Self Catherization: Issues and Problems

HI Hank,

That wasn't my experience. I have a very tight prostate and had lots of bleeding and pain with the straight Speedicath 14s. I tried 12s and they just collapsed into a twisted mess. But the coude 14s went in like a hot knife through butter and I've never looked back since. Maybe we are all different and just have to find out what works best for us. I even tried the much-touted IQ caths that supposedly are made for prostates like mine but all they did was twist and bunch and made me bleed - ouch!

All the best.

Neil

Hank asked: When was the last time you looked at the tip of a Speedicath straight ? 

-----------

The last time it stuck my prostate Within the past six months I believe. Unfortunately, I've thrown them all away (including the compact spears so I can't look again.

Again, all I can say is that coude catheters were specifically designed to go around larger prostates and other tricky navigation corridors such as a strictured urethra. 

That said, whatever works best is the best catheter for you. We will have to agree to disagree which one should be tried first for beginners,  but the coude is what my cath PA suggested from the outset and she has been proven right at least from my experience with both types. 

As to the tip of the coude, it shouldn't ever lead the way, so I don't see how it would puncture anything. FWIW Coloplast is apparently coming out with a new flexible tip this Spring which may be the best of both worlds. 

-- Jim

Hi Jim, AS you suggested i sent my urodynamics and cystocopy test results to another URO IN SIU.His reply was ,my bladder and enlarged prostate are the reason for retention.He said Turp or Gl would have 70 % chance of working. He also said Rezum could have a 70 % chance of working,however i would have to keep a foley catheter in for 4 weeks.If none of these proceedures work than back to CIC.I asked if CIC could rehabilate my bladder,he said no way.What I don't understand is if they do a GL or Turp ,how does that help my bladder?Jim you have proven the URO wrong? You had a enlarged prostate and a destented bladder and complete urine retention,and with no surgery you are doing NV.

Maybe at my age my bladder won't rehabilate.Why do these UROS have different opinions. The last one who did the urodynamics said i would have a 50 or 60 % chance of getting out of retention?He also said Uro Lift would not work for me.

I'm always interested in your opinion Jim

Thanks my friend,

frank  

Frank,

Your uro said: "I asked if CIC could rehabilate my bladder,he said no way".

-------------------------

LOL. Maybe it was my old uro because he said the same thing, actually worse. Something like your bladder will rehab when pigs can fly!!!''

So, this genius uro was wrong. And he's quite well known and respected. Now that doesn't mean he's wrong with you. We all have different situations. But what it does mean is that at least in my case the common professional wisdom that bladder's can't rehab is wrong. 

But back to what they said. You've gotten everything from 50-50 to 70-30 on whether a prostate reduction surgery would work. You have to weigh that against whatever side effects you might get from a given procedure. If retro ejaculation is not a big deal with you, then maybe TURP or GL or HOLEP. If you want a better chance of keeping normal ejaculation, then there's REZUM.

Did he give you odds with PAE or Urolift? And if you hit the lottery, there's the $20,000 FLA procedure which sounds promising. Lastly, there's what you are doing now. CIC. You already know how that works and how you feel about it. 

But if you do decide to continue with CIC, the mindset should be that it will be for life and not that one day you will be able to stop self cathing like myself. That would not be impossible, but you should view that as a bonus given your track record so far.

The reason Gl or TURP *could* help your bladder is because by removing some of the obstruction (prostate) your bladder will not have to work as hard pumping out the urine. The question really is if the bladder has enough horse power left to pump even with the obstruction gone. That's why you're getting these hedged bets from different uros. 

Don't think there's a right or wrong decision here, as you seem to know the pros and cons pretty well by now.

Jim

Hey Jim, Thanks for that reply. I guess it's all like shooting dice ,a crap shoot.i might be able to get out of retention or i might not. I think i'm going to take the chance,if it don't work i go back to CIC.At 87 i was told by the URO what do expect ,you've have that bladder 80 years Mr personality TLC.These uros need to learn the meaning of TLC.Out side of retro ejaculation,are there any other side effects thet you know of?

Thanks again JIm,

frank

 

JIm,Does this mean my bladder is getting better? I measure my output most of the time it's 200,250,300,350 ml , very seldom is it over that limit?

frank,

I assume then that you've experienced retro ejaculation on perhaps Tamsulosin (Flomax) and are OK with it? For a lot of men, retro is no big deal. For others it is a big deal. I always suggest that anyone thinking of a surgery that has a chance for retro to do a trial on Tamsulosin first to make sure they are OK with it.

As to other side effects, there's incontience and impotence, but I think that's a very small percentage. Your doctor should guide you here. More chance of those side effects with TURP, GL and HOLEP and less chance with PAE, Urolift and REZUM. On the other hand, from what your doctors say, you might get a better result from the first three. So talk to your doctor, as well as the fellow that did your urodyamic consult and see what you're comfortable with. If you're not comfortable, you could always get a third consult. Again, no right or wrong decision here. Like you said a little like shooting dice. Fortunately since you're doing CIC, there is no time pressure for you to decide. 

Jim

Are you cathing when you feel the urge or on schedule? If you're starting to feel the urge at a lower volume, that could be a good sign. Could mean your bladder is getting a little more elastic and that the nerve endings are firing up more. Hard to tell. Have you gotten any natural voids yet? Even if you haven't, you should try. Don't force anything, but stand over the toilet and try focusing on relaxing your bladder sphincter even more than pushing out. 

--Jim

JIm I was also told by a staff nurse that the longer i stay in retention the harder it is tio get out of it.Why do they put these thoughts in our  minds>

I don't get it?THis URo also said uro lift would not work for me?

frank,

I also agree in being positive. I think at least in a small part that has helped my bladder get better.

Did the uro who said urolift wouldn't work do urolift himself?

The paradox is this. If a doctor doesn't do a particular procedure, then they tend to talk it down more than the facts probably suggest. But if they do a particular procedure, then they tend to talk it up more than the facts suggest. 

So...ideally when looking at a procedure, let's say urolift as an example -- you would want to talk to a uro who does the procedure and a uro who doesn't do it. Listen to what they have to say, and let it stir around in your mind   If you can find a uro that does multiple procedures even better, but not a lot of them.

Jim

 

Jim. I wish i could get a natural void,but i can't .I always try ,but nothing.I wonder if doing sphincter exercise would help?A s far as retro ejaculation.i have not had an ejaculation  for many years.If i could just pee my problem would be so much better, i think??

frank

Frank,

I don't see the harm in doing pelvic floor exercises. Might help. Have you tried lightly tapping and/or tickling on the bladder, or even (again lightly) pulling the pubic hairs? It's called reflex voiding and the idea is to stimulate the nerve pathways. You could even try pushing (very lightly) to see if it can get something started. Sometimes when a void doesn't come right away, I do some very light rhymic taps (like a drum roll with my fingers) and more than not things start to flow right away.

Jim

Thanks Jim,for all the ideas,i will try them all. AS far as the UROS i've 

seen,they don't do uro lift.perhaps like you say ,thats  why they say it won't stop rentention.I am going to send my records to a URO that does do the uro lift. I will let you know what he says. The uro that does GL and Turp. also said if he were me he would do CIC. He is the one who said 50 or 60 % chance of geeting out of retention.

frank,

Good idea. Send your records to someone who does Urolift, someone who does PAE and someone who does REZUM. See what they say. No rush. Your uro sounds like a good fellow not pressuring you into anything.

Jim

Jim, i sent my records to SIU {Southern illinois university|} The uro there said Rezum would have a 70 % chance of getting me out of retention,however i have to have a foley catheter for 4 weeks. He also said uro ilft would not work?

I tell ya, something is changing in my body . Last night i only got up 1 time to cath. Today i'm

 going  5 hours without doing CIC. If i could only pee my problem would be over.I don't know if what you eat or drink makes a difference? I have been cathing 6x a day,sometimes 7.My output is 200,250, 300, 350ml once in a while it's 450 or 500ml

Is this good or bad JIm?

thanks 

frank,

 

Less frequency could be a good sign as long as your CIc voids say under 400 most of the time, which they appear to be. Do not worry about the occasional 450 or 500, that happens. Nice that you're getting a good night's sleep.

