Self-catheterization

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I have been recently had a total hip replacement. Immediately afterward I could not urinate.

Note that prior to the surgery I did/do have BPH, and have been taking Alfuzosin (Uraxatrol). I have made 3 trips to the ER in the last two weeks. This last placement has been in for 8 days and is due to come out tomorrow.

The plan is to self-cath again.  I tried that before. I was able to do it for a couple of days using red rubber cath, but ran into trouble when I tried to use some different ones I had been given to try. There was a lot of discomfort and then blood.

I am extremely apprehensive about doing this again, but seem to have no other choice for now.

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  • Posted

    I suggest that you go back to the rubber ones since they work for you before. You may have to pay for them. Self cathing can be tricky. Hank
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  • Posted

    Considering asking your doctor to prescribe disposal catheters for you. Many urologists have samples on hand they can give you as well - and in different sizes. The size and type can vary for each of us. When I needed to do CIC after a procedure I was fortunate that the doctor had provided me with a large box of samples. My preference was the SpeediCath Flex, 14FR. Even though I no longer need them and have not used them in a while, I will always keep some on hand, especially when traveling - just in case.

    Best of luck.

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  • Posted

    Richard,

    I have been self-cath'ing for about 3 weeks now due to having a BPH condition where my urethra is completely blocked by prostate tissue.  I use the red rubber catheter and have found it to be the most comfortable. Every bladder is different in terms of capacity for urine retention.  i have found that self-cath'ing usually two but sometimes three times a day is all that is needed to keep my bladder capacity at a reasonable level (say 500 to 600 ml).  I measure mine each time I empty it because I also have a severely stretched bladder and I'm trying to get it to contract. Anyway, I just do it before and after work in my shower so if it is a little messy, its no problem.  Just make sure its carefully and completely lubricated (I use KY jelly which works well) and go slowly and carefully and it really is not painful.  It is a little uncomfortable but you get over that.  The benefit is that when its done you can rest assured that your bladder is empty and you will not have the dreaded urge to pee frequently that comes with a full bladder. I have NO urge to pee for 8 to 10 hours or even between cath'ings - but I think that's because my bladder is stretched.  I will have a surgery in 3 weeks to remove the prostate tissue and hopefully have my bladder start to fully drain.  We'll see. But don't worry about self cath'ing. just be slow and careful and its not that bad and it IS very relieving.  Good luck!

     

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    • Posted

      If you're trying to rehab your bladder (and even if you're not) you should never let your bladder hold more than 400 ml. Also, if you're planning on surgery, please consider one of the non surgical options (Rezum, Urolift) before going under and facing a long, possibly messy recovery.

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  • Posted

    The Coloplast speedicath FR coude 14s seem to work well for most. A rubber 14 coude cath will work fine too - make sure you wash it well after each use. You can get used to it - I self cathed for about 4 weeks after Rezum and it evolved into a minor inconvenience. Anesthesia often causes retention - especially in people who already had problems. It usually resolves in 2 weeks or less, so this shouldn't last much longer.

     

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  • Posted

    Catheter comfort is very individualistic. If the red rubbers worked for you, then use red rubbers. Not a bad starter catheter because they are so soft. Did your red rubbers have a bent (coude) tip? If so, continue with that. Later, consider switching to a single use hydrophillic like the Coloplast Speedicath Coude in size FR14. Also check out the self cath threads for technique and tips. It's very nomal to be apprehensive and it's also normal to have some difficulty in the first few weeks. But most who self cath get through that part and find out that it's one of the easiest things to do, somewhere between brushing and flossing your teeth. I don't even think much about it anymore. It's just a minute or two added to going to the bathroom.

    Jim

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    • Posted

      Thank you to all who responded. You have helped me immensely.

      My post-hip replacement Foley catheter was finally removed (again) this past Friday (7/13).  This time I got excellent support and training from my Urologist and his assistants. Their patience and understanding really helped.

      I'm keeping a log and gathering data to devise a plan and schedule. Last night, before bedtime,  I cathed at 10PM. I woke up at 3AM feeling uncomfortable pressure and the urge to urinate. Went to the bathroom and just dribbled a little.  I then self-cathed  (800 cc) and went back to sleep.

      This morning the realization really hit home how restricted it seems life will be until and unless the situation improves.

      Once again, Thanks to all who reply and post.

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    • Posted

      Good to know that we could hep.  However, I hope you don't consider self catching as restrictive. I find it liberating. I no longer find myself waking up several times during the night to void a small amount or having to urinate 3 or 4 times in an hour. I don't worry about being away from home and having a sudden urge to urinate.  I have a travel kit I carry with me when away from home and have no problem maintaining my schedule when out of the house or traveling out of town.

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    • Posted

      @richard This morning the realization really hit home how restricted it seems life will be until and unless the situation improves.

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

      Hi Richard, I felt the same way when I found out I had to self cath. Actually I felt a lot worse, a combination of anxiety and depression. But I can say this, it didn't last that long.

