Survey for a serious problem.

We need information about a serious diving malady. There have been a couple of reports here about P-valve induced UTIs (urinary tract infections), like this one: http://www.cavediver.net/forum/showt...5579-Backed-Up

What we need to know is what bacteria(s) are responsible. There is a doctor in Australia (Dr. Harry Harris) doing research there, but so far, not enough information.

If you have had a P-valve induced UTI, or know someone else that has had one, please contact me (FW), or (DrHarry) via PM. What we need to know is the name of the bacteria, and what antibiotic was prescribed. If you went to a doctor, and had a culture done, they should have a record of the name of the bacteria.

Please don't post the bacteria name here, it might influence the response of other divers, and we need accuracy for this study. If we can identify the most common bacteria, we will do a report and post it here in a few weeks.

So you don't want to know about drippicockus ?


(I'm sorry Forrest, but you can't expect me to pass on such a easy one).

Would you like to know which bacteria is mostly found with UTI's at the hospital. I have several patients that come to the ED for UTI's. They are in no way pee valve users but the information might help.

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Originally Posted by TONY CHANEY

Would you like to know which bacteria is mostly found with UTI's at the hospital. I have several patients that come to the ED for UTI's. They are in no way pee valve users but the information might help.

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We are pretty sure it is a different bacteria, but go ahead and PM me.

It would be interesting to find out if any of these were reused catheters (yes,there are people who do this).

I should mention that the best prevention is rinsing the hose out. DrHarry recomends a mixture of vinegar, and alcohol. The same stuff DAN recomends to prevent ear infections (ear beer).

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Originally Posted by FW

I should mention that the best prevention is rinsing the hose out. DrHarry recomends a mixture of vinegar, and alcohol. The same stuff DAN recomends to prevent ear infections (ear beer).

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I go with a weak bleach solution

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Originally Posted by Kelly Jessop

It would be interesting to find out if any of these were reused catheters (yes,there are people who do this).

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ewww really?

only men or do you also want to hear from women that use the She-P? I have no idea if there is an association between she-p use and UTIs, but I would be very interested to know. Though women are more UTI prone, it would still be valuable to know if there is an associated risk with She-p use and if the bacterial culprits are different from other community-acquired UTIs.

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Originally Posted by LiteHedded

ewww really?

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Cave divers will spends $$$$ on gear,but there are some real cheap people out there.

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Originally Posted by Kelly Jessop

Cave divers will spends $$$$ on gear,but there are some real cheap people out there.

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I skip breathe to keep my breathing gas expenses down. :rollguy

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Originally Posted by LisaN

only men or do you also want to hear from women that use the She-P? I have no idea if there is an association between she-p use and UTIs, but I would be very interested to know. Though women are more UTI prone, it would still be valuable to know if there is an associated risk with She-p use and if the bacterial culprits are different from other community-acquired UTIs.

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There is certanaly a possibility, though not as likely. Keeping the hose clean will work there too.

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Originally Posted by LiteHedded

ewww really?

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Pretty quick to declare your disgust there big boy... guilty conscious???

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Originally Posted by OneBrightGator

Pretty quick to declare your disgust there big boy... guilty conscious???

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nope. i got a box of catheters

http://sphotos.ak.fbcdn.net/hphotos-..._8256619_n.jpg

Serious problem? uhm.. No one I know using the cheap bolt type have ever had a problem. (The only type we use.) Now if you are diving Peacock in summer during a drought you will probably have more issues with your ears!!

Dale

I do a few shots of vinegar and alcohol before each dive. No problems!

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Originally Posted by Kelly Jessop

It would be interesting to find out if any of these were reused catheters (yes,there are people who do this).

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I for one always keep a couple of 44mm catheters handy to loan to anyone who might have forgot their own and need one.

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Originally Posted by DA Aquamaster

I for one always keep a couple of 44mm catheters handy to loan to anyone who might have forgot their own and need one.

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do you keep duct tape handy as well? ;)

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Originally Posted by LiteHedded

do you keep duct tape handy as well? ;)

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Real men use zip ties.

On a serious note, just make sure your bolt is loose before you start urinating. The bacteria built up in the hose can be forced into the urethra if not...Yes, this will cause a UTI.

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Originally Posted by bletso

Serious problem? uhm.. No one I know using the cheap bolt type have ever had a problem. (The only type we use.) Now if you are diving Peacock in summer during a drought you will probably have more issues with your ears!!

Dale

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I was using the cheap bolt type :(

Dr Harry's research shows all the UTIs he has info on were using bolt type P-valves.

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Originally Posted by FW

I was using the cheap bolt type :(

Dr Harry's research shows all the UTIs he has info on were using bolt type P-valves.

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We'll he'll soon have one that was not...

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Originally Posted by LisaN

only men or do you also want to hear from women that use the She-P? I have no idea if there is an association between she-p use and UTIs, but I would be very interested to know. Though women are more UTI prone, it would still be valuable to know if there is an associated risk with She-p use and if the bacterial culprits are different from other community-acquired UTIs.

