Catheter issues

[spencoid2]

I live in a remote part of California. My doctors (primary care, urologist, oncologist) are from 1.5 to 4 hours (one way) away. I am having a great deal of difficulty urinating. I have a complicated history but summary is: Brachy, IMRT ADT gleason 0 PSAS low for a few years, now is up to about 75 with about 3 month doubling time. Oncologist is letting me wait to get on ADT agsin.

The current problem is that I have very unpredictable ability to urinate. Have urgency, frequency pain and ??? I had been able to get a catheter in until a few days ago. This made me feel much better about not being able to void because I could use the cath and not have to rush to a decent hospital at least two hours and the better one with an on call urologist 4 hours one way drive.

For two days I have not been able to get the catheter in although when I cant urinate getting the cath almost in does usually allow me to urinate with difficulty.

I was taking naproxin in the hope that reduction of inflammation m ight help but have since discovered that a side effect of naproxin is difficulty urinating. I just saw the PA of my primary care doctor for this and other issues. He said that the reason the naproxin can interfere with urination is because it is a vaso constrictor.

I am planning an experiment tonight I will try to insert a cath and if this is successful that will be great news and I will probably continue to do so daily. Also it is likely that I have a UTI which is sort of under treatment. I have another possible infection and that is being treated by ceflex which might treat the UTI if i have one. Have not gotten the results of urinalysis and culture yet.

If i can not get the cath in i plan to try some amyl nitrite which is a vaso dilator. It would be grat if this helps as all i might need to do is get a prescription if it is still available as a pharmaceutical.

Anyone try this or have ideas? Also possible to try nitro glycerin but certainly with the prescription by a doctor.

[Tall_Allen]

Let us know how it goes.

[spencoid2 in reply to Tall_Allen]

No effect at all. Still can't get the cath in. Hopefully I did have a UTI and that the antibiotics will cure it and then will be able to cath. It is pretty scary being 4 hours from an ER that has an oncall Urologist. At least I do have a bladder scanner and can tell how critical my need to void is before deciding when and how to get to an er.

Any ideas on how to deal with this would be appreciated. I am not ready for a supra pubic cath but might be considering it the next time there is an emergency.

Is it true that a supra pubic cath is basically for life? You can not go back to urethral peeing again?

[Tall_Allen in reply to spencoid2]

Did you try the poppers? It sounded as good a Hail Mary play as any. I don't know whether a diversion can be undone.

[spencoid2 in reply to Tall_Allen]

I tried the poppers and it did not help at all. Still can not get cath in but peeing well enough to not be freaked out yet.

Do I need Rosary beads for the Hail Mary method?

[spencoid2 in reply to spencoid2]

So now I am looking for ways to insert a catheter when I can't and prefer to not drive 8 hours round trip to the closest ER with a urologist oncall. I have looked for wire guiding online and every link is about using an arterial catheter guide wire and piercing the tip of a Foley cath etc etc although there seems to be one company that now supplies a ready made unit. I think it would be difficult to get some of these but I will try to get my urologist to get me some???

My former uro in WA state inserted a catheter at least twice when it was not possible to do it the routine way. What he did I have never seen done anywhere else nor can I find instructions online. He is an old guy, probably my age or older. He was an army doctor so maybe he learned the technique under duress.

He took a rather rattly looking old piece of wire that was probably sterilized but that might not even be necessary. He inserted the wire into the cath from the open end and spent a little time shaping it to the ideal shape. Then he lubed it and slipped it right in as if there were no obstruction., pulled the wire out and success!!!

I want to try this myself and probably want to do so before it is an emergency so I have the technique down when needed.

Has anyone ever seen this done? What kind of wire? I think it needs to be fairly soft but not so soft that it just bunches up as does the catheter. Copper wire, maybe 14 or 12 gauge? Bailing wire? Of maybe just a piece of plastic welding rod that would give enough stiffness to prevent cath bunching?

[ctarleton in reply to spencoid2]

These links might give you some more ideas toward getting a better solution, closer to home.

Insertion angles, relaxation techniques, etc.

pdfs.semanticscholar.org/b6...

Some guidewire info and photos.

ncbi.nlm.nih.gov/pmc/articl...

[spencoid2 in reply to ctarleton]

thanks, some useful hints in that pdf. i printed it out and am considering sending the link to the butcher ER doctor how inflated a foley bulb in my prostate. there is nothing about the internal guide wire of the type my old army uro used. i have some ideas that i will try tonight.

[spencoid2 in reply to spencoid2]

i finally found the information on a technique similar to what my former urologist used. i tried it with a 14 gauge copper wire and think it worked pretty well but am going to buy some of the stainless steel Amplatz wire referenced in the article or maybe in one of the articles referenced this one. it is amazing how difficult it was to find this. it seems like an easy solution with many advantages to other guide wire techniques but seems to not be popular? i will ask the old Uro when i see him in October

urotoday.com/volume-6-2013/...