      There are many men here including myself who have, or had to, self cath on a regular basis. In most cases it has almost no impact on their daily life, and whatever impact it had is mostly positive. That's because emptying your bladder completely means less bathroom visits, less urgencies and fewer UTIs.

      I sometimes tell people that after awhile self cathing is about as traumatic and time consuming as brushing your teeth, but it's true. Sure it can be a little inconvenient carrying them around with you when outside the house, but you'll be surprised how quickly you will find a system that works.

      Jim

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    • Posted

      Hi jimjames,

      It’s now 6 weeks post hip replacement and almost 4 weeks self-cathing. Your previous comments were prophetic. So far, so good. 

      Started daily Cialis (5mg), acupuncture (along with some Chinese herbs with creative names - “Open the Gates” and”Restore Integrity”).  Stopped Alfuzosin for now because it may be relaxing my bladder too much. 

      I am now starting to urinate a little on my own (usually 100ml) before I self cath another 150ml to empty.  I see my Urologist in a week. 

      I have been trying to find a description / explanation of your “Dive Bomb” technique. Would you please provide a link?

      Thanks for sharing your knowledge and wisdom. 

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  • Posted

    I have been self cathing 4 times per day for the past year due to an enlarged bladder and enlarged prostate.  My first two attempts resulted in bleeding like you experienced.  However, I then started using a red latex rubber catheter, and after that I was able to self cath without problem.  Since that time, I have improved my insertion technique, and I have experimented with other catheters and lubricants.

    Coloplast makes a plastic catheter that is nearly as flexible as a red rubber one.  Take note that they make two models that look identical, but one is much more flexible.  There is a difference in lubricants, and some work better for me than others.  They key again is to try different brands.

    Someone recommended a FR14 red rubber catheter.  Our plumbing is all different, but for me a FR14 rubber catheter is too flexible.  I usually use a FR18 red rubber catheter and a FR16 plastic catheter.  Best suggestion is to consult with your doctor.  Also, the tip design can affect insertion.  I use a straight tipped catheter.  However, many people find a coude tip is easier to insert.

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    • Posted

      pluff mudd

      I have the same issue as you with an enlarged bladder (was retaining up to 4 liters) and an enlarged prostate.  I was wondering if you tried any of the procedures to clear the prostate tissue from your urethra (TURP, Greenlight Laser, Urolift, etc.)  Also, have you measured your "output" with each voiding to more completely understand your bladder capacity and when the urge to pee returns?  I am only self cath'ing 2 to 3 times a day right now and voiding 400 to 600 ml.  I have NO urge or very little urge to pee between voids and if I do, its less than 50 ml. So I'm a little worried that my bladder muscles and reflexes will ever start to work again.  I am scheduled for surgery Aug. 2 and I'm deciding between the TURP and Greenlight Laser.  My Uro prefers the GreenLight Laser so I'm inclined to go with that. My hope is that, once my urethra is opened back up, my bladder will empty more completely with a normal urge frequency. But based on what's happening now, that seems like a stretch (no pun intended).  Any thoughts are appreciated.

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    • Posted

      Unless there is a specific reason based on your physiology, there is no reason to go under for you first prostate procedure. There is another thread about a man who ended up unable to speak, read or write with a paralyzed right hand due to anesthesia. I have a friend who ended up in a similar condition for the same reason. Yes, those events are rare, but why subject yourself to the possibility when there are other procedures that work as well in the vast majority of cases with shorter, less messy recovery times and almost no risk of any permanent problem?

      Look into Rezum, or if you don't have an enlarged median lobe, check out urolift. You can always do Greenlight if they don't work, but the chances are excellent that they will.

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    • Posted

      Hi Tipin, I would suggest trying to keep your voids under 400ml in order to give your bladder the best chance of decompressing and rehabbing. Six times a day is pretty standard with no or little natural voids but maybe try 4 or 5 first.

      Jim

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    • Posted

      4L is a lot to be retaining.  I was retaining about 1.5L before I started cathing.  I didn't realize that I was holding this much in my bladder, but I had been experiencing BPH issues for a number of years prior.  I do measure volume periodically, but I can estimate the volume by the time it takes me to empty my bladder, so I don't do it every time.  Morning is when I usually have the largest volume, since that is the longest period I go between cathing.  On some occasions, I have voided around 800ml, but other times it is between 250 - 600ml, depending on how much liquid I have had.

      I have not had any surgical procedures, but I was on Flowmax for a year or so before I started cathing and about 6 months afterward.  I also took finasteride for about a year.  I started taking it shortly before I started cathing, but the doctor said I could drop it a few weeks ago.  At that visit, he mentioned surgery options.  However, he said that there was no guarantee that I would not have some leakage afterward.  I don't leak now, so I said that I would stick with the catheters for now.

      Like you, I am hoping that my bladder shrinks down to a normal size and that I start voiding naturally again.  There are some folks on the forum who have experienced this.  I do sometimes feel the urge to urinate, particularly in the morning, but when I try, nothing comes out.  I have not had a natural void of any measure since I started cathing.  I have also not experienced any UTIs during the time I have been cathing, which is another reason that I am happy to continue the process.

