Which Foley Catheter is Best?
Posted , 6 users are following.
I've been doing CIC (self-cath) for 4 years due to my very large prostate (300cc). As I do not have a median lobe, I still have a good NV (200cc) during the day. I do 2 to 4 CIC's over a 24 hour period. I use the Speedicath 14fr Coude Hydrophilic catheter. Over the years I've tried other catheters but this one has always been the best for me. I have never ever had a problem with it, and as jimjames once promised CIC has become easier than flossing my teeth.
But a week ago I seemed to have nicked the prostate and it started to bleed. The bleeding is on the outside of the catheter when I take it out. There is no blood in the urine as I empty it into the toilet from the catheter. But as soon as I get the catheter out there is a lot of blood flow from the penis into the toilet. It is like a nose bleed.
It takes about 10 minutes for the bleeding to stop. Then the next time I have a NV some dried blood comes out first followed by a clear urine stream.
My urologist says I should put a Foley in for a week to give the wound on the prostate time to heal. But I have never used one and find them very scary! I wish to ask this forum for advice on Foleys. Are some types better than other for this problem? I would need a Coude tip to get through my large prostate but are coude tips bad inside the bladder?
And what about bladder spasms? Are there good drugs without side effects or are there easier ways to avoid/deal with spasms.
Are UTIs common with Foleys as well as bladder/kidney infections?
Thanks for your help.
Howard
0 likes, 10 replies
rdemyan Howard31850
Posted
Hi Howard:
I can't really answer your question, but I responded in your earlier post regarding your recent CIC issue.
When you say the natural voids are 200 mL, do you mean each time you void or are you saying this is the total for a day? If you are voiding 200 mL each time you go, that would typically be a good void for older guys. So, if you are saying each time, then I guess that means you are retaining a very large amount of urine. Would you confirm that for me please. I'm still trying to understand how all of these things interact.
Howard31850 rdemyan
Posted
Hi rdemyan,
Thanks. Before I ran into this problem I would have good natural voids throughout the day that ranged from maybe 150 cc to 250 cc each time I would pee. I would only measure them just before I did a CIC to see how full I was.
I would usually CIC around noon and then again at 6 pm and then again around 11pm before bed. The results were pretty consistent over the years. My NV was almost always equal to my catheter volume: e.g. 200/200; 250/250; 300/300.
But in the middle of the night I always awoke in great discomfort in full retention. Then my CIC volume ranged from 600 to 900 cc!! Yet amazingly first thing in the morning my NVs were right back at 150 to 300cc.
So now I am in a pickle. I cannot do CIC during the day to give the wound site a chance to heal. So I am living like I did in the years before CIC. I find I have to pee every hour about 100 cc but I know I am carrying a residual of 300 cc in my bladder which is very uncomfortable. This is ok if it is temporary for a week but after that my bladder muscle will start to weaken. I've been very happy to see it regain its strength over the years with CIC as jimjames had promised.
But at night now I HAVE to CIC as I awake in full retention. So far I still get a lot of bleeding after I withdraw the catheter even though I did not CIC for 24 hours. The fresh blood drips from the penis head like a nosebleed. After 10 minutes of pressure it stops. My pee is always ok with no blood.
Sorry for the long story here. Any thoughts. Thanks. Howard
Howard31850 rdemyan
Posted
I should also add that I am afraid to make things worse with a foley so I wonder if the bleeding would stop eventually.
Do you recall a discussion about 2 months ago that said that Speedicaths could cause bleeding even with coude tips because they were rigid? I remember writing in that I had done over 4000 CICs with them with no problem. I guess I bragged too much.
But someone wrote there was another brand that was able to navigate through large prostates with no bleeding and did not require the coude tip to be oriented a certain way as the Speedicaths do. Do you remember what that brand was? Maybe I could try it now instead of a foley to see if at night it reduces the bleeding. Thanks.
rdemyan Howard31850
Posted
Hi Howard:
Sorry, I don't remember which brand that was.
I agree with Jim below. I think if I were you I would try the Foley approach and I might leave it in for 10 days for extra healing. Your concern is when it is removed. If I were you I would remove it myself and not let someone else do it. That way you can go ultra, ultra slow to hopefully minimize a chance of reopening. Still after 7 to 10 days it seems reasonable that the wound would be more healed than if you continue to CIC. But as I understand it, Foley catheters are bigger in diameter. Maybe talk to your uro about using the smallest size possible.
