstrate the niggling pain. It felt like an infection, slowed the flow, felt like I was going to wee etc. His ears pricked up and did quick check up the butt. He discovered my left side of the prostate was squidgy and suspected I have prostatis. I have been diagnosed a 6 week course of ciproxin as I understand the infection can be a bugger to clear up.
I've been taking them for a few days and the symptoms have already started to clear which is promising, however I am keen to understand if anyone else out there has suffered a similar experience?
Does the CIC work ?
Does the suspected prostatis clear up?
I wonder if it was brought on by the camera that was inserted back in Jan 2017. No anaesthetic, it was pushed straight up there was 4 young lady nurses watching on. I couldn't pee for 2 days after !
Any advice or experiences from you guys would be really grateful. I am trying to stay positive as it could be so much worst. However it's all a bit daunting. Thanks
jimjames tim68354
Posted
Hi Tim,
It's very important you be under the care of a sophisticated urologist, who has treated a sizeable CIC population. If not, there is tendency to overtreat UTIs, or in fact treat a UTI when indeed it is only normal colonization very common with CIC. Normal colonization brought on by CIC is called asymptomatic bacteriuria or colonization and does not require antibiotics that carry their own risk profile.
Ciproxin and other antibiotics however can be effective with prostatitis, if that's what you have, but it's unclear whether it's because of their anti-bacterial or anti-inflammatory effect. Again, you want to be under the supervision of a sophisticated urologist so you don't get either under or over treated.
As to CIC and progress with residuals -- what is your average void volume right before you cath and what is your cath volume. If you aren't already, you should do a void log for a few days, logging the time and volume of every void, either natural or via CIC.
Jim
zdzislaw jimjames
Posted
jimjames zdzislaw
Posted
Not sure of that notation, but it's not so much the bacteria count, but whether you're symptomatic or not and how symptomatic. Also, the type of bacteria per culture might also play some in the decision.
Jim
tim68354 jimjames
Posted
I think the uro is fairly experienced, 35 years in the game. However I suppose the risk is they get stuck in old habits and resist new theories ?
hank1953 tim68354
Posted
jimjames tim68354
Posted
What are the volumes of your pee just preceding the catherized volume? The total of those two volumes should not exceed 400ml or your bladder will remained stretched. If that's the case, then increase cath frequency to make sure bladder is not holding more than 400ml at any one time.
Jim
jimjames tim68354
Posted
Jim
tim68354 jimjames
Posted
Yep, good advice. Never used to drink as much, it's almost like I have become obsessed with drinking due the uti risk etc. Do suffer with headaches a lot too if I don't drink enough.
So in your opinion is there a realistic chance of bringing the bladded back into good shape ? .. do you hear of success stories, how long can it take ?
jimjames
Posted
Quick update and a few observations. As mentioned previously, broke my 5 month streak of being off the catheter thanks in part to over hydrating for a routine bladder/kidney scan. Probably just as well, because while I probably could have gone much longer, there were times when it became a PITA to void which resulted in all sorts of contortions as well as walking around the house, etc, to warm things up.
So after a "welcome back to CIC UTI" (I should have taken prophylaxis antibiotics as my urethra was no longer used to cathing) things have settled into a nice rhythm the last couple of months and I've been cathing between zero and twice a day, except when I had my UTI and I was cathing like every hour or so!
Sometimes I have to cath because I lock up, sometimes I electively do it before bed to empty out even though I'm not holding that much. And sometimes I do it just to keep the urethra conditioned, as for example if I haven't cathed for a week.
My natural voids now are between 250 and 400ml (I can get consistent 400ml voids if I hydrate a lot) and I'm never holding more than 400ml in my bladder with PVRs as low as zero, which typically would be after a double void, where the first void left me with around 100ml. My IPSS score is in the mild range. No frequency, urgency, dribbling, etc.
Technique wise, back to my trusty Speedicath FR12's, Coude tip, although I accidently pulled out a FR14 the other day and used it. No big deal. For cleaning head and meatus, I used to use the Providone Iodine Swabstix (3 pack) but ran out so bought a bottle of Providone Iodine solution and my own sterile swabstix. Just dip them in and go! Advantage, other than cost, is that you can get as much Providone Iodine in as you want, so I actually drip a drop or two right into the opened meatus which seems to settle into the urethra. (Thinking of going back to a little squeeze bottle for convenience and a better squirt). "For those that haven't used it, Providone Iodine is a bit messy so I would think twice for travel and/or frequent cathing, but works for me as I pretty much only cath at home and infrequently.