      I assume that you have had a urodynamics study.  Mine indicated low bladder pressure.  Because of this, I am not convinced surgery to open the urethra and bladder neck would provide any improvement.  I also wonder if my bladder will shrink up and regain normal function, but I am willing to keep self cathing for a longer period of time before I consider surgery.  In addition, I would probably seek a second opinion before undergoing surgery.

      I pee on a regular schedule, with no sudden urges or leakage, and I haven't had any issues with catheter use when traveling.  Right now, I am a happy cather.

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    • Posted

      Hi, pluff mud,

      I heartily endorse your comments and all the ones made by the others posting to this thread. The three variables I experimented with were the catheter proper, its size, and the lubricant (water-based gel, and hydrophilic). Originally I thought all gels and hydrophiics were roughly the same. How very wrong I was! I went through a number of iterations before settling on my present combination.

      To give you an idea of how successful this has all been, on occasion I have to go back and check my used catheter box to make quite sure that I had cathed myself because I felt no sensation that was telling me that I had.

      So, from another happy cather, thanks. alan86734.

       

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    • Posted

      Pluff Mud,  My Urologist told me that one of the reasons you have more urine in the morning is because your kidneys process more while lying flat in bed.  He said that during the day liquids pool down in your legs due to gravity.  I definitely measure more urine in the mornings, but also go longer between caths.

      Thomas

       

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    • Posted

      Our situations seem very similar. I've been cath'ing for over a month now and I'm comfortable with generally although I cancelled a family vacation when I started because I just didn't want to deal with it traveling. But my conclusion is this.  I know my urethra is 95%+ clogged with prostate tissue. Like you, if I pee at all between cath's, its a very small amount.  Then I'll cath out 500 to 600 ml at a minimum twice or 3 times a day.  I just don't want to do this forever and I've decided to take my chances with a doctor with proven skills and very good references to do the Green Light Laser vaporization of the prostate tissue. From my research, it looks like the outcomes from this have been better than TURPS and the risks are less. I still have to go under a general antithesis but I've done that 4 or 5 times with no issues. I'm schedule for Thursday pending a good MRI tomorrow.  My PSA jumped from 0.5 and 0.7 in my last two annual physicals to 5.25 two weeks after I started cath'ing. My Uro say its probably a false positive resulting from the cath'ing but we'll see tomorrow.  Then I get my tube cleared and see if my peeing gets back to normal.  If not and I still have to cath, at least I tried what I thought was the best procedure to correct the situation.  I'll let you know how it goes.

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    • Posted

      I opted to have the GreenLight Laser procedures done by Ricardo Gonzalez MD at Houston Metro Urology on July 19.  I was in the hospital for 3 days because I had to have a second procedure due to some continued bleeding after the initial procedure. Having the thick catheter with the bladder wash tube in me for a week was the most uncomfortable aspect of the whole procedure. Two weeks post op  I am urinating on my own with a fairly strong stream on a regular basis.  I am tracking my retainage  by self cathing every other day.  I seem to still be retaining about 500ml.  I'm hoping that goes down but I'm thinking that may be what I normally have in my bladder. I don't know if that's harmful in any way.  Have not had sex with my wife (or anyone else :-) ) So cannot  report on dry jac or not.  erection does not seem to be problem.  Generally happy with my progress to date.  Happy I have had the blockage removed.  Would highly recommend Ricardo Gonzalez for the GreenLight procedure.

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    • Posted

      500ml is a lot of urine to be retaining. It will likely cause UTIs and/or kidney problems later. I would self cath more often, perhaps several times a day, until and if it goes down.

      If it does not go down, either your bladder is badly stretched or you still have some obstructions that were not removed by the GL. Good luck. Hank

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    • Posted

      Like Hank says, 500ml may be too much to retain. How much of a natural void precedes that cath? You should strive for a total bladder volume of 400ml or less. That would include the volume you cath and the volume you naturally void preceding that. If the number is more than 400ml then increase your cath schedule. Sounds like you may have to cath several times a day for the time being in order for your bladder not to stretch out an potentially lose what you have gained by the green light.

      Jim

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    • Posted

      Thanks for input guys.  I will take that into consideration. Remember, I was holding 4000ml.  So I feel pretty good getting to 500ml.  But I hear you and appreciate your comments.  I am thinking about my next move.
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    • Posted

      4000 ml   Yikes!  I was retaining somewhere around 1600 and the ultrasound tech told me my bladder was stretched up to my navel.  The bladder should show on the ultrasound much lower down than that.
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    • Posted

      Tpinhou,

      That's a good point and no doubt your bladder is undergoing a significant degree of decompression and healing even with the 500ml. That said, and again depending on how much you're voiding before that, you will not get the maximum benefit of bladder rehab unless you keep total bladder volumes to 400ml or less. And until you do that I would also have periodic ultrasounds of the kidneys to make sure you do not have hydronephrosis which is urine backing up into the kidneys.

      Jim

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