Microcyn/Hydrocleanse/Vetericyn usage & general UTI questions

[faji_tama]

How I've managed to miss all these Microcyn posts over the years, including that BIG thread, I know not, but I just caught wind of it today, and had some questions since there are a ton of posts and the information is all pretty scattered.

So, some general SCI urinary questions first:

• When folks here say they've experienced UTI, they're specifically referring to symptomatic UTI, right?
• Those who catheterize are oftentimes colonized and asymptomatic: what are the risks, if any, of staying colonized? Is this still a bladder irritant?
• Are cloudy urine and sediment in urine caused by different things? I always assumed the latter was when the former progressed too much.
• How do SCI folks who cath know when they should be tested for stones, especially for those who feel no pain?

Some background of my situation: I intermittent clean cath, and will usually use a paper towel that I've moistened with sink water to wipe the meatus and glans. I'll hold the end of my catheter, dunk the tip into a bottle of KY, and then insert: my fingers never touch any part of the catheter that gets inserted, so the only possible bacteria points are the KY bottle, the paper or water, or anything that was already in/on my penis.

I will occasionally get a bout of asymptomatic cloudy urine or urine with sediment every couple months, that would historically clear up within 3-5 days with increased water intake. I've been given antibiotics a few times, but was really only symptomatic once that I can recall in the past decade or so. However, I've now had cloudy urine for the past three months that hasn't cleared up at all (but the cloudiness varies), with sediment once every two weeks or so: would this mean a biofilm has formed and taken hold? No symptoms, so I haven't gotten tested since the advice here seems to be to not test or treat if you're not experiencing any issues - should I get tested though, given that this is pretty different from my past?

The Microcyn etc specific questions:

• People seem to use this for a variety of things, some as a urethral flush, most as an retain and cleanse of the bladder. Have those who just done the flush found it to be sufficient/effective?
• It seems that people suggest *cyn be used only after UTI has been cleared. What if you're colonized?
• The general procedure for injection into the bladder I've seen seems to be 1) fully void, 2) insert x amount of *cyn into bladder, 3) retain 5-10 minutes or until next cath.
  • Is the catheter that's currently in place the one that's used?
  • Wouldn't this push urine that's in the catheter back into the bladder?
  • And if you void the urine in the catheter first, how do you prevent pushing air from the catheter into your bladder?

[gjnl]

How I've managed to miss all these Microcyn posts over the years, including that BIG thread, I know not, but I just caught wind of it today, and had some questions since there are a ton of posts and the information is all pretty scattered.

So, some general SCI urinary questions first:

• When folks here say they've experienced UTI, they're specifically referring to symptomatic UTI, right? I think generally that is right. The only real way to know if you have a urinary tract infection is to get urinalysis and culture & sensitivity urine test. In this way, you know what bacteria is causing the urinary tract infection and which antibiotic is most effective.
• Those who catheterize are oftentimes colonized and asymptomatic: what are the risks, if any, of staying colonized? Is this still a bladder irritant?
• Are cloudy urine and sediment in urine caused by different things? I always assumed the latter was when the former progressed too much.
• How do SCI folks who cath know when they should be tested for stones, especially for those who feel no pain? Blood in the urine and/or frequent and recurring urinary tract infections.

Some background of my situation: I will occasionally get a bout of cloudy urine or urine with sediment every couple months, that would historically clear up within 3-5 days with increased water intake. I've been given antibiotics a few times, but was really only symptomatic once that I can recall in the past decade or so. However, I've now had cloudy urine for the past three months that hasn't cleared up at all (but the cloudiness varies), with sediment once every two weeks or so: would this mean a biofilm has formed and taken hold? No symptoms though, so I haven't gotten tested since the advice here seems to be to not test or treat if you're not experiencing any issues - should I get tested though? My physician suggest getting urinalysis and culture & sensitivity tests every six month, symptomatic or not.