Lately, been trying to figure a way to get around my occasional "lock up" hump, without marathoning around the house. Hard to explain, but there's this "feel" I get just prior to voiding and at that point I can tell whether it will come out or lock up. I've been trying to visualize/internalize/duplicate that feel I get when it flows just prior to the void. Too early to tell, but I'm having some success duplicating it using some simple Yoga bandha's (mula bandha and uddiyana bandha) which might be viewed as a precursor to Kegels. I haven't done any exercises per say, but use the in and up abdominal movement prior to the void while relaxing at the same time. We shall see how this goes, and at worst, it will get me back to practicing yoga a little more.
This morning I checked my residual with my home bladder scanner and was down to 100 after the first void, and then close to zero on a second void. Even though the scanner showed empty, I decided to cath anyway, as a double check. Well, sure enough it was empty, but the interesting thing was that I had a little over 3" of catheter left sticking out when normally the plastic funnel almost rests on the tip of my penis. The 3" difference of course is the difference between the size of my full bladder and my empty bladder.
I've noticed this before, but for some reason never put two and two together, and often thought that the reason I couldn't get the catheter past my internal sphincter on an empty bladder is because it shut tight. Now, that may also be possible, but also possible is that I was indeed past the internal sphincter but just ran into the bladder wall right away because the bladder was empty. In any event, another good reason never to push the catheter too hard past a resistance. In today's instance, the resistance was not the internal sphincter but the compressed bladder wall. Of course I couldn't see it (can't cath and use the scanner at the same time) but that's what I think!
Jim
kenneth1955 jimjames
Posted
Jim Sorry about your problem but I know your the type of guy that can handle it. When you lock up would a hot bath or shower help you. I know right know with prostatitis when I feel I can't go. A hot bath helps me. Take care Ken
jimjames kenneth1955
Posted
Hi Ken,
Thanks for the concern, but I don't view it so much as a "problem" but as pretty much the only remaining symptom/issue I have from my significant case of BPH/LUTS over three years ago. Today, I am for all practical purposes asymptomatic as long as I cath every once in a while, as for example when I "lock up". I'm sure a bath or hot shower would help, just like I found out that a little exercise helps, but at 2am in the morning, it's just a lot easier (and much quicker) for me to cath than take a bath! The Kegel like Yoga moves only take a few seconds so I am trying to incorporate that into my voiding and see if it works.
Jim
kenneth1955 jimjames
Posted
That is great. I bet a lot of doctor don't like what they hear if you know what I mean. If you went in and told them that you were locking up. I bet they would tell you that you need a procedure done. I hope the men on here pay attention and learn what you have done for yourself. You have help many Take care Ken
mike588 jimjames
Posted
That's interesting Jim, I was wondering why sometimes catheter doesn't seem to go in far enough, that could explain it for me. If under 100ml bladder is somewhat compressed.
jimjames mike588
Posted
Oh, yes. Very evident on my home bladder scanner. When below 100ml, it becomes quite small. From 0-50ml, you can barely see it. For some reason never put these two things together, but it's really quite obvious that the fuller/bigger the bladder, the farther the cath will go in, and vice versa. Of course the other resistance point could be the internal sphincter which would be very close to a fully compressed bladder wall, however if even a little comes out of the catheter, I think you can assume you've passed the sphincter and are against the compressed bladder wall.
Jim
keith42667 jimjames
Posted
Thanks for sharing Jim.
I've noticed oftentimes that after I drain my bladder I sometimes twist the catheter clockwise & counterclockwise (I use a straight tip speedicath) to do a more thorough job. I've heard you talk about this. But I also sometimes I go in & out once or twice about an two inches or so. I do this mainly because in my early cathing there was once when after abut 300 cc i just felt it wasn't done. When I moved it back in about an inch I got another 100 cc. And the catheter stopped with such a jolt that I felt it was sucked up against something inside, but it hasn't be a problem. That makes sense about the bladder being shrunk. Often when I try to push it back in further it doesn't want to go even an inch and I don't force it.
jimjames keith42667
Posted
The static photos and You Tube videos of the bladder draining during catherization are misleading. They show a static bladder with fluid draining out the bottom but in actuality the bladder is decompressing and getting smaller while it drains.
The "twisting" I refer to is mainly to get by the internal sphincter and it's very subtle and by now very much reflexive and by feel. The sucking feeling that sometimes occurs at the very end is the catheter sucking on the bladder wall itself. I haven't experienced that for some time but it's something you probably want to avoid.
On the other hand, going in and out, can help drain that last 50 or so ml from the bladder. At that point, sometimes put my finger over the funnel on the "out" part of in and out. It seems to create a bit of a suction when down repeatedly that pulls even more urine out. Not sure if this is necessary for most, but have a bladder diverticulum (pouch) that drains into the bladder. The catheter probably doesn't reach in there, or if it does, it only goes in a little after the bladder is decompressed. I think the in and out with the finger suction technique helps draw some of that diverticulum urine out which in my case could be another 50-100ml.
