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

Carry-on said: "...Rigid Cystoscopy, seems too new for me to confidently pursue it...

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Didn't follow the part about "Rigid Cystoscopy". Is that part of the Rezum System? But I agree, not a lot out there about Rezum.

BTW what I meant about the "video" was not that I needed one, but that for all the care and attention I was given instruction-wise, a video would have been just as good or better. And as you inferred, self-cathing is not rocket science and is easy to do. It's just some of our bodies adjust to it easier than others. In my case it took several weeks of discomfort but long term it was more than worth it. 

Jim

I was wondering why you hesitated on the PAE. I had an appointment with Dr Bagla in Virginia but cancelled and decided to cath and wait. I had a Urolift with a lot of side effects and that's what actually got me cathing because my bladder had stopped working. 8 months later and I'm in great shape. No urgency or frequency and no nocturnia if I cath before bed. However using Tamsulosin and cathing are not a super long term strategy and I know I'll probably have to have another procedure...just not sure what at this point. Every procedure has ia downside when you really investigate them. Most people are more willing than I am to roll the dice.

Jim I'd suggest you look at the clinical trials report on the NIH website.  ASs the moderator would hold up a link to that, I won't try.  But, it's easy to find.

On the first page of that site, on the report for Rezum, they - NIH - describe the procedure as "rigid cystoscopy".  I wasn't making up the description, just repeating what NIH said.

I'm hesitating on the PAE simply because continuing with CIC, now 4x/day, seems to have things sufficiently under control that I can afford to wait to hear more.  

There is a hospital near me, Tampa General (generally considered the best in the Tampa area, and associated with the USF Morsani Scholl of Medicine, as well) which is part of the national trials; I expect to read more on this as everyone gains experience.

So, it's not concerns per se about PAE (I do have serious concerns about TURP or anything else derivative from it), but simply a desire to gain insight while I have the luxury of an under-control problem, simply waiting for validation of the best way to solve this permanently.

I found this online:Efficacy and safety of rezum system water vapor treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia

Urology, 07/27/2015Dixon C, et al.

In this study, authors want to assess 1 year efficacy and safety data from pilot trials of the Rezum System water vapor to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). The Rezum System provides effective relief of LUTS associated with BPH at 1 year. The procedure is safe with an acceptable side–effect profile.

Methods

A total of 65 men with symptoms of moderate to severe BPH were enrolled in pilot studies at centers in the Dominican Republic, the Czech Republic, and Sweden.

Each patient was treated with transurethral delivery of sterile water vapor (steam).

International Prostate Symptom Score (IPSS), peak urinary flow (Qmax), quality of life (QoL), post void residual (PVR), International Index of Erectile Function (IIEF) and prostate–specific antigen (PSA) were evaluated at 1 week and 1, 3, 6 and 12 months post–treatment. Safety was also assessed.

Results

Statistically significant clinical improvements at 1, 3, 6, and 12 months were reported for IPSS (decreased by 6.8, 13.4 13.1, and 12.5 points, respectively) and Qmax (increased by 2.0, 4.7, 4.3, and 4.6 ml/sec, respectively).

At 12 months, these results equated to a 56% improvement in IPSS (P <.001) and="" an="" 87%="" improvement="" in="" qmax="" (p=""><.001).

qol also improved at 12 months with a 61% improvement.

sexual function was maintained.

most of the adverse events (aes) were related to endoscopic instrumentation and were of short duration.

one case of urinary retention was classified as a procedure/device–related serious ae."

" qol="" also="" improved="" at="" 12="" months="" with="" a="" 61%="" improvement.="" sexual="" function="" was="" maintained.="" most="" of="" the="" adverse="" events="" (aes)="" were="" related="" to="" endoscopic="" instrumentation="" and="" were="" of="" short="" duration.="" one="" case="" of="" urinary="" retention="" was="" classified="" as="" a="" procedure/device–related="" serious="" ae."="">

qol also improved at 12 months with a 61% improvement.

sexual function was maintained.

most of the adverse events (aes) were related to endoscopic instrumentation and were of short duration.

one case of urinary retention was classified as a procedure/device–related serious ae."

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Thanks. Yes, I did check it out. It looks like the "rigid cystoscopy" is part of the control group but not used with the Rezum group. 

 

If it's not too personal, is your bladder not working at all? That seems like a lot of cathing per day. Has your bladder size and retention been greatly reduced by all that?

I had tried the Magic 3 because it had the best plastic safety profile but I found it hard to use because it was not nearly as rigid as speedy cath/hislip alternatives. After reading your comments I'm giving it another cause I'm quite concerned about introducing plastic compounds into my body.