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I think the She-P has been used for very little time so far to have such results. I have bought one since the first latex ones (February 2008 ) and now have a silicone. I do around 80-100 dives per year, always using it. Never had a problem. This could be a separate thread. I am interested in hearing about any problems. Haven't heard anything so far although I have been reading anything that is out about it.

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Originally Posted by DA Aquamaster

We'll he'll soon have one that was not...

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He will be interested to hear about it, but will also like to know which bacteria was cultured.

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Originally Posted by FW

I was using the cheap bolt type :(

Dr Harry's research shows all the UTIs he has info on were using bolt type P-valves.

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Well not too rub salt in the wound so to speak but the older was get the more prone to UTI. Your immune system isn't quite as robust. I would love to see some research into how aging in general affects divers. Lots of baby boomer cave divers out there over 50, and one or two I know well over 60.

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Originally Posted by Cindy

Well not too rub salt in the wound so to speak but the older was get the more prone to UTI. Your immune system isn't quite as robust. I would love to see some research into how aging in general affects divers. Lots of baby boomer cave divers out there over 50, and one or two I know well over 60.

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Probably the only age issue was forgetting to open the @#$% bolt! I had made an OW dive the day before, and didn't bother to hook up, so I had to close the bolt to keep the suit from flooding. It is so rare that I dive OW that I just forgot to open it back up :(

When I first put my bolt type in I had a looped hose. Got a UTI (2007) on the second time diving it like that. Cut the hose short, point him downward, and have never had another. I also rinse with ear beer. I went to my ER Doc / Buddy and get an antibiotic, so I can't tell you what the bacteria was. I knew what it was and why I had it (looped hose backed up) so we didn't need to test.

That IRAP post was from my "adventure" - it was a bolt type P-valve, yup, I'm too cheap to buy a balanced valve. I dove a semi-dry for a couple of years after that, because I was gunshy of the UTI and I "expanded" and wouldn't fit in my suit. I've since got another suit, put a bolt type valve in it. I leave the bolt open, no issues there, and use a new cath each dive (I also usually only do one dive a day - caution prevails).

The doctor did not tell me what variety of bacteria I had - they first thought my bladder had burst, they were worried about septic shock type stuff, then they used an industrial strength antibiotic and suppository tylenol to get the infection under control and get my fever down. Oh yeah, there was also some morphine involved.... and it did not work on the pain. NICE!!

Be careful - a bad UTI will put you in the hospital, a badder one may kill ya.

Mark

I experienced a UTI from a pvalve. I can almost guarantee it has nothing to do with balanced versus unbalanced. There are just more unbalanced out there, I would say way more being that I was selling 10 to 1,,,,,and sold a total of roughly 500. UTI prevention with a pvalve is quite easy knowing what caused mine. Hose kinked caused back pressure. almost died according to emergency room doc's. I was very dehydrated. Couldnt eat, sleep or drink fluids for 3 days and was in major pain and only then decided I needed medical attention....Dont like Doctor visits or hospitals, thats why it took me so long. They hooked me up to an IV to hydrate me, gave me antibiotics and something the nurse said was 6 times stronger then morphine. Doc gave her dosage of pain killer, she cut it in half and injected me.......it sent me on a wild trip, girlfriend asked if I was alright, I said yes tell the nurse to bring the other half :)

anyways,,,,prevention..........route your hose as straight as possible, cut off some of the catheter tube end, make sure bolt is open, try to pee before zipping up suit all the way.

UTI's are bad news, take the necessary preventions

is that a basset hound in your avatar?

...

There are a few things that can cause higher than desired pressure during urination - kinlked hosed, folded over ends on the cath, or even a too tight crotch strap if things are routed funny.

However, it is not just the pressure issue that causes problems but rather not being able to clear old urine out of the tube and/or having urine stay in the tube under pressure when there are germs in the tube. In essence you don't want to create a situation where a germ could swim upstream and cause an infection.

Following my own drug resistant UTI and kidney infection I use a large syringe to push 50% Alcohol and Vinegar solution through the valve, hose and connection bits after every diving day and sometimes before hooking everything up if things have been stored awhile. I also let it sit a couple minutes in the system when possible, then if it is a post dive disinfection, I ensure it dries thoroughly.

I will also from time to time remove the vale from the suit and boil it. I tend to do this if it acquires any kind of odor.

In this regard I think the general move toward delrin pee valves in prefernece to stainless steel is probably going to aggravate the infection situation as delrin is far more porous and much harder to disinfect than stainless steel. So in my opinion, delrin pee valves require a much higher level of care in terms of keeping them clean.

He is part Springer, part Beagle. Very smart but still a pup, so he is hell on wheels. Has selective hearing issues :) http://www.cavediver.net/forum/image...8&type=profile

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Originally Posted by FW

I was using the cheap bolt type :(

Dr Harry's research shows all the UTIs he has info on were using bolt type P-valves.

