Hi Chip,
First, thank you very much for the information on EP Turp. It's a procedure I had never heard of nor ever mentioned by my urologist, Fortunately, my self-catherization program (CIC) is going so well, I have the luxury of waiting, an in fact unless I have a regression sympton-wise, I may have achieved similar goals to surgery already.
For example, my International Sympton Prostate Score (I-PSS) went from 33 (severe) to 9 (mild/moderate) after 2 years of CIC. If you want to know more about the I-PSS scoring, search for my thread entitled
"What Is Your International Prostate Sympton Score?" In fact, I'll bump it up for you later but afraid to provide a link because every time I put a link in a post, it goes to "moderation" and doesn't appear until the next day or so. I also have another thread you should search for (I'll bump it up later as well so you can find it easier) entitled "Self Catherization. An alternative to Turp, Greenlight, HoLEP...?". It was from 7 months ago and covers a lot.
As to your questions and a general overview -- Yes, I have a favorite catheter after over a dozen of the more popular ones here in the States. I tried everything from red rubber, to vinyl, to a 4 or 5 different hydrophylic ones.
The one I like best (and it isn't even close) is Coloplast's Speedicath which is a single-use hydrophiic catheter with the coude tip. Coude Tip is very important if you have an enlarged prostate as it helps prevent any snagging as you pass over the prostate.
The size I started with was 14 French (14F) which is the typical starting size for most men. Once I got the technique down, I switched to 12F. As a general rule, you want to use the smallest size catheter that you are able to insert because a smaller diameter translates into less micro trauma. That said, I think if I started at 12F I might have been frustrated since it take slightly more skill since the smaller size means it's more flexible and therefore a little harder to handle, but only initially. I also should add that I have developed an in effect sterile "no touch" procedure where I only touch the plastic funnel end of the catheter and never the catheter itself. For this reason, I can actually do CIC quite quickly (without gloves or hand washing even) since the catheter itself is never touched. But again, this involves a little practice and is much easier with the 14F as opposed to the 12F which I use.
Basically I unwrap the speedicath at the top, and the nice thing with speedicath is that it's already coated and ready for immediate use by it's pre-packed fluid, so no need to break any packets.
Then I either wash or spray the head of penis and meatus. I have experimented with several different methods from providone iodine wipes to antispectic sprays.
Now, I gently pull my penis out and up (toward the ceiling) to straighten out the canal and give the catheter a straight shot going down. I do this with my left hand. At the same time I use my leftt thumb and forefinger to open up the canal by gently pulling the head of the penis out thereby exposing the meatus, but being careful to keep a sterile field by not touching the meatus. Then, with my right hand, I hold the plastic tip of the catheter and basically "dive bomb" (but very slowly) it into the opened ureretha. If I miss and the catheter touches anything but the meatus at the opening of my urethra (maybe one out of 50 times) I throw the catheter away and start over. But if it hits the urethral opening it will stop by itself a mm or so into the canal. Then I gently push the catheter in (again, only holding it by the plastic tip) and as I push it in I change the angle of the penis from straight up to more of a 45 degree (or even less) angle as I navigate through the plumbing and into the bladder. You may find two points of resistance in the process, the second when you push through the bladder neck.
It may sound complicated and time consuming, but the entire process for me, as described, takes less than one minute plus maybe another minute or so for the urine drain. I actually spend less time in the bathroom urinating with the catheter than I did before without the catheter with my on and off dribbling!
But again, the technique as described, is my own personal technique. I believe the stanard instructions have you feed the catheter in by hand which means you should wear gloves and frankly that hydrophillic is very slippery so not sure how easy that would be.
As for as UTI's go, I had problems the first couple of months due I think to system shock. I therefore highly recommend prophalactive antibiotics for anyone starting CIC, but unfortunately the stock answer from the doctors is "they aren't necessary". Ha!
After a while you may develop colonization, which basically means your urine will test positive for bacteria but you will have no symptons. This is normal and OK and you are NOT supposed to to treat this with antibiotics.
The way to actually avoid a real UTI is with careful technique, whether my "no touch" technique, or by the more standard technique of using gloves, or thorough washing, etc. The other way is to carefully monitor your bladder and catheter volume, at least in the beginning.
I've read it expressed two ways. The first is that if you catherize more than 400cc, then you should increase the frequency of CIC to get the catherized volume below 400cc. Or, if you catherize less than 100cc, then you should decrease the frequncy of CIC.
The other method which is more conservative says your bladder shouldn't be holding more than 400cc of urine at any one time. Therefore, assuming you have a natural void just prior to catherization -so let's say your natural void is 150cc, and you then right away do CIC an 300cc comes out.
Now going by the first formula, everything is good and you continue on your current daily frequency since your catherized volume was under 400cc. But going by the more conservative approach, your total bladder volume was 450cc and therefore if you had been catherizing 3X/day you might up it to 4X/day
In the beginning, I started with the less conservative approach and even then was cathing up to 6 times a day. Later, as my bladder started to regain elasticity, I went to the more conservative approach to keep bladder volume down at all time.
Now, my average void is 150-250 cc, and my PVR is usually between 50 and 150. And this is without CIC. So, since my total bladder never holds more than 400cc or urine, I was able to stop CIC completely except for every now and then when I might take in too much fluid, too quickly.
Hope I didn't lose you with the details, but you seemed interested in technique.
And so the important stuff doesn't get lost, I'll again repeat that for someone like yourself CIC has to advantages. First, it can buy you time until a procedure comes along you are 100% comfortable with, as opposed to picking the best of the worst available. And second, if your like me, your bladder may actually rehabilitate itself to the point where you may be able to stop CIC altogether.
Jim
ejaculation.