So, it sounds like everyone is against Urolift so far, be interesting to see what a urolift doctor says. As to REZUM, that might be a possiblity but I would go back and read those threads from top to bottom and take notes. I also wouldn't do a Rezum unless the doctor had over 100 cases under his belt. There's also FLA but my guess is that it would be 50-50 like TURP or GL, plus it's a lot of money out of pocket since insurance doesn't pay.

Jim, Glad to hear it's a good sign to have output most of the time under 400ml. Does this mean my bladder might rehabilate?Would'nt that be great,these Uros  would be falbergasted!!Did you just out of no where start to have NV?

Thanks JIm

frank

Frank, anything is possible, and a positive attitude is helpful. So try some of the things we talked about. You have nothing to lose. If you start having NVs, great, but if not you still have a solid non-surgical, non-drug method of emptying your bladder and protecting your kidneys. 

My case was different. I've had NVs most of the time although before CIC they tended to be very small with a significant retention. But progress was not always gradual. Sometimes it seemed like things would never get better and then all of a sudden they got much better. 

How long have you been self cathing at this point?

Jim

 

Jim, I started CIC in October, 2016 . I do try NV ,it does not happen.

i remember back in year 2004 i had a bladder ultra sound,was told i did not emthy my bladder,i just ignored this ,perhaps this is the reason this problem happened.The uro said, what do expect your bladder is over 80 years old.TLC ,he is lacking.This is the uro i sent my records to . I wouln't go to him if he was the last uro.It seems like every day is quite different.My output  has been under 400ml most of the time,and like you said this is a good thing.If i could just NV,my problem would be over.

thanks  Jim,

frank,

Frank, That's only five months. I think you could give a case for giving CIC more time, assuming you're tolerating the process OK.Nothing guaranteed of couse, but I saw improvements up to the 2 year mark. 

Jim

Jim, My concern is infections with CIC. I was told 2 times to come in and do a urinalysis ,both times were negative. I wish i had a better understanding of infections doing CIC. I know a fever is one,i was told excessive reasons for doing CIC. At times i would get the urge to pee almost every 2 hours.Sometimes sooner.Now it verys.

JIm does this analysis sound right?

frank 

How many infections have you had in 5 months from CIC that required antibiotics?

After a rough start -- I had two UTIs right out of the gate --I am now averaging one symptomatic UTI a year, a number I am comfortable with. 

Do you mean a negative "urinalysis" or negative "culture". To simplify, urinalysis are those strips they use where you get an immediate result and a culture is when they send it to the lab which takes a few days. 

 

Hi Jim, will UTI and colonization go away on their own? I have been CICing for about 6 months w/o any UTI that I know of. Some days my urine is cloudy, some days it is very clear. Is cloudy urine an indication of colonization ? Thanks. Hank.

Hank,

Probably. If curious, get some Siemens Multistix 10G at Amazon or Ebay. (check expiration dates before purchasing). If you CIC it's not uncommon to find positive leucocytes and sometimes positive nitrites and even positive blood. My guess is that your cloudy urine was caused by white blood cells (positive leucocytes). But even so, doesn't mean you have a symptomatic uti, so if no symptons you don't want to treat. "Colonization: is synomymous with asymptomatic uti or asymptomatic bacteria.  Not uncommon for leucocytes to go from positive to negative and then back. 

Good that you haven't had any UTIs. If you did, you would know it.

-- Jim

Hank, Regarding my last post, "probably" was in response to your question

"is cloudy urine an indication of colonization". 

As to your first question, (will uti and colon go away on their own) -- both in theory could but more likely with colonization which doesn't need treatment anyway. You don't want to play around with a symptomatic UTI for too long. Depending on the symptons, you might try and increase fluids for a day or so to flush things out but if that doesn't work then its antibiotics

Jim, I had a culture sent to a lab, no infections. What are the symtoms for infection,besides  fever? Would doing CIC more  often then 2 hours be a symtom? chills, What else determines a vist  to the Doctor,for a  urinaylsis?

 thanks JIm

frank

Frank,

Unfortunately, there isn't a clear cut answer to what determines a visit to the doctor for urinalysis and culture when you are self cathing. It's often a judgement call. So best to contact your urologist if things seem out of the ordinary and let him decide how to proceed. 

You have mentioned frequency before, and while that can be a sign of a UTI, your negative urine cultures suggest that treatment with antibiotics isn't necessary. Same with chills without fever. It could warrant a urinalysis and culture but I believe you already did that. What you don't want to do is treat every sympton with antibiotics, especially if your cultures are negative. On the other hand, if you have pain, fever or if things don't feel right or different, definitely contact your urologist and take his lead. 

-- Jim

 

Jim,  THANKS .FOR ALL YOUR HELP.

FRANK

Hi Jim,Latey,doing CIC gives me testicle discomfort. Is this a downside to CIC? Trying to figure this one out?

Thanks JIm,

frank

Hi Frank,

I think you've mentioned that you had this discomfort before. If it continues, or starts getting painful, call your urologist and he will probably want to test your urine and take a look. As far as I know, testicle discomfort is not directly reated to CIC, but it could be related to an infection from it. There could also be other reasons.

Jim

Hi Jim. I wish i had a uro i could talk to.When i have a question i email the office they then forward this to him.Is there such a thing as being able to talk to your uro?I wish i knew one like that.I'm i asking to much?I asked a question that was  had mentioned about my urodynamics test which i thought was something i should know. I asked this question over 1 week ago,still no answer.Today i emailed the same question,same routine i will forward this email to the doctor.Is there really  a Uro that take the time to talk to there patients?I wonder?

Thanks JIm.\

frank

Frank,

What you are describing is a universal problem although I have been fortunate to find some doctors who do return calls within a day or two, or better those set up with email portals who often respond the same day.

You could always find another urologist who is more responsive, but you have to look at the whole picture. Your doc does seem like he knows what he's doing and he's also not pushing you into a procedure. So before you consider dropping him, make sure you find someone equally as good. 

What you might do first, is have a frank discussion with him about the communciation problem the next time you see him in person. Perhaps it can be resolved that way first. Also, if it's something really important and time sensitive, I find calling the office and explaining to the the time sensitive nature of the call often will get the doctor either on the line or to call back the same day. And if he doesn't, I call again. Squeaky wheel gets the grease thing.

Jim

Aloha all,  I was going for speed, just to see how fast I could do it, from the point of entry to penetrating the bladder with a FR14 coude tip.  My best time was 3 seconds, and I did it several times at that speed.  My surprise was about a week ago, I tried to CIC and I couldn't get in to the bladder.  That worried me, because I thought to myself, oops, I'm in trouble, if I can't empty my bladder, what then?  Fortunately, the next time I tried which was several house later, I was able to get into the bladder, and it was been business as usual since that episode! Anyone had that trouble?

 

Aloha Dennis,

For some reason didn't remember you were from Hawaii. Any surfski racing in your present or past?

But too your question, the only time I seem to remember not getting in the bladder was when I had completely emptied it via CIC, then backed out, then tried to go back in within a minute or two. The explanation in this case is that when a bladder empties out completely, the sphincter can sometimes shut like a clam for a bit, which is normal. However, I don't think this is what you are talking about, but I'll take a stab (no pun intended) on what happened to you.

By this point my mind and body are so in tune with CIC, that I believe the sphincters relax reflexively as soon as I enter the urethra. I feel a very slight resistance at the external sphincter and no discernable resistance at the internal sphincter where I believe you might have had that one time problem.

So my thinking is that your body may be reacting the same way but you simply went in too fast and confused the sphincters. Going in a litttle slower (maybe 5-10 seconds in your case ) may give your sphincters the heads up they need to open wide, and a one second or so mental "relax, relax" as you go by the sphincters can't hurt. Either that or something else like maybe you hit a false passage, another byproduct of trying to set a Guiness record for fastest cath time  Anyway, glad it only happened once. Would not be concerned, just slow down a second or two. 