A course of antibiotics might not be a bad idea to take while wearing the Foley. I would also take D-Mannose to make it harder for the bacteria to stick to linings. Also, do you have urine dipsticks? If not, you can get some from eBay. The Siemens Multistix 10 SG professional cost about $24 USD for 100. I have these as well as Chemstrip (which are more like $75). I check my urine on a regular basis and if I notice anything odd going on with my urination, I test more often. The idea is to get out ahead of any UTI by starting antibiotics ASAP after a positive test rather than wait several more days before seeing the uro. To that end, my uro provides me with a supply of antibiotics for travel, but also emergencies (I would start taking these if I have confirming postive tests and then schedule to see the uro ASAP). Not everyone might agree with this approach, but I had a really nasty UTI about 18 months ago and after that experience, these steps seem prudent to me.
These are just some thoughts and I am not a doctor or anyone with actual direct experience with regards to Foleys.
Let us know how you are doing and best of luck!
Howard31850 rdemyan
Posted
Thanks very much for your response. I was looking at Byram Healthcare where I get my catheters and they sell a Foley Coude 14fr plus accessories which is the same size I use.
I do take D-Mannose daily for many years and I think it helps keep my UTIs down to one/year. I take Amoxicillin which works best for me and like you I keep a course handy.
I also have a 10-parameter test strip that jimjames recommended a few years ago and I use it as you do.
I try to fill a champagne glass with my NV to test as the strips are so long. Do you test the catheter pee?
Thanks again. I always worried what would happen if I could not CIC for some reason but never thought it would be because of a prostate bleed. Gee whiz.
kenneth_42676 Howard31850
Posted
all depends on the size of the foley .....
jimjames Howard31850
Edited
Hi Howard,
First, I know little to nothing about Foley's, and never had one. With that out of the way, it sounds like a reasonable solution to your problem, and if you trust the urologist, I'd just go with his recommendation. Foley's do have a higher incidence of UTI's than CIC, but hopefully you won't get one since it's only a week. That said, you might ask the doc about taking prophylactic antibiotics to make double sure. Macrobid has always worked for me.
Foley's always gave me the creeps, but now that I've been doing CIC for years on a regular basis, I don't think I would mind a Foley at all, especially if only a week. Look at the upside -- no getting up at night at all to void! Let us know how it goes and don't sweat it. Glad to hear the CIC has been going so well.
Jim
Howard31850 jimjames
Posted
Hi Jim,
Great to hear from you - I hope you are doing well.
I wish to ask you this question:
I have done over 5000 CICs now using my Speedicath 14fr coude hydrophilic catheters without any problems. Somehow a week ago I must nicked the prostate and it bleeds everytime I CIC. There is no blood in the urine or while my bladder is emptying.
The bleeding starts as I am withdrawing the catheter. The blood is on the outside of the catheter - not inside.
But after the catheter is out the blood keeps dripping into the toilet until I put some pressure on the meatus for several minutes. It is like a nosebleed.
Have you had this problem in all your years of CIC??
I recall when I was learning CIC that you cautioned against the use of a straight tip for a very large prostate like mine because it could poke a hole in the prostate and cause a bad results. I don't think I did this but I wonder how you have treated prostate bleeds in the past like mine? Do I really need a Foley or will it heal in time?
When I first started CIC 4 years ago I had bleeding but that went away after a few months just like you said.
Thanks again and ll the best.
Howard
HowieF Howard31850
Posted
I've mentioned this on the other thread. If you go to the Emergency Room (ER) and tell them that you have to pee urgently but you can't, they will most likely install a Foley catheter. Last time I tried to post a link, my post got deleted so I won't buy, if you search for Foley Catheters and pick the Wiki one, it gives a good explanation. The catheters are made of rubber/latex. No metal or plastic. They come in different sizes, just like the ones you use for CIC but I'd hesitate to compare the same size Foley to a CIC catheter. The ones I had inserted in me had a rounded but slightly pointed tip. I never needed a coude catheter, and didn't even know they made different tips in Foleys until someone on the thread mentioned it. Picture a catheter that wiggles like a worm. Most Foleys are two-channel. One "channel" or Inner tube is the channel that carries the urine out and into a bag. On the side of the catheter just off the tip are holes for the urine. The other channel is for the balloon. Since this catheter can stay in you for a long time, it is kept in your bladder by an inflated "water balloon" of sorts. So, just in from the tip at the bladder end, you have the urine holes, then there is a strangely softer section of rubber which is actually the balloon. The balloon is inflated by it connecting through the second channel to another tube in your groin area with a weird valve on the end. Sort of like a flying saucer with a little smoke stack on the top. They use a 10 ml syringe with a screw interface on the tip filled with sterile water or saline). It fill fill up most of the smaller catheter balloons. On the larger ones, the balloon holds 30 ml so the nurse or urologist will use three syringes of fluid to fill the balloon. Also, many of the large Foley catheters are three-channel. The third channel usually has a conical "cork" or, should I say, stopper, in it outside the body in the groin area. I used to use this for irrigation at home but several staff said that this is only for use in a hospital bed where they are running continuous irrigation via a pump. For home irrigation, you get a kit and then disconnect the tubing and use a syringe/pump to squirt sterile water directly into your bladder going the opposite direction to which way the urine comes out. There are Youtube videos on this procedure. But you will need to ask if you have to do irrigation and exactly how they want YOU to do it, if so. AT Kaiser, they said their rule is that no catheter stays in a patient for more than a month.