Jim, I looked up the catherter you suggested, and found it online.  The problem was, I only found it in boxes of 30.  Can this be bought at a drug store, singularly?

Where do you live? In the US you can buy them individually online for around three dollars each. But keep in mind that these are hydrophillic catheters, meaning they are single-use only, so you will want several around, even for emergency use. They are very easy to use with practice, but it's always possible to drop,or other contaminate one, especially in the beginning if you're not use to self catherization. You can also get free samples here from the manufacturer as well as some of the online distributors. Do you have insurance that will pay for them?

Jim

I've got insurance, but that means going to the doctor.  I do live in the US.  Surely a drugstore will carry these.  Also, the videos show using some kind of iodine to wash with.  Is there an alternative to that?

I would be very surprised if you found these particular catheters in a drug store. You might get them from a surgical supply store but they would probably have to order them and probably by the box. If you check out atcmedical on the web, you can order these catheters directly without a prescription. There are other sites as well. I prefer providone iodine swab stix but there are a little messy. BZK antiseptic towlettes are an alternative. One fellow here uses WetOnes which you can purchase at a drug store. Stay away from anything with too much alcohol or it can sting if you use it on the meatus. 

Forgot if you mentioned it, but have you ever self-catherized before? If not, it can be uncomfortable, even painful for the first couple of weeks, which various symptons including false urges and some bleeding. Not everyone gets this but not uncommon. You could also develop a uti from the initial trauma. Again, not always but not uncommon. For these reasons, learning to self catherize under a doctor's supervision is a good idea. Not that most of them are experts in technique, but at least they are there for support and antibiotics if needed. On the other hand, it might be easier if you have had a foley in prior. In my case, self catherization was the first time I had any catheter in me so it was a shock to my system.

The other thing about the speedicath is that they are very slippery, which can make insertion a little tricky the first couple of times. Unlike some other hydrophillics they don't come with a "sleeve" to help keep the catheter from slipping as you push it in. If I remember correctly, a pair of latex gloves might help in that regard. In my case, and with some others here, we don't touch the clear part of the catheter at all but feed it in only touching the colored funnel at the end. If you do it this way, it's not slippery at all but again, it also might take more practice because instead of "feeding" it in little by little, you're sort of pushing it in from the very end. Again, not rocket science, but it may take a couple of times (and tossed away catheters) until you get it right. As I've mentioned before, the 14 French size are easier to insert than the 12 French size, but once you get the hang of it, you can drop to the 12 French size as the idea is to use the smallest size catheter that works. 

As Jim said, I use the antibacterial version of Wet Wipes, which uses Benzethonium Chloride as its antibacterial agent.  You can get them in canisters, for home use, or in single packets for use on the road or on vacation or at the office.

The BZK wipes he mentioned use Benzalkonium Chloride as their antibacterial agent.  I hasven't the foggiest idea of the difference, so I'd go with either one.

Jim mentioned Amazon, and you can get BZK wipes very, very cheaply there.  You can also get Wet Ones antibacterial wipes there.  There appears to be a difference in size of the wipes, so it may be a matter of personal preference, or ease of use due to size, versus cost.

As previously mentioned, in 2 1/2 yrs of CICing, I've never had a UTI, so I;m sticking with what works.

I just went on Amazon and "yes" both the BZK wipes and Wet Ones have B. Chloride as their main ingredient. However Wet Ones is .3% while the BZK wipes are .13%. So I guess score one for Wet Ones. 

Carry-on -- Do you use the cannister or individual packets? Are they both equally moist because I've found that the BZK individual packets often dry out which is not good.  In theory, the individual packets would seem to be more sterile, but because of the ingredients they might be self-sterilizing. 

Jim

Jim, as previously indicated, I use the Rochester Medical Magic3 hydrophillic catheters, and it's never been a problem to insert them without my fingers getting anywhere near the first ten to twelve inches of the catheter, so there's no risk of any germs - if someone didn't wash their hands, and didn't use an antibacterial wipe - getting into one's bladder.

There is sufficient riigidity in the catheter (14FR/CH, Male 16 in) that guiding it into the meatus is a snap, and the rest, as they say, is history; the instructions I got were to hold the penis in a vertical position (12 o'clock high) so that gravity is an assisting friend in getting all this to work easily.

Jim recommends the coude head.  Does the Magic 3 have that, and, if not, do you miss the coude?

I don't know if Magic3 has a coude tip version, but, no, I have been using straight tip catheters since I began in early 2013.

My understanding is that the coude option is used for guys that have certain types of urethra restrictions, but I've never explored that, my urologist did not select that, and I have successfully - and easily, after the first week's experience - used the straight tip from the beginning.