-- Jim

I've gone completely in the opposite direction now.  I go really slowly now, so as not to injure or irritate the entire area.  From a 3 second best time, I proabably take around 30 seconds now. I go as slow as a snail. I am still hoping for renewed bladder strength. About surfing, I used to surf from my teens to around mid-fifties.  After moving to Kaneohe, and having a yard to care for, the  beach became pretty much a memory. I practically lived at the beach, through out my youth, and into my adult life.  The beach, was everything! I am not sure what you mean by surfski racing?  I am now in the rainforest of Kaneohe, with song  birds, wild pigs, and wild chickens frequenting our yard.  The pigs, can make a mess of the yard, when they are rooting for grubs!

 

Hey, Dennis,

I haven't been timing my CICs since my bladder stone removal. Since the removal my NV volumes have dropped, and it takes longer to get past my external sphincter. There are times I have to use 2 or 3 catheters to get past--sometimes on the 2nd or 3rd try the catheter slips in as though there wasn't an obstruction at all. Not sure why that happens.

You said earlier that you had bladder stones removed some time ago. Were you doing CIC afterward? Did it affect your NVs or CIC? I'm hoping this set back is temporary.

Coloplast announced that their new Flex intermittent catheter will be available in April. I called my medical supply rep to see if he can score some samples for me. They might make CIC easier for those of us with problem prostates.

Stebrunner

Hi stebrunner,

You may have what I have : a false passage. It may explain why sometimes it is easy (correct passage = urethra passage) yet sometimes so difficult (false passage). What type of catheter are you using ? Coude or straight ? Hank

Hi, Hank,

That's interesting. I guess I thought a false passage was when you accidentally penetrated the urethra, but it sounds like you're saying that a false passage doesn't necessarily do that. I use 2 different brands of coude tip catheters--and 2 sizes--Speedicath FR12 or Origo FR14.

Sometimes the Speedicath FR12 will work several times in a row--then stop. Then the Origo FR14 will work several times, and then it will stop getting through, and I switch back to the other brand/size. Sometimes i think the difficulty is due to inflamation from something I ate or because of tension in my pelvic floor. Didn't think of the false passage. How do you deal with your false passage?

Stebrunner

Hi Stebrunner, I can feel that the catheter has entered the false passages when it refused to advance further with normal pressure over a reasonable time. I usually pull it back out out and reenter with a slight twist. Sometimes I even take it all out and put it back with in with a 90 or 180 degree twist. Now the tip will point away from the false passage. You can do this only with a straight catheter. I also find out that i have more chances of getiing the false passage with the coude catheter, perhaps because its tip is smaller so it is easier to enter a false passage which is usually smaller in diameter. Hank

Hi Hank,

Have you had your false passage confirmed by cystoscopy or imaging? My understanding is that that they can be fixed within a few days if that is what you have. 

Jim

Hi Stebrunner,

If you think you have a false passage your uro can take a look to confirm one way or another. I believe the test is a retrograde pyelogram. As I mentioned to Hank, false passages can be treated within a few days. Hank and I differ on the coude vs straight, but the literature suggests that if you have a false passage, you should use a Coude. Not saying you have a false passage, and you probably don't, but something to discuss with your doctor.

Jim

Just wanted to add that false passages are fairly common. I think I might have had a very small one a couple of years ago. Hit it maybe once or twice near the bladder sphincter. Just backed out a little and then went back in. I was a little more careful after that and then it went away. I never had it confirmed by imaging. One way to avoid false passages is to try and go slow and gentle so you have time to feel the way. 

Jim

Hi Jim + Stebrunner,

I never have the false passage confirmed by a uro, just by self experimenting and feeling. I can get by OK by using straight cathetter w/o any problem. I will look into having it fixed but I have had it 6 mos ago, probably from a uro nurse sticking a catheter (of course it was a 12fr Speedicath coude into my urethra, causing a bloody mess. Now, I am a little wary of letting them sticking something else into me, even if it is a cystoscope.

Hi Jim, is it possible that my false passage is actually the spermatic duct ? It is only about 2-3 cm deep. Thanks. Hank

Hi Jim, re whether or not my occasional cloudy urine is just colonization or UTI ...

I googled "cloudy urine" and one of the causes seems to fit my situation : retro ejaculation since I do not have any other symptoms what so ever. Hank

Hi Hank,

Two possible causes of cloudy urine are sperm mixed in and/or white blood cells (leucocytes) which are often present with CIC.  If you want to find out more, go to your doc or get some urine dipsticks (I use Siemens 10SG). If "leucocytes" (white blood cells) are positive than that would be enough to turn your urine cloudy although it doesn't eliminate that there could be some sperm in there as well. 

Positive leucocytes in and of themselves doesn't mean you have a UTI or even that you have bacteria. If "nitrites" are positive, more likely there is some bacteria but again not necessarily a uti if you are not symptomatic. 

Colonization (asymptomatic bacturia) and UTI (symptomatic bacturia) can be confusing at times and are sometimes a judgement call. On one hand you definitely do not want to treat with antibiotics when not necessary, but on the other hand you don't want to live with a raging UTI.

Jim

Hi Jim, below is a quote from a study by ncbi in 2009 regarding coude catheter and false passage I think that happened to me by a uro nurse :

... However, a Coudé tip catheter should only be used in patients with prostate problems, and not in cases of urethral stricture. If a patient has a urethral stricture, the use of a Coudé tip catheter can create a false passage as the catheter tip points toward the side. The strictured lumen of the urethra is usually very resistant to passage of a Coudé catheter. A Coudé tip catheter usually cannot achieve the goal of dilating the stricture and tends to pierce the delicate urethral wall at the side of the strictured lumen, creating a false passage...

Hi Hank,

Not surprisingly, there's a paucity of studies out there regarding CIC, probably for the simple reason that there are no big bucks to be made there by doctors!

That said, I have read the opposite of the 2009 study you posted in any number of places including in the field commentary by cath nurses and patients in the SCI (spinal chord injury) community. If you google "coude vs straight catheter" or "coude and stricture" I think you will find more hits to support my understanding than that one study you site.

There is also a decent article on CIC on Medscape, titled " Review of Intermittent Catheterization and Current Best Practices".

From that article: "...Using a curved catheter tip in the male patient with an enlarged prostate or a narrowed urethra (for example, from a stricture) may allow for ease of insertion"

Jim

 

Hi Jim, I agree with you that coude is great for many men with BPH. However, it may not be good for some like me. Used incorrectly it may cause problems. It happened to me when that uro nurse forced the coude into me. I felt a sharp pain and then a lot of blood came out of my penis. I think the false passage was formed then. On the other hand, CIC is quite safe if you are careful and do not force it. For 6 months I never experienced that again. Hank

I agree with what you said. Sounds like your nurse messed things up. Luckily the urethra heals pretty quickly. I believe my false passage, if that is what I felt, also helaed by itself. In bad cases of false passage, I believe they put in a stent, give you antibiotics and within 5 days you are as good as new. If anyone thinks a false passage is giving them a repeated problem with CIC, they should discuss with their urologist because it can be confirmed with imaging although I think a cystoscopy might be necessary. Not sure on that but main thing is that it is a temporary condition when minor or when treated.

Jim

Hi Jim, some studies suggested having a Foley for few weeks to allow the false passage to heal. I my case, it never did heal even after I only use straight catheter (no Foley for me) for 3 months. As soon as I started using the coude (because I remember the ease that the coude navigated through the few times that I was successful using it), it navigated back into the false passage. Maybe I will wait longer next time.