The Microcyn etc specific questions:

• People seem to use this for a variety of things, some as a urethral flush, most as an retain and cleanse of the bladder. Have those who just done the flush found it to be sufficient/effective? I'm not sure I understand your question.
• It seems that people suggest *cyn be used only after UTI has been cleared. What if you're colonized? If you read the the early posts in the "BIG" thread, you will find that "Leila" recounts that her husband has been able to cure a urinary tract infection using (at the time) Vetericyn or Vetericyn VF. He instilled 60cc every 2-3 hours round the clock until he was no longer symptomatic and urine was clear. If I recall correctly, this took a couple of days. Personally, when I have gotten a urinary tract infection, I have instille and retained (for 5 minutes or so) the product while taking antibiotics. Generally speaking all indwelling urethral and supra pubic catheter users are colonized. I have been using Vetericyn, Vetericyn VF, and mostly have very clear urine. Am I still colonized, I don't know. But, my urine is clear and does not have an odor.
• The general procedure for injection (instill, not injection) into the bladder I've seen seems to be 1) fully void 2) insert (instill) x amount of *cyn into bladder, 3) retain 5-10 minutes or until next cath. How long one retains the product depends upon what one has determined beneficial and tolerable.
  • Is the catheter that's currently in place the one that's used? Intermittent catheter users should cath as usual, before instilling the product into the bladder through the catheter used to empty the bladder. Supra pubic and indwelling urethral catheter users instill through the catheters that are in place.
  • Wouldn't this push urine that's in the catheter back into the bladder? It may, but that would be a very small amount that becomes mixed with the product.
  • And if you void the urine in the catheter first, how do you prevent pushing air from the catheter into your bladder? Again, it may, but it would be a very small amount.
    
  
  
  

Hope this helps.

All the best,
GJ

[faji_tama]

• When folks here say they've experienced UTI, they're specifically referring to symptomatic UTI, right? I think generally that is right. The only real way to know if you have a urinary tract infection is to get urinalysis and culture & sensitivity urine test. In this way, you know what bacteria is causing the urinary tract infection and which antibiotic is most effective.

But again here, when you say "to know if you have a UTI": if the UA and C&S come back positive, but you're still asymptomatic, does that qualify as having one? This is where much of my confusion comes from, because it seems most people talk about UTI here in the context of needing fairly intense treatment.

• People seem to use this for a variety of things, some as a urethral flush, most as an retain and cleanse of the bladder. Have those who just done the flush found it to be sufficient/effective? I'm not sure I understand your question.

So, it seems like some people use it more as an antiseptic, where they'll spray onto the glans, and then instill some up into the urethra, but not all the way into the bladder. Others do the post-cath instillation into the bladder. I'm curious how effective the former is, without the bladder instillation?

• Wouldn't this push urine that's in the catheter back into the bladder? It may, but that would be a very small amount that becomes mixed with the product.

• And if you void the urine in the catheter first, how do you prevent pushing air from the catheter into your bladder? Again, it may, but it would be a very small amount.

Assuming I did my math right, a fully filled 16" 12 French catheter is about 5cc of liquid? So 5cc of urine or air is fairly insignificant here?


Thanks GJ!

[gjnl]

But again here, when you say "to know if you have a UTI": if the UA and C&S come back positive, but you're still asymptomatic, does that qualify as having one? This is where much of my confusion comes from, because it seems most people talk about UTI here in the context of needing fairly intense treatment. I think it would be very rare to test positive for a urinary tract infection (urinalysis (UA) and culture & sensitivity (C&S) and be asymptomatic.)



So, it seems like some people use it more as an antiseptic, where they'll spray onto the glans, and then instill some up into the urethra, but not all the way into the bladder. Others do the post-cath instillation into the bladder. I'm curious how effective the former is, without the bladder instillation? Actually, Oculus Innovative Sciences describes Microcyn/HydroCleanse as an antiseptic vs. an antibiotic.



Assuming I did my math right, a fully filled 16" 12 French catheter is about 5cc of liquid? So 5cc of urine or air is fairly insignificant here? I cant speak to anything other than my own experience over 6 years. Urine/Air inside the catheter has not caused me any problems when instilling the product.


