Urinary retention - looking for help from those with experience in CIC

Men's health
1

I'm not in urinary retention.

I am able to void but my PVR has gone from 89 cc to 389 cc. I was forlorn when I discovered this yesterday.

I saw Dr. James E. Lingeman, the foremost HoLEP surgeon in the US. It seems I don't have the luxury of time anymore.

I'm willing to try CIC, and guys here like jimjames and oldbuzzard have been helpful.

I may get a different urologist. The one I see is a great surgeon and the definite go-to guy if a man has prostate cancer. But with BPH and chronic prostatitis, I am not his typical patient.

Any suggestions on videos to watch for CIC?

I'd like to start with a smaller catheter. Does a 12 gauge sound right?

Are there videos on YouTube that teaches how to self-cath? I don't have a computer other than my work laptop so I can only watch them on my iPhone.

For the experts, can CIC cause the prostate to swell even more?! If so, wouldn't that make matters worse?

Does CIC raise PSA? If so, when do you go for a follow up PSA check?

Any tips on how to relax when doing it the first time?

Do you stand or lie down?

How do you know when you've reached the bladder?

I know I have a lot of questions. I greatly appreciate any help from you men.

Thank you.

Michael

2

Michael, I'm sure you can learn from a video but my doctor had his nurse show me. Embarrassing but effective. I would start with a 14 because the 12 is likely to bend. You can go to a 12 later. Try both straight and coude tip. Get samples. Use the one that works best. Catheters never made my prostate swell or my PSA go up. Just don't ever try to force it in. I started by sitting but standing is actually easier. You'll know it's in when the urine starts coming out. Be sure to hold your finger over the opening or you will have a mess. Good luck,

3

Michael:

1) That sounds like a big increase in PVR. What was the time span between the 89 and 389 readings? Was a second reading taken in case it was a mistake? 2) After you get comfortable with CIC, collect the urine to get an idea of the PVR. So urinate first and then self-cath collecting the urine in a graduated beaker. 3) I've only self-cathed twice. My plan is to do it in emergencies.I have a walk-in shower with a seat and that is where I plan to do any self-cathing that I might have to do. I'll quickly disrobe and CIC. That way if there is any spillage, the mess is easily contained in the shower and goes right down the drain. You might consider a similar plan especially at first. 4) Consider whether you want a rubber catheter that you have to self lube or a sterile already lubricated one. I prefer the latter since it is prelubricated and sterile out of the package.

Best of luck.

4

Michael,

You can learn to CIC and this should be very helpful until you can get in for the Holep - a very effective procedure. Some here do CIC on a regular basis and it's easy for them. It wasn't easy for me, and the last time I tried it before my bipolar TURP in April I was unable to complete the procedure - too painful. Since your retention is so high you have to get the urine out of your bladder either through CIC or some operation, otherwise there could be some permanent bladder issues. This is something that doesn't occur to most when considering a BPH procedure, but the longer you wait the more likely it is that you may have bladder issues.

In the past I was able to complete CIC several times, but I would rather you learn from others who are more experienced here.

Hope all works out, Tom

5

I've been self cathing for 3 and a half years. It's very straight forward. The most important tip is using soft catheters, otherwise you may experience serious bleeding. The stiff ones can save you time, but generally are for more experienced people. The second tip is make sure you have enough lube. Number 3 tip is guiding it in slowly. Watch an animated video on YouTube. That's all. Good luck. Can you PM me the contact info on Dr Lingeman. Holep is the best choice, if you are not concerned with retro ejaculation.

6

Use a straight catheter. It's better for beginners, so you don't have to worry about the orientation, less chance of bleeding. I am still using and prefer straight catheters.

7

There are videos you can find online and on some of the catheter manufacturer's website. However, your medical professionals should be able to instruct you.

As for size, I use 18FR and 16FR size catheters. My uro recommended going with the largest size that I can insert without problem, as the larger lumen size drains the bladder quicker. For me, softer is better. I use latex and soft plastic straight tip catheters. I had some serious bleeding issues my first couple of tries using stiffer plastic coude tip catheters. I strongly suggest that you try different manufacturer's products. They will all provide samples. Some medical supply companies will also provide samples. Also try different lubricants.

I can't say the catheter causes the prostate to swell, but I do find sometimes the urethra is tighter when inserting a catheter. As for relaxing, I read wriggling you toes can help. Just try to relax. I find standing is easier for me. Makes the process feel more natural. I meet some resistance when I reach the prostate and at the bladder neck before the catheter goes into the bladder. Urine starts to flow when you have reached the bladder.

8

Hi, Michael, CIC does raise your PSA I stand doing CIC whatever is most comfortable. Since you are not in retention and have a N.V. why do CIC?You will know when you reach the bladder urine starts to come come.Be sure your DR or nurse shows you how to do this. ASk if you need a coude tip as well. I hope this helps. How old are you Michael frank,

9

Hi. Could you tell me the name of the latex and plastic catheters ,you use? I/m have bleeding problems as well .i have been using cure catheters fr14 hydrophillic catheters ,for almost 3 years. i get a gross hematuria .I also use a coude tip of which i was told to use.Does the flow work as well with the latex catheter? This Cure catheter has a strong flow .I have to find an answer to my problem? THANKS VERY MUCH frank,

10

I'll send you a PM, as I don't know what the rules are on brand name recommendations.