Sorry that I seem to be a pest to you on this subject at times but it is my intended contribution to this thread (and this forum): raising awareness of false passage, especially with coude catheter, if not handled properly. You made (still are making) immense contributions to this forum. However, you may have overlooked on this subject due to your unwavering love of the coude. Hank

Hank,

Well, first, we don't know for sure that you had a false passage since you were never imaged for it. But assuming you did, and it wasn't treated properly, I could see a coude finding the false passage,  easier than a straight in an individual case, because of the way a coude can wind around things. But that doesn't mean that straights aren't more apt to cause a stricture in the first place because of their pointed tip. Does that make sense? 

But truth be told, if I "love" my coude, as you suggest,  it is far from "unwavering" and in fact it is time for a Sunday morning confession --

I have cheated on MS Coude several times

The first couple of times was just to play the field, you know, see if someone else is better. And then I had my eye on the "Compact". Boy was she a beauty, you know the type, and more than that she was so easy to travel with unlke MS Coude who wasn't flexible enough to go with me easily

But alas, as so often happens, my cheating ways came back to sting me. Literally. In the prostate!  That's what they often tend to do. Just google the subject and read the studies. Or better yet, watch Dr. Phil. 

So, reluctantly, I'm back with MS Coude, who is now Mrs. Coude, thank you. Afraid I won't leave her again.

Jim

 

Hi Jim, it is good to hear your hilarious confession toward Mrs. Coude. However, you keep referring to straights with "pointed tip" while all I ever see is a dull, rounded broomstick ends, at least with the Speedicath 12fr and 14fr straights that I have. I don't think that I can cause any false passages without really, really jamming it in. Sometimes I wish they can be more pointy so I can navigate more easily. Maybe you are referring to another brand of catheters, not the Speedicath ? Hank

Hi Hank,

I have only used two straight catheters. The Coloplast Speedicath Straight hydrophillic and the Coloplast Compact. The end may look "dull" but my prostate said "ouch" both times, as unlike the coude which sort of bounces around the prostate, the straight catheter just stopped.

Jim

Hi Jim,I have a theory,need your opinion?

I  NEED YOUR OPINION ON MY THEORY.IF I WERE TO LEAVE  THE CATHETER IN MY URETHA JUST PAST THE PROSTATE, NOT GOING INTO TO BLADDER ,FOR LETS SAY 3 TO 4 HOURS UNTIL I GET THE URGE TO PEE AGAIN .IF I CAN PEE THEN I WILL KNOW iIT’S MY PROSTATE AND NOT THE BLADDER THAT IS CAUSING MY URINE RETENTION?

DOES THIS MAKE SENSE?—-ALSO HOW WILL I KNOW WHEN I’M JUST PAST THE PROSTATE?

Thanks JIm

frank

Hi Frank,

I'm not sure it's safe or necesssary to leave it in 3-4 hours. That said, I think I might have suggested something similar a ways back in terms of helping you get a natural void.

So maybe try this. When you get the urge to void, push the catheter past the prostate but just short of the bladder sphincter. If you push too far and the urine starts to flow, then back out a little until it stops flowing. Now try a natural void. Then measure the NV. As soon as the natural void is over, now push the catheter in and drain the bladder and record that volume. 

The first volume would be a Catheter assisted natural void (CANV) and the second volume would be your post void residual (PVR).

Depending on what numbers you generate, I believe it might be helpful in determing whether a prostate reduction surgery would work. But even if the results were unclear, ie a very small CANV and large PVR, it still might be some sort of interim step in helping you achieve a NV. 

Should add I'm not 100% sure on what the data might mean, but I don't see any harm in experimenting like this, as the catheter will only be in a minute or two longer than usual. 

Definitely let us know how it works out!

Jim

 

JIM, I will try this JIm. If i have a NV with the catheter in but short of the sphincter this would mean it's my enlarged prostate causin the retention?Not my bladder? Wow ? if this works i think i would i have Gl surgery.

Is this the way to try?

Thanks,

frank,

 

Frank,

It wouldn't be that simple. It would depend on the volume of the NV and the volume of the PVR. That's why I suggested you first measure the NV and then push the catheter into the bladder and measure the PVR. 

More directly to your question, if you have an NV with the catheter in, it would suggest that a prostate reduction surgery would allow you to have a NV, but it would not necessarily mean that it would allow you to empty completely enough in order to get off CIC post surgery. 

I would just take it one step at a time. Try it and see what happens, but to give it a chance, wait until you feel the urge.

Jim

Jim, Another thought? I had a inguinal hernia 2003 laporscopic surgery,a mesh was put in. Do you know of any one having urine  retention because of this mesh?

Thanks my friend.

frank

Hi Jim, I tryed several times,going just past the prostate , if i go to far i start to pee.,then i back off .No luck ,i can not NV. It is getting depressing.

I know how this all started. I was peeing 3 to 4 ounces ,frequently,then one day i noticed a bulge on my stomach. Went to a URO. He put me on dutasteride and flomax. From that day on i could not pee.Do you think i should do another urodynamics test. My report says that i did a self cath, The nurse did this and used a coude cath,I was bleedind a lot after the test.  I always use a straight cath.Maybe thats the reason the i failed the test>

I value your opinion JIM

Thanks

frank

If you start to pee, and the catheter is not in the bladder , then that's a natural void, isn't it? 

Jim

Hi Jim,No ,i cannot do NV. Jim do you know of anyone else that had a bladder rehabiltate,besides you? I'm going to make an appoint with a URO that does Uro LIft .I will let you know what he says.

frank,

Frank,

I'm a little confused. You said, "if i go to far i start to pee."  By "too far", do you mean if you push the catheter into the bladder itself?

I don't know anyone with as dramatic an improvement as me. I did my IPSS just now and it is 5 (mild). Three years ago, before self cathing, it was in the 30's (severe). I haven't had to cath for close to 4 months now. No urgency, Very few night time trips lately. Went to bed around midnight last night and woke up at 5am to pee, that was it. 

That is not to say there haven't been others. In fact, I'm sure there are others because my plumbing system is not that unique. I'm thinking that one reason we don't hear too many cases like mine is that most people go the surgical or procedural route first rather than try longer term bladder rehab with self cathing. 

This doesn't mean it will work the same for you and we've talked about that in length before. 

I think it's a good idea that you are exploring the various options. Let us know what the Urolift guy says. Just make sure to ask him how many Urolifts he has done and what kind of success he has had with cases similar to yours.

Jim

Hi Frank, Watch out for those nurses. Sometimes they don't know how to cath though they should. The first time I had a uro nurse cathing me, I was bleeding profusely and nothing but blood came out. She used a coude catheter. She then tried another coude, and again all blood no urine. I became suspicious and looked more closely on her activities. It turned out that she did it all wrong. I never cathed before that but from reading and watching videos, I knew that she was doing it incorrectly. The first thing wrong was she had the marker for the coude catheter pointing downward (should be upward). The second thing was once she could not advance it, she practiccally tried to shove it in and then twisted and turned it viciuosly. Of course that second coude failed. She almost gave up when I asked her to try the straight catheter. This 3rd time it worked, my first CIC experience.

My suggestion: If you can cath yourself, don't let any one else doing it for you. Hank

Hi Frank, my bladder has improved somewhat since I started CIC, though not as much as Jim, but I have only been doing it for 6 months. Better flow, more natural void, less retention than when I started 6 months ago. I am also taking doxazosin which is similar to flowmax. Hank

Aloha everyone,  I've been self-cathing for around 7 months.  So far, I don't see any kind of improvement.  It feels great to have an empty bladder, but very little urine, when I do a NV.  Jim, how long before you had improvement with your NV?  Much Mahalo, Dennis N.