Thanks GJ!

All the best,
GJ

[faji_tama]

I think it would be very rare to test positive for a urinary tract infection (urinalysis (UA) and culture & sensitivity (C&S) and be asymptomatic.)

Oh, maybe I've misunderstood this entire time: I thought that even if you were only colonized, a UA and C&S would still show positive. Is that not the case?

Actually, Oculus Innovative Sciences describes Microcyn/HydroCleanse as an antiseptic vs. an antibiotic.

Right, that's how I understood it too, which is why I'm wondering if using it up to, but not into, the bladder itself is effective at all.

[gjnl]

Oh, maybe I've misunderstood this entire time: I thought that even if you were only colonized, a UA and C&S would still show positive. Is that not the case? The UA and C&S may show positive for bacteria when colonized, but the bacteria count may not come up to the level that would indicated urinary tract infection that needs treatment.

Right, that's how I understood it too, which is why I'm wondering if using it up to, but not into, the bladder itself is effective at all. There are some people who have posted here that they only use the product as a urethral rinse before cathing and claim (intermittent catheter users) they have good results. I don't have any personal experience with that usage.

All the best,
GJ

[annev308]

FWIW, I am colonized (indwelling foley for the last 8 months) with a bunch of (mostly MDR) stuff (pseudomonas, providencia) and although asymptomatic, I routinely had bacterial loads way above the 100k treatment threshold after UA and C&S. Because I'm asymptomatic, I don't get treated. Which is fine with me - I got wicked debilitated and weak after relocating and having a doctor and urologist unfamiliar with SCI try to eradicate all that stuff while leaving the foley in. 6 months of IV antibiotic treatment resulting in an unchanged bacterial load and a massive decline in quality of life and independence later, no thanks.

I flush my my bladder with sterile and saline water every week or so, and that alone has brought the bacteria load way down (the highest it's been on culture is 5k mixed types) - and the sample for testing is drawn right before flushing.

[faji_tama]

although asymptomatic, I routinely had bacterial loads way above the 100k treatment threshold after UA and C&S. Because I'm asymptomatic, I don't get treated

I appreciate the feedback! I've definitely heard mixed opinions about this stuff: some sources have said to treat above a certain amount, and others say to never bother unless you have symptoms, so I can never quite decide what to do. After a post a while back where I learned about the link between increased bladder cancer risk for those of us who cath and how it's partly due to bladder irritation, I can't help but wonder if being colonized, even without symptoms, is a health risk.

[annev308]

So my understanding (which may be entirely wrong!) was that the increased risk of bladder cancer wasn't linked to intermittent catheterizarion, it was linked to the balloon from indweelong foley rubbing in the same place for prolonged periods of time. Like, years. Hopefully one of the SCI nurses will check in and be able to clear that up.

I also wonder about about the risks associated with being colonized - but I know all too well the misery and lost ground from aggressively treating asymptomatic (and in my case MDR) UTIs, and especially since plain old saline flushing has made such a huge difference in the extent of being colonized (for me), unless someone turns up with data on that, I'm inclined to keep going as I am. It's working really well, and I'm gaining ground I had lost, both in terms of strength and attitude (6 months inpatient on IV ABs was not at all good for me. It was frightful.).

[faji_tama]

So my understanding (which may be entirely wrong!) was that the increased risk of bladder cancer... was linked to the balloon from indweelong foley rubbing in the same place for prolonged periods of time...

I know all too well the misery and lost ground from aggressively treating asymptomatic (and in my case MDR) UTIs

I remember reading that indwelling was much higher risk than IC, but the general mechanism was one of bladder irritation, be it from the catheter itself, or the bacteria. But, I could also be wrong on this, so if anyone else can chime in!

And agreed! I'm not suggesting antibiotics to deal with asymptomatic colonization at all, but I'm wondering if it's worth doing either what you do with the saline rinse, or what others here do with the Microcyn rinses, or if there's any risk in just letting things be.