Self-cathing (CIC) techniques for very large prostates

Hi Jim - that was 90 second info that Alan discovered earlier and I think it referred to air-time exposure so once the catheter is inside the urethra maybe it doesn't count.

But when I first started using the Speedicath hydrophilics I would do as you say (and still do) shake it up inside first before opening. But then half the catheter was still exposed to the air as I stood and waited for the coude tip to pass through the external sphincter. Once that happened it would atke another minute to drain the bladder. Back then I almost always had sticking when I would then slowly withdraw the catheter. It lead to a series of really bad urethral irritations and bleeding and one UTI.

My continence nurse back then said I was tearing the mucous membrane from the urethral lining and exposing the underlying tissue to bacteria which caused the inflammation.

So that was when I started adding lube down the sleeve which coated the catheter nicely as it mixed with the saline solution. After that I rarely had sticking and no problems.

So fast forward to last week when I cathed at 1 am ok and then awoke an hour later in severe burning pain. I did note when I did the catheter I did not coat it fully and there was sticking on removal after a few minutes. then Alan86734 found in his research that the hydrophilics are not to be exposed to air for over 90 seconds or they become sticky.

I have ordered some non-hydrophilic 14 coude samples from coloplast but in the meantime cannot seem to shake this inflammation in the urethra from the incident last week. The C&S was negative but I cannot seem to get the inflammation down.

Usually I NV a good 200ml and then cath 200 to 300ml. But for several days now I cannot NV at all which is really freaking me out. Thankfully I CIC ok 5 times a day about 300 to 400ml using a lot of lube so no sticking. But the inflammation is so bad that I still feel I have full bladder even after the cath. I really panic at the thought of not being able to CIC in this condition as you can imagine.

Thanks as always and your advice is much hoped for. So do you disagree with Alan's finding about the 90 sec rule? I did seem to confirm it when I first started CIC 2 years ago w/o lube. Howard

I would like to know Alan's source for the "90 second rule" although in the end it's whatever works better for you be it hydrophilic or external lube. It is hard to tell from his post if he's talking about "air time" or just total time. In my case, I only have a few seconds of air time. The rest of the time I'm all the way in with very little room between the plastic funnel and urethral opening.

I wouldn't worry too much about no NV's for a few days. You're inflamed and when it calms down you will go right back to where you were before. Right now I only cath a few times a week, but when I had a UTI I was cathing 6x/day with almost no NVs. I realize you don't have a UTI but I think the priniciple is the same in that when you're irritated and inflamed NVs can be more difficult. Thankfully we have the catheters and I don't think you'll have a problem as long a you lube them up a lot.

That said, if your pain persists, you might try a different catheter material like a red rubber which is very soft. Or possibly the new Coloplast Flex coude. I'd also test again for a UTI and also pick your urologist's brain. He may want to look inside.  Last resort would be a temporary suprapubic to give your urethra a complete rest.

Jim

Jim

Hi, Jim, my source(s) are manufacturers literature (leaflets, directions for use) but I should have been more explicit that I was treating this as "Worse Case Scenario)". In my own case I've had a few "stickers" which occurred anywhere in the 2 to 4 minute window. Some of these resulted in mild hematuria.

But surely it must depend, in part at least, on the state of your urethra?

But your role Jim is to question, question, then question yet again. And this is why we trust you; it is the very basis of quality control!

All the best, anan86734.

 

This issue has been brought up before so I'm not questioning your account, just curious of the source for further research. Speaking of research, it appears its the saline osmolality (concentration) of the hydrophillic coating that determines how well it retains it's water and therefore slipperiness. I haven't had any issues with Coloplast's Speedicath, however Lofric claims its precise saline osmolality  allows it to retain its coating longer so you might want to give their Origa a try. I tried the Origa years ago and can't remember how slippery it was but had an issue with the Coude tip.

Jim

Dear Jim,

The true value of question, debate, argue, dispute, confront, challenge, or whatever you want to call it, is that by repeating coverage we identify and weed out the discrepancies and thus sharpen understanding. I think this is particularly necessary when dealing with the complex issues at hand. So please, Jim, carry on doing what your doing, the way your doing it. The alternative is silence, and how the heck do we benefit from that.?

Unfortunately I got clobbered by the Fluoroquinolone Toxicity Syndrome (yes, it is one of Patient's segments) and I would not wish this upon my worst enemies!

So Jim, we are moving forwards, not as fast as some would like, but my time-honored response to impatient  client's, in  those happier days when I had them, was, "How long is a piece of string?"

Warm regards, alan86734.

 

Thanks Jim. I have a bottle of Toradol for severe pain. It is a strong NSAID. I took a pill last and during the night and then this morning. I am trying to go one day at least w/o CIC to give it a rest. So far it is working. My NVs are back up to 100ml every hour and the swelling seems to be going down. So I will continue this for another day even though it makes it difficult to work from drowsiness.

I did CIC this morning at 3 am. It went well. I really coated the catheter with gel just before use and had a good CIC (450ml).

I spoke with my Coloplast rep this morning and she says she never heard of the "90 sec" but then added that the coating will get sticky after "handling". I told her I never touch the catheter just the green funnel and she was impressed as she said most men have to handle the coated part which then gets sticky. I told her about the famous jimjames dive bomb technique but I don't she got it.

I fired my uro again as he wouldn't see me again unless I agree to a simple prostatectomy!! I have a new one set up for 6 weeks for a reviews that they say is young and open-minded - we'll see. Thanks Howard

Hi Allan - You did not fail - in fact you succeeded very nicely. Since your initial post I have taken extra steps to peel down the sleeve 2/3 of the way now instead of 1/3 and also to squeeze in the gel just before use rather than giving it a minute to slide and coat the catheter and then I make sure on pulling it out of the sleeve slowly to rotate it and make sure the catheter is well coated. So your information was very important and has already helped me with my CIC.

As to temperature I know the importance of keeping the temp elevated - above 70F for both the gel and catheter to keep it fluid-like and not have the gel form a gooy sticky state at lower temperatures.

Thanks Alan.

Howard