Hank,

As I've mentioned before, I had signficant progress up to the 2 year mark, and beyond, and it wasn't until the 2 year mark that I was able to get off the catheters for months at a time. Of course, I used a COUDE catheter for my rehab, so your results may vary

Jim

Hi Jim, It is great that you only get up once at 5AM. Did you measure how much your void was ? Any potato chips before bed ? Hank

Hi Jim, the way things are right now, I have good chance of rehabilitating my bladder like you. Since my IPPS score is below 10, with CIC and doxazosin, I am not planning on any procedures soon. I may go on doing CIC for years and be the the one that proves you are not a freak. Sorry, I mean a blessed person. Darn the autocorrect. Hank

lol. Yes, chips last night. Hmmm. Didn't measure, but guessing my 5am 'chip limited' void was in the 250-300ml range  

Jim

If you post or PM me your cath history with a few days of void logs, I might be able to give you some tips in speeding up the rehab process. As I see it -- and this is more theory than fact -- it's a three pronged process. The first is decompressing/resting the bladder for more tone. The second is strenghing the detrussors and nerve impulses. The third I think is will power or the power of positive thinking. 

-- Jim

My night time void is still a problem. Basically, 10PM before bed CV = 200-250ml, 3AM NV=200-250ml + CV =250ml-300ml, 7AM NV=100-150ml. I know that sometimes when I went out and ate saltier foods for dinner, I slept longer and had less both NV and CV, perhaps at 5AM or 6PM. But I have not been able to convert that knowledge into a workable eating plan yet. Maybe I just follow you chips stretagy. OK. Tell me more details of your magic chips. Hank

Hi Dennis, are you using Jim's cathing techniques ? I don't think passive cathing will improve your bladder functions. Hank

To add to what Hank said, at a certain point I began what I would call "challenging" my bladder to perform outside of CIC. Sometimes I would coax it along with 5mg Daily Cialis, sometimes I would coax it along with some reflex voiding techniques such as light tapping and sometimes I would coax it along with an easier semi-prone voiding position. This forced the bladder to work harder and to get the message that I wanted it to work with the tube!  During these periods I sometime cathed only once a day or sometimes went up to a week without cathing.

After the bladder (and myself) got tired of that nonsense, I would then go back to pretty agressive CIC, often 6x/day to give it a rest. 

So it was sort of like gym workout plan -- heavy days (weeks) and rest days (weeks). 

As a word of caution, even during the off catheter time, it is important that you don't let you bladder fill up too much. I gave it some leeway here, maybe 600ml instead of 400ml, but if I felt things were going out of control I would cath as a reality check. What you don't want to do is stop CIC for a week and find out you're carrying around a Liter of urine all that time. Doing a void log also helps keep track because if you know your previous 24 void volumes while self cathing you can then compare those volumes to the volumes when you stop.

As time went by, my "heavy" workouts became less of a chore, and finally almost no chore at all. That's where I am now. For the past four months no CIC, with maybe only 2 or 3 times where I had a problem initiating urination. I was able to get by those times by walking around a little and then urinating. Other than that, things work normal. 

 

I guess you could say, i'm passive cathing.  I do it three times a day usually. I don't see the need to cath, if my bladder is not full. If it's only 200 ML, then I don't even have the urge to urinate.  I hope I'm not ruining my chances to rehabilitate my bladder.

Hi Dennis, passive cathing is good, to protect your kidneys and reduce chances of UTI (if done cleanly). However, to improve your chances of rehabilitating your bladder, I would follow Jim's method. It does make a lot of sense and he's done it himself. I think the most important thing to do is trying to push urine out during the cath, using your detrusor muscle. It is kind of exercising your bladder muscles. Other things Jim already mentioned on one of the above posts. I used Jim's method and my bladder functions have improved significantly. Hank

Hi Dennis, what is your average cath volume ? No urge at 200ml bladder volume is quite normal. I usually do not have any urge until 400-500ml. Hank

Hank, around 300 to 400 ML. If I don't cath, I'll have to go every 15 minutes, till the bladder volume is reduced.

Hank, I think I'll try the pushing the urine out while cathing.  Are you on any kind of medication, such as doxazosin or avodart?  Thanks for the help.

Hi Dennis, 

I thought you said before your cath volumes were more in the 200-300 range at a cath frequency of 3x/day?

If your cath volumes are 300-400, you might try at least temporarily increasing your cath frequency to 4-5x/day (or even 6x/day) and see if that additional bladder compression helps things along. Doesn't have to be every day either. Of course, it's also a lifestyle issue. In my case, I often work from home, so throwing in another cath or two, here and there, was never any big deal for me. And yes, "pushing out" is a good way to exercise the detrussors. Just don't overdue it. Don't push too hard, and it's not necessary to push every time you void, or even for the entire void, especially since I assume you get some detrussor exercise on your normal voids. Speaking of normal voids, I found that focusing more on relaxing the bladder sphincter during urination produced bigger natural voids than focusing on pushing out. 

Jim

Jim

Jim

Hi Dennis, I am currently on 4mg doxazosin but I experiment with it a lot. Sometimes I go down to 2mg for a while, sometimes even 0mg. I go out and find it a hassle to carry a catheter then I take some to make sure that I can void naturally. I think it is critical to maintain natural void if you have it. If you don't have it, try to experiment with different ways to get it. It becomes a base line on which you can work to improve on using Jim's tips. If you have to go every 15 minutes I think you can try something like Cialis (less side effects but more expensive) or alfuzosin, doxazosin, etc. Don't over worry about the side effects. You can always stop or reduce the dosage after you strengthen you bladder.

Hank

Hi Hank, You are so right. I will never have anyone do a cath besides me. I can't figure why they said on my report {urodynamics} that i did the self cath,which was not true, the nurse did this, i bleed also.I never passed the NV throughout the test. I wonder if i should do this test again?She also used a coude catheter . i always use magic3 hydrolic sure grip,with no problem.

frank,

frank

Hi Jim, Yes ,if i hit the bladder i will start to pee. I back off about an inch,urine stops to come out,also i cannot pee.I sure wish i could at least get a NV.

Like you said it might take more time doing CIC.Also JIm When i did my 

urodynamics test,my report said i did the self cath, i did not ,the nurse did this and i did bleed a lot.Do you think i should tell the office about this?

I did fail the test,Whats your op-inion on doing the test again?

thanks Jim

frank

frank

Frank,

I've been thinking about the test a little more and not sure how useful the info may be. That's because even though you're opening up the urethra, it appears that it may still be significantly blocked by the catheter unless it's in the bladder which voids the test. I will try and test it myself the next time I cath but that may not be for awhile. Maybe someone else who does CIC and is able to do natural voids will test it for you sooner?

Don't quite understand what you mean the uro report said "I did the self cath"?

If my bladder is full then I often have the pee start flowing well before I get the catheter inside the bladder. Sometimes the pee even flows around the outside of the catheter and when the catheter gets into the bladder it is interesting that I cannot increase the flow rate by contracting my muscle which I normally can do otherwise.

Neil,

Interesting. In the example you gave, did you already do a natural void? Frank is doing a little experiment and this may be relevant.

Jim

Hi Frank, next time bring your own catheter and do it yourself, even the nurse is young and pretty. Hank

Hi Jim + Frank, I did the experiment. I voided naturally first, then inserted the catheter, then back out a little after urine started flowing until the flow stopped. I could not urinate that way (with catheter inside me) either. Hank

After you did the experiment, did you then put the catheter back in and see how much was left?

I don't remember the exact number (2 days ago) but it was just my typical day time after-void PVR, around 150-200ml. Hank

Jim + Frank

The fact that I can not void with the catheter in, but just outside the bladder, can only means 1 of the 2 things , or both:

1. My obstruction is at the bladder neck.

2. My bladder is still too stretched out so that my detrusor muscles, though stronger than before, still can not push the rest of the urine out. In other words, my bladder can not collapse completely flat.

What do you think ? Hank

Hi JIm, The urodnamics test {my copy} said i did the self catheter insertion.

However i did not ,the nurse that gave me the test did this.I don't know why it said that i did the self cath? I was bleeding a lot after the test.May i should have told my urologist?

What do you think?

frank

Hi Hank, I am trying this ? I do CIC ,I assume you do CIC also.This test i do to see if i can NV with catheter going past the prostate into the bladder,than i back off ,out of the bladder about 1 inch,flow stops,then i try to pee with catheter just 1inch out of the bladder.I still can't Pee.Have you tryed tryed this test?Have you had surgery>

Frank

Hi Frank, I tried it and I could not pee either (with the catheter in just outside the bladder, after I NV all I could w/o catheter). I posted my theory to Jim and you about an hour ago, just a few above this post. Just scroll up and read.