The key is always to be gentle and like you say, don't force it.
Jim
hank1953 jimjames
Posted
Jim, was there any reason for this ? Also, can your lockup be due to constipation ? Hank
jimjames hank1953
Posted
The reason was very painful urination (even with maximum strength AZO) and frequency, both typical of a raging UTI. It was just easier to cath than void through the pain, so nice to have CIC in my tool kit. Also, antibiotics work better on an empty bladder, so frequent emptying may have been beneficial in that regard. As soon as UTI resolved, I stopped the
CIC Fest
I'm fairly regular but during a period when I was constipated, I didn't notice any correlation with locking up. That said, constipation and/or a full colon can always factor somewhat into the voiding process.
Jim
hank1953 jimjames
Posted
jimjames hank1953
Posted
100ml was the residual after my first void. I voided down close to zero after my second void. There was no straining and in fact I have better results by relaxing as opposed to straining/pushing.
@Hank: Does it make a difference as long as your total volume is less than 400cc ?
--------------------------
Sort of different concepts. You want to keep total bladder volume less than 400ml so it doesn't stretch. PVRs, on the other hand, should be as low as possible, both because of the therapeutic aspect of decompression as well as the fact that you don't want your urine to get stagnant. Self cathing accomplishes that even in a compromised bladder by emptying your bladder completely every time you cath. A fully functional "normal" bladder should empty close to zero as well without CIC. I'm very happy I can get down there even if it's a second void. Three years ago I was carrying around between 500-1000ml at all times between my bladder and diverticulum. This morning per my bladder scanner, I had it down to zero in bladder and around 30ml in diverticulum.
Jim
hank1953 jimjames
Posted
Thanks Jim. I need to learn how to relax but I am afraid I have an obstruction that relaxing won't solve. I don't strain when my bladder is nearly full but I have to strain some what to get the low volume near the end out. Hank
jimjames hank1953
Posted
All theoretical of course, but both by relaxing the area and perhaps some of the yoga bandhas I mentioned, you can ease the obstruction by either moving/better positioning the prostate or making the prostate incrementally pliable enough so that the urine passes easier. This in addition of course to bladder rehab by decompressing it on a regular basis through CIC as well as challenging it at times as I mentioned in the "on/off" thread. I will report back at a later time on how some of these bandhas and relaxations are working for me as still too early to tell.
Jim
Jim
jwrhn1951 jimjames
Posted
The bladder wall thing is interesting, with a fairly full bladder full bladder I can insert the catheter and it stays in place with no problem but I have noticed a couple of times with a very small void that if I dont hold the catheter in place it pushes itself out and I can't reinsert it. After reading your post I'm thinking maybe it is the bladder wall that is causing this and not the sphincter contracting and pushing the catheter out like I assumed it was doing.
The first time this happened I used three catheters but they all were pushed out immediately upon insertion and the last I held only yielded about 20ccs,, I felt the need to void but with my nuerogenic bladder maybe I should not trust the sensations...
jimjames jwrhn1951
Posted
It could be a combination of both. I've been unable to re-enter the bladder on occasion after a cath, and it was probably because the sphincter shut tight as it's supposed to. I also experienced the "pushing out" and now think it's as much the bladder wall compressing as the sphincter. And, as mentioned, I don't use as much catheter when the bladder is compressed. The good news I guess is that when this happens you probably are pretty much done cathing, or you should be, like when you only found 20ccs. Because I have a bladder scanner at home, I can verify, at least for the time I posted, that my bladder was close to zero when the catheter didn't go in all the way.
Jim
frank74205 jimjames
Posted
HI Jim, Jim ,Who is your medical catheter distributor ? I want to change mine ,don't know how to do this?Can you tell how this is done? I have been under a lot of stress,as my wife passed away.
Thanks my friend,
frank,
jimjames frank74205
Posted
Very sorry about your wife. I have sent you a private message with some information on a good catheter distributor.
Jim
dennis47445 frank74205
Posted
Frank, so sorry, about your wife's passing. Take care, and be well. Aloha, Dennis
stan98754 mike588
Posted
thank you Stan
mike588 stan98754
Posted
Thanks for asking, in general better but not really what I was hoping for. Still rely on Flomax. I feel that there was some improvement, and together with CIC I helped my bladder somewhat. I rarely feel the desperate urgency I used to have and can easily go for 2 hours.
The big positive is no sexual side effects.
I think I will still have to do something so I can get of the damn medications.
Thanks for asking.