11

I agree with Light1 have your doctor or one of his nurses who specializes in it show you how. They all gave you good advice here, if you can afford it get the pre-lubricated ones - less chance to get a UTI that way and it's all over with in less than a minute, with cheaper non lubricated you have to apply gel, worry about all surfaces being clean, it used to take me about 15 minutes and just made me nervous thinking about UTIs and just taking so long.

I insert standing up, pushing down into the shaft which you hold in left hand facing upwards, hold the catheter with right hand guiding it in slowly downwards, and when you feel the resistance take a deep breath and push it through slowly but firmly, doesn't hurt much and you quickly get used to it.

What do you do for chronic prostatitis and how did they diagnose it? I suspect I might have that.

12

Hi Frank

You say you have bleeding problems. Do you think they're caused from doing CIC?

I've been thinking about switching from speedicath coude tip to the Cure one's you've been using. But if they're making you bleed; maybe not. I'm looking for a good discussion on here about different catheters. Actually, I like the Coloplast speedicaths that I'm using but they're expensive. I'm not paying it out of pocket but my medigap insurance company is and I just want to do my part to keep costs down. Also, there must be a reason why so many of the catheter manufacturers are trying to use different materials other than latex.

13

Keith, I think in Frank's case, he will bleed no matter what catheters he used, now. He most likely started with Coloplast Speedicath and had bleeding first, like most of us here, unfortunately. Bleeding begets bleeding. If you keep on catherizing, especially with high frequency like Frank, bleeding will never go away, because the injury never had a chance to heal. I used Sperdicath for 3 years and suffered frequent bleeding, was ready to go for Holep, 6 months ago. Then I decided to heed someone advice and try Cure. Now I am free of bleeding. I tried out different catheters and found out that many other softer would be as good, not just Cure.

14

Try Cure, you'll see why bleeding with Cure is very unlikely, unless you're really trying. I couldn't. 😀 I am now very bitter at Coloplast. They probably had fakers on this forum, pushing for their catheters, ending up doing to many people serious harm.

15

Good to hear from you Hank.

I'm not down on Coloplast. I like their product. I was using the speedicath 12fr straight tip, but because of raised PSA and I was under the impression that bumping the prostate on the way in can cause a raised PSA; I requested getting a coude tip instead and have been using it for several months.

I found that if I start out with the penis raised almost straight up and then lower it when encountering resistance it will just slide in easily. I think what I would like to do is go back to the straight because the coude IS a little bit scratchy sometimes and I don't think I really need it because the straight works for me. The straight is considerably less expensive to medicare also. My provider always wants to contact my Urologist in order to change from a straight to a coude tip.. they don't mind changing brands as long as I stay with the same kind of tip.

The thought occurred to me that some people may be pushing the speedicath on this forum but I really haven't seen any evidence of this. They are just better, to me, because they are stiffer and I can use a 12 rather than a 14 and still use the dive bomb method in which one can use one hand. So the sleeve that comes with some of these catheters seems useless to me and just get in the way. I should probably just stick with what is working because I don't think my medigap plan will raise my rates too much... I think they are required by medicare to keep these raises to a minimum and are reembursed by the government if they lose money. Don't quote me on that but I think that's the way it works.

16

Last August my PVR was 89 cc.

About 2-2.5 years ago, it was 50 cc.

Today, I went to see my uro's nurse practitioner. I was pretty dehydrated this morning and could barely get enough urine for them to test for bacteria and white cells.

But she measured my PVR on a brand new US machine. It was 4 cc.

I measured my urine output overnight (got up 3x and urinated 900 cc).

Usually, in the morning I will drink about 16 -20 oz of water plus 12 oz of green tea before heading to work. This morning I only had 8 oz of water.

After getting to work, I usually don't pee for 2-4 hours from the time I leave my house. This morning, I decided to pee before walking over to my doctor's office (a 30 minute walk).

I was pretty "tapped out" when I was asked to provide a urine sample.

However, my bladder was practically empty. That at least tells me all the liquids I consumed yesterday passed through me ok and I was not retaining 389 cc in my bladder.

I don't know what to make of all this.

I felt very hurried to have HoLEP because I thought I was facing AUR and a visit to the ER.

I'm going back in 2 weeks to have a repeat PVR test. That time I'll drink more fluids so I'm not so dehydrated and empty.

One night last week, I went to bed at 10 pm and got up at 2 am to pee 500 cc. Then I got up 3.5 hrs later and peed close to 400 cc.Before going to bed, I drank water and had a lot of watermelon. I took melatonin to sleep better. I thought I'd be up 5-6 times that night.

Other nights, I do get up 5 times, and sometimes 6 times, and feel like I cannot empty my bladder. There's no rhyme or reason to any of it.

My niece is an OR nurse. She suggested I avoid a firm catheter if I did CIC because it could lead to bleeding and I would not want to damage the urethra before having an intra-urethral procedure a few weeks later (I'm schedule for HoLEP in 6 weeks).