I never had any procedures, yet. I can still NV some w/o catheters. Hank

Hi Hank,

I just want to make sure I'm clear what  you did.

1. First you did a natural void. Do you know the volume?

2. Next you inserted the catheter into the bladder, but just for a second to make sure it was in the bladder. The moment the urine started to flow you backed out of the bladder a little so that the urine stopped flowing.

3. Keeping the catheter in this position (just outside of the bladder) you tried to void but could not.

4. You then pulled out the catheter instead of going back into the bladder to measure your PVR.

5. Based on past history, you think your PVR was 150-200ml

Is this correct?

If so, I don't think you can necesarily conclude what you did. A third reason may be that the catheter itself was causing a significant obstruction. Keep in mind that trying to void with a catheter in is not the same as say trying to void with a stent in. With a catheter, you have to void through the very small eyelets and/or around the outside of the catheter. That said, you might want to repeat, maybe with a smaller catheter that will give you more room to void around it?

Jim

What we really need here is a catheter that acts more like a stent. Something with as big an eyelet as possible. Remember, it doesn't have to fit through the bladder sphincter since we will stop short. It just has to pass around the prostate. You would think a uro could do something like this? Getting them to do it would be another story but it seems like a good test to see how a prostate reduction surger would work. Better IMO than current urodynamics which only test indirectly though urodynamic pressure testing. 

Jim

Usually I did not do an NV before. Recently now that I avoid an NV right before CIC to get it in easier I do have pee flow starting before I actually get into the bladder. I have to clamp down to keep from making a mess.

Prior to this when I had trouble getting the catheter in I would just wait at the obstruction and then push a little oon my bladder like I was trying to pee and that would open up things and let the catheter in. But sometimes it would also start the pee flowing before I was in. That would always be right after an NV but now I am trying this new method of not doing an NV just before CIC. Always something new to learn.

Neil

So how many times a day do  you do a natural void now? 

Right Jim - I agree with you here. That is the reason the pee flows AROUND the catheter with little going through it when the catheter is not in the bladder. The little eyelets present a lot of flow resistance to the pee when still compressed by prostate tissue so the path of least resistance is around and not through the catheter tube at that point. It makes a mess. Usually this is not a problem but when the baldder pee is under high pressure then it is a problem. Since I don't NV now before CIC I have to be careful of this effect if my bladder is full. That high pressure works for me and against me: for me - because it helps dilate the urethra so the catheter gets in easier but against me because it can flow out and around the catheter and make a mess if I am not careful.

Neil

Hi Jim, Wow !!! Only you can think that thorough. I am beyond impressed. And I thought that I am pretty clever. You must have mechanical background or you dream of prostate situations nightly.

Anyway, correction to number 4 above: I did not pull the catheter out. Instead, I pushed it back into the bladder and out came the urine into a cup, where I measured the PVR.

Number 1: I don't know why this NV is significant ? But my NV is normally 120-150ml when I have a small urge. Though I can have up to 250ml if I forget or lay down.

Hank

10 to 12 over an 18 hour period with the NV generally in the range of 150ml. Note that I do one CIC during this 18 hour period. the other 3 are between 11pm and 6 am.

 

Oh oh Jim, You made me think and I just thought of something else. The eyelets of the catheter are on the side. They will most likely to be covered tight be the lining wall of the urethra. Now I understand your stent reference better. Hank

So you pushed it back in. What was your measured PVR then? 

Hank, Neil, Frank, and others.....

BTW, and I haven't digested it fully yet, but something like we're talking about was postulated in 2011. "Test by Stent" which basically is a test to see if a TURP will yield desired results. This probably went nowhere but I think this could be a valuable approach for a motivated patient with a motivated an enlightened urologist (if they exist ) 

Google "New developments in the use of prostatic stents" and see if you come up with the full text of the 2011 study. I'm going to PM you the link anyway.

Jim

 

I was just concerned you stopped doing NV's. As long as you're getting the detrussor's exercised with several NVs a day, then the rest is whatever works best for you!

If you have a drill to open them up (just kidding ) 

Hi Jim,

A couple of things ...

I cathed last night at 11pm (450 ml) and then again at  5am today and took out 800ml. In both cases I did not NV before the CIC. So I wonder if the higher pressure pushes out more pee than first doing the NV? That is, if I had NVd at 5am and got 200ml first would I then get 600ml by CIC to total the 800 or does the NV first reduce the bladder pressure to such an extent that the CIC is not as effective in getting out all the residual pee? Unfortunately, this is not a repeatable experiment.

And here is something else I am looking at regarding why we pee so much at night. The kidneys store a lot of water - in excess of several litres that can be used to handle dehydration. During the day when we eat and ingest salt, potassium etc the water storage increases in proportion to how much we drink.

But then at night when we do not eat, the salt concentration in the blood drops as well as the fluid volumes of the blood. This triggers a dehydration signal which then causes the kidneys to dump a lot of that stored water (and sodium) into the blood stream. It all has to do with osmotic pressure regulation.

Anyway, I wonder if this is why we produce so much pee at night? The father  modern physiology, Arthur Guyton wrote in his 1970 text that we drink way to much fluid during the day and should only drink when thirsty and not out of habit. Back then he quoted fluid intakes of 1700ml not including fluid from food and respiration.

So .. I wonder if we would pee less at night if we drank less during the day and loaded up the kidney reservoir which gets dumped out at night when electrolyte intake stops? I will try this as an experiment and reduce my voluntary fluid intake during the day to times when I just start to feel thirsty and not drink because I am told I need to drink 2 litres.

The downside could be bladder stones as the pee would be more concentrated but I will just try it for a few weeks.

Neil

I meant "sodium" concentrations and not "salt" - better not have serum salt levels!

Hi Neil,

I don't think bladder pressure has any significant effect on how well you can empty your bladder with CIC. Unless your technique is off, or your bladder irregular, you should be able to get it down to zero or let's say under 30ml with a catheter. Sometimes it may be filling up as we cath out so it may seem otherwise.

Yes, sodium intake is one factor with nocturia, and with some people, those sensitive to sodium, it might be a major factor. I joke about my potato chip cure for nocturia, but the truth is that if I have a high sodium dinner (such as including potato chips) then I will often sleep better thought the night because my kidneys are holding onto the fluid because of the sodium. The flip side is that at some point the kidneys will unload and you will have to deal with it then. Btw a news article today on salt/sodium an nocturia if you want to google it. I was planning on posting about it later. 

Be careful of limiting fluids to less than six, eight ounce glasses of fluid a day. A lot of the low fluid advocates are also often on a vegetarian/grain based diet where a lot of water is in the food itself and where less is needed to counteract the effects of meats.

Also back in the 70's, Macrobiotics I believe told us not to drink any additional fluid, just what was in the food. They also recommended back then regiman number, I think "9" which was 100% grains. No fruit, No veggies. That was until someone died on regimen 9 and then they revised. BTW I was on regimen "9" for about 10 days and frankly felt great but then again I was a young man. 

Jim

Google "Night-time loo trips 'linked to salt in diet'" and you will get the BBC article from today. I was trying to find the source study this morning but life interfered. If you find the source study please post the key words or PM the link. Thanks

I don't remember the exact number (2 days ago) but it was just my typical day time after-void PVR, around 150-200ml. Hank

Hi Jim - I'll check that out. Just now we are heading to Detroit to see if I can get my ISVs tied to make me fertile again and incidentally cure my BPH. This is what is so great about CIC - it gives me the time to explore all sorts of options other than having my prostate removed which had been scheduled for last June.

I too was on Regimen 9 way back then and for a while became a Fruitarian which is one step removed in sanity from vegan. I still am mostly a vegan and have no salt in the house or diet - just what is in the foods.