As for spasms, I found that all of my urgent races to the bathroom seemed to have been bladder spasms. I still get them though not as bad now, post-TURP. I hated them because, if my bladder was empty, my bladder still wanted to urinate. Just in case, I'd head into the toilet and pound the wall. If there was urine in the bladder, it can come out by spraying OUTSIDE of the catheter along the tubing in an uncontrolled manner. I did a lot of laundry those three months. And mopping. Bleeding is something you can not only tell by the urine color in the bag, but you may also see "threads" which are clots. Clots can mean you will need to run an irrigation procedure if the flow stops.
As for bags, what I initially received were two. A leg bag is great for the day as you can go out and have a life but not good for at night. You need to keep any bag at least 8 inches below the height of the catheter. Something to do with the siphon effect, I guess and to prevent back flow. So, at night, they gave me the 2 liter night bags. Every nurse gave me different directions so I did what worked for me which was to hop in the empty tub and disconnect the leg bag at the join with the tubing and connect the night bag tubing to that connection so you have a nice long tube to leave the bag on the floor next to the bed. (Note: If you have a cat, not a great idea as you wake up with the animal sleeping on top of the bag). In the morning, you empty the bag and then hop into the tub to reverse the hookup and then use the straps to connect the leg bag to your ankle/shin.
As for CTIs: yes, I had tested positive for infections even before the catheter experience started. I personally think it's important, if you are going to be on a Foley for any length of time that you get the urologist or nurse to run a urine test and a urine culture as many times as possible. If they come back positive ASK what the name of the bacteria was and look it up. Mine had a side-effect of "death" so I wasn't even objecting to taking CIPRO (yes, I know about the negative reviews but I never had an issue. But "being floxed" vs dead....). Especially if urine gets passed over the outside of the catheter (between the catheter and the urethra), UTIs can be common according to my Urologist.
Hope something in here helps.
Howard31850
Posted
Here's a quick update and a strange observation.
I have a visiting continence nurse scheduled for tomorrow (Thursday) to come by and show me how to do a Foley. I had to go through my family doctor to get this very fast home visit as I received almost no response from urologist - typical!
She should provide me with the materials as they are difficult to come by - especially the coude foley 14fr. But i will insist on inserting it myself.
Now here is something strange. I stopped all my BPH meds (Avodart/uroxatral) plus all my supplements and vitamins 3 days ago. The reason is I worried maybe some of these act like anti-coagulants and have been making my prostate bleeding worse.
For the past 3 days my natural voids have actually increased dramatically, from 50cc to 250 cc with really good flow rates! I find I can go all day w/o the need the CIC at all. There is no bleeding at all with the NVs or any discomfort.
BUT at night the whole situation changes. I go to bed at 11pm w/o a need to CIC. But an hour later I am awakened with severe pressure pain and run to CIC. The pee is great, no blood at all. The volume is 500 to 600 cc. But then when I slowly withdraw the catheter the bleeding starts around the outside of the catheter and gets worse as I pull it out more. Then blood drips every 5 sec from the penis into the toilet like a nose bleed for 10 minutes and then stops on its own.
I go back to sleep and awaken again at 5 am with the same scenario which repeats exactly. At that point I stay up and read till my wife gets up at 7 am.
From that point on through the rest of the day I don't even know I have BPH. My first full pee around 8 am is a strong NV with some blood initially to clear out what is in the urethra from the night. Then all is great for 15 hours.
I don't get it at all. It's like living 2 different lives. I just hope the Foley doesn't make new problems for me. I will show the continence nurse the bleeding when she comes by. take care all. Howard