That's only partly correct. A coude (curved) tip is primarily used to make it easier for men to thread the catheter past an enlarged prostate, like most of us here, including myself. It is also useful for certain types of urethral restrictions as Carry-On mentioned.

Because the tip is curved, it is less likely to "snag" the prostate or puncture the urethra and create what is called a "false passage". In my case, it was prescribed by a major medical teaching hospital that has many catheter patients.

Now, obviously Carry-On is doing well without a Coude tip, so he doesn't need one. But frankly, I wouldn't make a decision based on just two people's experiences. Better would be to consult with a doctor or center familiar with catheters and the condition of your prostate and/or do a little more online research.  In the end, we all have slightly different anatomies, so what works best for me might not work best for you. 

As to technique, mine is similar to Carry On's. Our method works in the standing position and not sure if it would work in any other position since i have never tried it. So basically I only touch the plastic funnel and not the catheter itself. I also start close to 12 0'Clock high with a very slight pull on the penis to stretch it out. At the same time I open the meatus with with my thumb and forefinger to open the "target". Once I get to the prostate, I now lower the angle so that the tip of my penis would now be facing the wall ahead of me. While this step isnt necessary, I find that this makes navigation around the prostate easier, but it's something that you can feel out yourself as you get used to the procedure. The trick is to relax and not fight the catheter. You should never force it. Think gentle, and then think more gentle. And that goes for both the hand that is feeding in the catheter as well as the hand that is holding the penis. You don't want to hold it so tight as to constrict the urethra. 

Jim

Jim

Absolutely agree with Jim to go with the doctor's recommendation, depending upon the nature of your various constrictions, restrictions, or other.  

I didn't choose the catheter type or size, and it sounds like Jim didn't either.  It also sounds like we both had urologists at major teaching hospitals, mine in Tampa, at Morsdani School of Medicine and Tampa General Hospital.

Carry On is corrrect. I started with a 14 French, Red Rubber catheter with a Coude Tip. That's what the nurse handed me. A red rubber catheter is very soft and flexible but unlike a hydrophillic, requires a lubricating gel. Later, I experimented with a half dozen or more different types of catheters such as vinyl, closed systems, and hydrophillics. All of these were either free samples from the manufacturer or from the distributor who sent me my catheters. I ended up with the 12 French Coloplast Speedicath with Coude Tip, but as I've said before, it would probably be easier starting out with the 14 French because it is stiffer and therefore feeds in more easily.

All these catheters have their pro's and con's. For example, the red rubber easily fit in your front pocket because they roll up so well. My Speedicath doesn't roll up at all. Also, the red rubbers are reusable for up to a week or more. That means if you're paying out of pocket, the savings with a red rubber catheter are very significant -- 1 catheter a week, as opposed to 42 if you're cathing six times a day. It also means that on a trip, you don't have to pack boxes of catheters. On the other hand, the red rubbers require a separate lube and you have to touch the actual catheter part to feed them in. 

Jim

Jim

I ended up with the 12 French Speedicath hydrophillic. 

Yes that is used on men that had strictures of the urethra.   That is the type they have to use on me I have a sticture just before the prostate.  A straight catheter will not work.  Take care  Ken 

I finally took the next step and called Coloplast.  They said that they would send me a sample, but that I needed a perscription.  I don't want to go back to my urologist, because he believes that one size fits all, and that size is a TURP.  So, is there any way to get a sample without having to get a scrip?

Hi Rich, Check out my post to you two days ago. I mentioned a web site where you can buy the Coloplast hydrophillic catheters for around three dollars each without a prescription. 

Jim

Jim, in reference to non-perscription, this is all I found in your previous posts. "You can also get free samples here from the manufacturer as well as some of the online distributors."  There was no website listed, and when I called Coloplast directly, they told me I needed a script.

"

It was a later post but I realize this site is hard to navigate, I miss stuff all the time. You can get them individually online without a prescription at  ATCMedical. 

Hey Rich,

When I went to that article on Rezum I was quite impressed. Not so much by Rezum but by the study in general. Very up to date about all the minimally invasive treatments available today. I found one approach I found really intriguing PEMF. Pulsed Electromagnetic Fields. Basically using high tech magnetism.....same technique is used to heal bones, increase blood flow etc. They've done a couple of studies on humans and animals. Seems amazing. The kind of new thing I'm waiting for while using CIC or SC.

Michael

Yesterday, I ordered three caths.  I followed JimJames' lead, and ordered what he is using, but went with french 14 instead of 12 (also his suggestion). I'd love to go to sleep at night without a urine filled gut.  Hope I can handle it.

Rich, if I can do it, and I'm up to 4x/day, then anybody can do it.  Just expect there to be a brief initial adjustment period where you have doubts; that passes quickly.