Last night at 11 pm I cathed about 450 ml and then went to bed just to find out at 6am that the water fairy had placed 800ml in my bladder during that period. I know as we age the anti-diuretic hormones that are supposed to prevent water reabsorption during the night are less effective. It is Nature's way of making old men get less sleep so we age faster and die off. There are hormonal therapies to offset this deficiency but they have bad side effects.

While salt is one of the major reasons we retain fluid there are also other hormones not related to electrolytes that act as ADHs. And then there are factors like high/low blood pressure, GFR, edema and a whole host of diseases.

But for me, I want to understand where that 800ml dump came from last night (and many other nights) so I will try reducing voluntary water intact and see what happens. Since my fruits and veggies are 90% water I probably get way too much water during the day. Also if my bladder were tonic then I would likely be awakened twice at night to pee - each time it filled to 400ml. Normal cell metabolism cannot explain it.

Take care.

Neil

 

Neil,

It's pretty much fluid in, fluid out, whether it comes from drinks or food. The problem is their is no easy predictability because of reasons mentioned. But in general, if not too much comes out during the day, then a lot will come out at night, ie nocturia. There are strategies which have been mentioned such as napping, compression stockings, diuretics and hormonal replacement. If you haven't, you might want to play around with diuretics earlier in the day to force more urination earlier.

Jim

Hi Jim, just google "nocturia salt intake". Hank

Jim,  I've been keeping records of every cic, since the beginning which was August 25, 2016.  my numbers are pretty much just an estimate.  More like I just "eye-ball" my measurements, by looking at my records.  To be more accurate, say for March 11 till yesterday, I'll give you just the first void of the day, which would be the morning void.  Here goes: 350ml, 425ml., 300ml., 400ml., 425ml., 400ml., 400ml., 500ml., 450., 500ml., 500+ml., 250ml., 475ml., 450ml., 425ml., 375ml., 400ml., 375ml., and that was to March 28, 2017.  I missed one morning of measuring my first void.  I guess it looks pretty high?  The latest thing for me is that I took Hank's advice and when I cic, I tense up my bladder in the hopes of restoring bladder strength.

Dennis,

You might want to use a marked beaker for a day or so to make sure your "eye ball" measurements are accurate. But simply, your bladder should not be holding more than 400ml at any one time. That would be the sum of whatever you void naturally plus the catherized volume right after. If you don't have a natural void, then it would just be the cathed volume.

When you push out or "tense" your bladder during CIC, be gentle and you don't have to do it all the time. In fact, if you're doing natural voids it's not necessary, but it is important if you're not doing natural voids. You will know if it work because the urine will come out of the catheter faster. 

My point on relaxation versus pushing out, had to do with natural voids. I have found that focusing more on the relaxation aspect of voiding produces larger natural voids than focusing on the pushing out phase. That doesn't mean you shouldn't use your detrussor's, it has more to do with focus.

Jim

No, I wasn't doing CIC. I wasn't aware of patients doing only CIC instead of surgery etc. I wish I did know of it.  Doing CIC,is the best thing yet for my prostate and bladder!  I wish I could be of more help, but my experience is very limited.  I can tell you a person that I know, whose grandfather was doing CIC for two years and doing fine!  One day, just a few weeks ago, he couldn't get the catheter in to empty his bladder.  He had to go to emergency to have a foley installed.  I heard last week, that he is now ok.  What happend was that the doctor had to give him a smaller catheter, so that it could fit into the bladder.  My guess is that his prostate grew in size slowly after two years since his Turp. For me, I am taking betasitoterol, that I buy from the Vitamin Shop, here in Kaneohe, Hawaii.  It cost around $8.00 for I think 60 capsules....very inexpensive.  I believe it helps the prostate from enlarging.  I had a turp done last year, and so since I am not on anykind of medication, I need to try to keep my prostate from growing again....so I take the betasitosterol. I hope it is working. Maybe you may want to consider doing the turp.  It wasn't painful, just a lot of hospital time, and seeing the urologist, and taking it easy for around 5 weeks after the surgery.  You may then have an easier time doing CIC.  Whatever you decide, the best of luck, and God Bless!

 

Hi, Dennis,

Good news to report. Over the weekend I suddenly had several easy CICs! This is after 1 1/2 months of hard cathing. About a week ago I started having some that were fair in their difficulty--and now some easy ones. I'm not sure if it took a while for my urethra to heal following my bladder stone removal--or if the improvement is from the paleo diet I started about a month ago. My NVs have slightly increased as well.

Stebrunner

That's Great!  I wonder what the cause of your success is? Hopefully, you will be like JimJames, and have super NV's. If you discover what the answer is, please let the rest of us know.  

 

Hi Dennis,

My formula for success, if you want to call it that, was to schedule my caths so that my bladder never held more than 400ml at any one time. That would be the sum of any natural void plus the following catherized volume. The idea is to decompress the bladder so that it will start to regain tone and also improve nerve response so that the bladder will signal sooner when it is full. Step two was to combine this with what you might term "challenge" periods where I would go off the catheter and let the bladder do its best on its own. The concept here is like easy/hard days (or weeks) at the gym. The progress with me was not always linear and I did not see signficant benefits until the second year. All of our bladders and underlying conditions are different so my success may not be yours, or ir could be. Happy to help you along if you want.

Jim

Jim, thanks for your imput.  It's been around 8 months since I've started cic. Not much improvement so far with nv's.  I will continue to try my best at regaining bladder strength. .  I am 68 years old, so God willing I still have a ways to go. before the end.  Might as well have a strong bladder, as much as possible for convenience sake.  In June, I have to take a day trip to another island, and so it would be the first time that will be using the catheter outside of my bathroom....should be interesting.

Tell me, what your hard cathing was like? I can pass catheters more or less easily, but sometimes it is painful during CIC and after, with inflammation in the scrotum. Has this happened to you?

Jim, was it sometimes painful to you? During and after? I have this problem of pain. Even inflammation. Ibuprofen helps a little. CIC 6 times/24h, no NV at all. Zdzislaw

My first month or so was very bad. Pain, bleeding, false urgency, UTIs, anxiety, depression. Flash forward and today it's about as painful and traumatic as brushing my teeth, just takes less time. 

That said, I don't remember ever having the kind of resistance/obstruction that Stebrunner and a very few others talked about. I had the usual resistance (and some pain) at the prostate and bladder sphincter but was always able to push through fairly quickly. Today, the resistance is so slight that I can say it's almost non-existant at time. My timed caths (from entering the meatus to urine flow) are around 5 seconds (with the regular Speedicath) and that is without rushing things. There is a new cath I just tested called the Flex Speedicath. Takes a little longer due to the way it's designed but I think it's an excellent starter catheter and also something for anyone to try who is having any difficulty with their current catheter. 

For me, it was a matter of both my body and mind getting used to the process. With the mind, it was a matter of focused relaxation, but that is hard to do when the body anticipates pain, so they sort of go hand in hand.

Jim

JIm.I have tryed the test,catheter past the prostate hit the bladder ,back out till urine stops ,still no NV .I sure wish there was a way to find out.I am seeing my URO Nurse, friday to see how much urine is left in the bladder after CIC.

Can you think of any other question i might ask? 

Thanks JIm

frank

Hi, Zdz,

About 1 1/2 months ago, I had bladder stones removed, and the uro took them out via my urethra. I think the equipment they used damaged my urethra. Now when I CIC I hit a spot well before my prostate that is painful and sometimes difficult to pass. Often I get past by very gently and slowly wiggling the catheter side to side. It's somewhat slow going until I reach the external sphincter.

At the sphincter on a hard CIC, I feel pain--sometimes very sharp. I keep a gentle pressure on--sometimes I pull the catheter back slightly and slightly turn it in an attempt to find the way through. A message therapist told me once that you can't tense your muscles when you are exhaling--so I try to gently press ahead while I'm exhaling. I use some yoga/relaxtion techniques, and sometimes before I CIC I do pelvic floor relaxation techiques.