If my next PVR test is more in line with last summer (89 cc) than last week (389 cc), I probably won't pursue CIC.If I do go with CIC, I probably need to find a urologist who would show me or have his nurse show me.

I will look at the videos.

Very helpful comments here.

Many thanks, Michael

17

Thanks Tom,

I do think Dr Lingeman is very good, and HoLEP in his skilled hands should give me relief. As we know, it's a difficult procedure to master. Dr Lingeman has done about 4000 procedures.

The 389 cc retention scared me. I immediately scheduled HoLEP for that reason.

This morning, I had a PVR re-check at my urologist's office. I urinated 900 cc overnight, getting up 3 times over a course of 7 hours. When I got to work, I urinated a little. I felt pretty dehydrated this morning because I didn't drink much liquid before rushing to work. The nurse got a urine sample from me (I could only pee around 30 cc). She measured my PVR today and it was 4 cc.

I'm having my PVR re-checked in two weeks.

I also have an inguinal hernia. My urologist is an expert in radical prostatectomy and also performs simple open prostatectomy.

My PSA, which was 11 last summer, came down to 5.1 and just bumped to 5.6 but my PHI score now gives me a 33% chance of cancer.

My PSA density is around 0.04. My % free PSA is around 31-32%.

Doc wants to do a repeat biopsy (I have a negative MRI-guided 16 core biopsy from 4 years ago pluse a 4Kscore of only 3%).

The nurse told me that my uro can do the hernia repair at the same time he does the simple prostatectomy. I have a small (grade 2) hernia now. And I have a mesh and plug from a prior hernia on the other side.

So, I am now debating that 2nd biopsy. I don't want to to that because my prostate is so big, over 130 cc.

Adding a hernia into the mix only makes all this more difficult.

I have a friend who had Greenlight (or PVP, I'm not sure which) about 3 years ago. He said once they took out the catheter (following day), he could urinate so forceably that he had to hold back because it was coming out too fast for his still healing urethra to handle.

If HoLEP can give me that kind of a result, I would dance for joy.

Thanks, Michael

18

I agree with you that coude is more scratchy, and more expensive. Coude also cause bleeding more easily if it's stiff. So I now only use straight. But some people prefer coude. I still use dive bomb method with Cure. I just don't usually use the sleeve.

19

Thanks Hank,

My niece is a surgical nurse and a former ER nurse. She told me a firm catheter (coude, I think she said) could lead to bleeding, especially being inexperienced.

She said in the ER, nurses insert Foley's which are more flexible. She recommended I use a softer, more flexible catheter and have a uro or his nurse show me before doing it on my own.

I will send you Dr Lingeman's info.

Yes, he did tell me RE was almost certain.

I'm not so concerned over that. My wife and I are not intimate anyway and it's been that way for a long time. I think we've grown so far apart that we've both just learned to live without physical touch. I'm 61 and am not going to remarry and am never going to father children again, so RE is not a big deal.

The only thing that bothers me about RE is if I develop an infection, I cannot send a semen sample to a lab for a culture to ID the type(s) of bacteria.

I have chronic inflammation too (shows up on my MRIs), and HoLEP removes the adenomas but I don't know if it does anything for the prostatitis.

I don't think Rezum is for me (too much swelling and I don't want to wear a Foley for 2-6 weeks or however long). At 130+ cc, TURP is not an option. Greenlight perhaps, but HoLEP offers long-term advantages. HoLEP produces immediate gains in urine flow, and has that over PAE in the short-term, and from what I've read, better long-term results in terms of Qmax over PAE at 12-24 months.

If I am truly in urinary retention, I can't even try to shrink the prostate with Finasteride down to say 100 cc and then try Rezum as that would take 6-12 months.

I'll PM you shortly, Michael

20

Michael:

1) Urologist assistants don't always know how to use a bladder scanner correctly. I have my own bladder scanner. Last year, when I started having problems, I went to a new urologist and his assistant measured 0 mL 4 times using two different machines (because I didn't believe him). I told the uro what happened and he didn't believe it either. The uro then used the bladder scanner to get 68 mL, which is more in line with what I expected. 2) I suggest you start keeping a daily log of all of your urinations. Try to get an idea of what the average amount urinated per trip is during the daytime. Nighttime will be different as I'm sure you already know. 3) If you would like, I can PM you a link to a cheap device ($10) that you can buy on Amazon to get an idea of your maximum urine flowrate. It's the parameter urologists use to get an idea of the extent of bladder outlet obstruction (BOO); it's not the only parameter but it is a major one. 4) If you're unsure what to do at this time, you might consider taking dutasteride and alfuzosin. I know that many men hate these pills and you do need to be aware of side effects. But they have worked well for me for 1 year now. If they work for you, it might buy you more time to get a handle on your situation and decide what to do. I'm currently working on a plan to reduce dosages and will be visiting my uro in 2 weeks to get his buy-in/verification. The plan includes having quarterly blood tests for sex hormones (esp. DHT). 5) Have you had a 3T MRI? If so what were the results? Do you have an enlarged median lobe? Do you know how large your prostate is?