Also when I have trouble at the external sphincter, I will change the angle of my penis--for example it might work better if I keep the head of my penis almost pointed toward the ceiling--sometimes it might work if I hold my penis straight out toward the wall. On occasion, it works if I gently undilate the catheter up and down as I apply pressure. Seems each CIC is different for me. I also use 2 brands and 2 sizes of catheters--if a CIC is hard, I might switch to the other size and brand.

Yes, when I first stated CIC about a year ago, I sometimes experienced pain in my scrotum--well, it was more in my testicle. The pain was slight to moderate and didn't last long. I typically CIC 5 times per day, and that pain cleared up over time.

Hope some of this helps.

Stebrunner

Frank,

As I mentioned in an earlier post, I don't think the test we did is a good one. 

You should not have any significant amount of urine in your bladder after CIC unless you are doing something wrong or your bladder has a very irregular shape, or perhaps you have a diverticulum.

Does the nurse use a bladder scanner that shows a picture of the bladder or does her scanner just show a number? If the latter, then she will not be able to tell.

Also, you would in theory have to have the bladder scan done almost immediately after you self cath. If you waited, say five minutes, then there's a possiblity that your kidneys have produced additional urine that will now show up in your bladder. This then would not be urine left in your bladder after CIC but rather urine produced by your kidneys AFTER cic. 

Jim

Hi, Jim,

Prior to my bladder stone removal I had gotten my CIC time down to 15 secs--hard to believe, I know! Post stone removal for 1 1/2 months, it was hard, slow cathing until this weekend. Then suddenly  for 3 days I had 3 out of 5 CICs that were easy--I gave into temptation and timed one--and it was 25 seconds to reach my bladder.

Now today I've done 4 CICs so far, and 3 of the 4 have been hard. Not sure why the ease of CIC changes so often. It could be inflamation from something I ate--or tension. I've been making preparations for hernia surgery, which has been stressful. The more I read about BPH and the more I experience with CIC--the more I think that everything in my body is connected--genetics, diet, stress, medications, medical procedures, etc. No wonder urologists have trouble figuring out our problems! I do like your temporary stent idea as a way of testing the odds of a BPH treatment success. It would remove some of the guess work.

BTW, I will be traveling for my hernia surgery, and it will be the first time I've traveled by air with catheters. Do you think I should take along a note from my doctor in case I have trouble at airport security?

Stebrunner

Thanks JIm,

frank

Stebrunner,

Inflammation would be a good guess. And given the fact that you've had a difficulty history, tension would also seem a normal response. In my case, except for in the beginning,  CIC has been smooth just about all of the time but I do have occasional episodes of pain when trying to initiate urination. My guess here is a combination of both a full bladder and inflammation. Inflammation is a biggie down there I think.

You said: " No wonder urologists have trouble figuring out our problems! "

Google "mayo clinic second opinion" and you should come up with some hits on today's news. The summary is that over 80% of all diagnoses are incorrect! Sound familiar

I only traveled with catheters by air once. I had a doctors note but more important I read all the regulations regarding "fluids" and had all my cath fluids measured out in a neat little see through plastic bag. The agent seemed very impressed but never asked what the fluids were for and never asked about the catheters which were scanned inside my check in bag. But I'd probably do the same thing again. 

One suggestion, in addition to packing catheters with your check in, have enough with your carry on in the event they lose your check in bag for a day or two. Worst case, your cath distributor could always forward you more catheters.

Good luck with your trip and surgery. There will be ups and downs with the cathing but if it got easier once I'm pretty sure it will get easier again. But when you have time, have them take another look inside (imaging and/or cystoscopy) to see if they find any physical reason for the difficulty.

Jim

 

Should add that I haven't heard of anyone running into trouble at the airport with catheters but it only takes one time! Oh, wait, I do remember someone saying they were questioned and then offered to self cath right in front of the agent so they would believe them!!! The agent declined and let him through. (Don't know if I'd go that far, but....

Jim

Thank you very much, Stebrunner! People don't mention pain and I began to wonder whether in my case it was related to my prostate cancer. Your post helped me! I hope that you will be getting better and better! Zdzislaw

Hi Stebrunner, with all the inconsistencies with CIC, do you think that you may have a false passage ? What type of catheter are you using ? Hank

Hi, Hank,

At this point, I don't think I have a false passage. Most of the time when I get to the painful, difficult parts, I am able to press on through. I alternate between to brands and sizes of catheters--LoFric Origo FR14 and Speedicath FR12--both with coude tip.

Stebrunner

Hi, Jim,

Thanks for your traveling suggestions. Got the note from my urologist, and have catheters and antibacterial wipes in carry-on and checked bags. My flight times will throw my CIC schedule off, but I'm sure it will be ok.

For the past 2 days CIC has suddenly become super easy! Instead of 1 or 2 easy cathings out of 5 per day, I've been hitting 5 easy ones out of 5. I don't know if it's because I changed my technique 2 days ago--I started covering the end of the funnel as I enter the urethra and keep it covered until I enter the bladder. When I get into the bladder, I feel a change in pressure--and also, I know about when I'm at the bladder by how much catheter remains outside.

NVs still haven't come back to what they were before my bladder stone removal. Hope to see that improve. It will be interesting to see if my hernia repair changes my NVs. I read one research paper that said inguinal hernias can increase LUTS. Don't really think that's true in my case, but it will be interesting to find out.

Stebrunner

That's really great your cathing is going easier. Easy enough to test if covering the funnel makes a difference. I've only covered the funnel on the way out (so urine does leak all over the place) but then again I didn't have your issues. It could just be that your body/mind is just getting used to the process and now accepts it as normal and not something foreign to fight. 

For the life of me, still don't know why sometimes I get really good NVs (300-400ml) and other times 100-150. Last night I had a beer which in the past appears to be an irritant, but this morning what appeared (didn't measures) to be close to 400ml came out nice and easy with zero strain. I still think, at least in my case, that prostate inflammation plays a role and that can be intermittent for a whole range of reasons. 

Still haven't had to cath for months now although some times I just can't get things started but walking around for a couple of minutes seems to do the trip. You might want to try walking around before your NVs for five minutes or so to see if the volume increases.

Good luck with your trip. Maybe you will get bumped and collect the 10K reward which at least one airline is willing to go up to! Another reason, of course to have enough catheters and supplies in your carry on in case you get separated from your check in baggage.

Jim

Hi Jim, I remember that you mentioned several times before that urination became easier for you when you reclined and urinated into a beaker so having nothing better to do this afternoon, I decided to give it a try. Not risking stinking up my recliner, I simulated a reclining position on the side of my bathtub and peed into a bottle. And lo and behold, urine came out much easier than standing up or lying down (I tried this too). I think I am going to use this pose more often.

Can you explain how this works ? Did anyone else try this ? Maybe we should petition for public bathrooms with reclining toilet seats.

Hank

Yes, a reclining toilet seat would be perfect

No, I didn't read or research anything, just sort of came about it by trying it out. Not even sure why I did that initially, it was so long ago the first time. But for me, it's definitely the go-to position when all else fails. 

I've probably only done the recline thing a few times the last four months, but a couple of years ago when I was weaning off of CIC, I'd do it a lot.

As to how/why it works, all all I can think of is that the reclining position must ease up the pressure on the urethral canal caused by an enlarge/obstructive prostate. 

FWIW if you want to do this in a little more comfort than the side of your bathroom, just pick a comfortable chair and get hold of a male urinal for a couple of dollars on Amazon. They are pretty good at cathing everything. 

The position I use is really more of a slouch than a full recline, but whatever works, best, works best. 

The other thing I find that works is to walk around for a few minutes before a void. I still do that from time to time when I have trouble starting a stream.

Jim

Hi Hank, I had a simular experience,when i had my urodynamic test. She did not caterterize me the right way. I always use a straight  not a coude ,she said all they have is a coude ,so i went along with that. From now on i take a extra catheter with me , no one will catheterize me, but me.

thanks for that info.

frank