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FWIW, I replaced the balanced valve that came with my White's Fusion suit with an unbalanced valve at the suggestion of Steve Gamble. Never had a UTI with the balanced valve, but I seemed to notice much more back-pressure with the balanced valve. Maybe routing of a stiffer Norprene discharge tube, shortening the catheter tip to prevent kinking, etc. had more to do with it, I don't know and have no desire to run a controlled experiment.

To those brave/stupid souls who would re-use a catheter, what pennies you save may be spent a thousand times over in $ and anguish if/when you get a UTI - commonly harder to get rid of in men than women as they can involve the prostate, which is a bear to disinfect.

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Originally Posted by JamieZ

He is part Springer, part Beagle. Very smart but still a pup, so he is hell on wheels. Has selective hearing issues :) http://www.cavediver.net/forum/image...8&type=profile

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http://sphotos.ak.fbcdn.net/photos-a...47092_5318.jpg

my basset looked a lil like that when she was young. that's why i ask

nice looking pooch

They told me the test showed no bacteria but I convinced them that I did have a uti. It was a crappy week and I'll never know the bacteria that caused it :(

That was the one time I didn't clean the tubing.

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Originally Posted by JahJahwarrior

They told me the test showed no bacteria but I convinced them that I did have a uti. It was a crappy week and I'll never know the bacteria that caused it :(

That was the one time I didn't clean the tubing.

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You may have had prostatitis, and unless a urine sample is collected after prostatic massage (yep, via a rectal exam), the culture may well be sterile. The difference in treatment between a simple UTI in men and prostatitis can be as long as 2-3 weeks of antibiotic treatment necessary in cases of prostatitis.

I had a UTI and kidney infection bcaused by a drug resistant bacteria, but even after it resolved my lucocytes were still elevated due to prostetitis and that took another month of antibiotics to resolve.

I lived in fear of peeing for months after that.

I don't know much about prostatitis. I know that the day after diving, my back seemed to hurt more and differently than usual, and I felt funny. I chalked it up to the strenuous diving, but towards the end of the day, I really wasn't feeling that well, and took my temperature. It was only half a degree high. Over the next 4 hours, it shot up to around 104, if memory serves correct. I actually started feeling much better, but still couldn't sleep, so took my temperature again, and when I chatted with someone on Facebook about it and mentioned the temperature, she told me to call a friend or an ambulance and get to the ER. :)

Pee in a cup showed nothing, docs had never heard of cave divers and it took a while to explain a p valve to them. Honestly it was the best looking female doctor I've ever seen, and she insisted on a rectal exam thinking maybe it was prostate issues. Urine sample was taken before rectal exam. I was leaving for another city early the next morning and they finally agreed I probably had a UTI, and gave me a prescription. I felt pretty bad for the next week. Hurt to pee, and that bright orange/red colour caused by one of the medicines....will never forget that! Scared the bejeesus out of me at first! I didn't feel like doing much of anything. A friend who I met that evening who I've gotten to know more since then, said when she met me she thought I was heavily medicated or something, I just seemed sort of out of it.

I always clean with a quick blast of vinegar and alcohol, before and after the dive. Catheters don't stick to me that well, so I have to change them daily, and I usually do one long dive instead of multiple short dives. I was diving every weekend at that point, and a friend tells me it was likely I got it the weekend before, but it didn't show up until 8 days later.

One week of antibiotics cleared it up, but I didn't feel back to normal until the very last day, when it suddenly stopped hurting to go to the bathroom. I don't ever want to go through that again, but I am glad for the friend who pointed out that my fever was dangerously high.

If I knew the culture, I'd gladly send the info along, but I don't :(

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Originally Posted by JahJahwarrior

docs had never heard of cave divers and it took a while to explain a p valve to them.

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Same here. My doctors first reaction was that a male with a UTI must be engaging in some interesting sexual practices with some scary partners. It is DC after all. His first thought was to run about $800 worth of tests for STDs as well as for a UTI.

It took awhile to explain cave diving, drysuits and pee valves. In my case, on my ast FL trip a few day before I had managed to cram the exterior end of my pee valve into some silty ooze in a tight spot and my suspicion was that something got past the mushroom valve, started growing and found it's way upstream during an event with a kink in hose.

Once he understood another possible route of infection he stopped looking at me like I was nailing the pool boy.

Oh my pvalve is a bolt style unbalanced jamiez special.

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Originally Posted by JahJahwarrior

... Catheters don't stick to me that well, so I have to change them daily ...

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I have heard of people re-using caths... which is pretty bad in and of itself... but are people wearing caths for multiple days? Mine goes on at the beginning of the day and off at the end. A new one goes on the next day if diving multiple days.

I don't know that there is anything inherently wrong with wearing them for multiple days. If I somehow end up with only one cath for two days of diving I'd make it work, but I do know that I like it better with it off.

Chris

Urine is sterile when it comes out (assuming you don't already have a UTI) but it won't stay that way long. I think leaving a catheter on more than one day is really asking for an infection as what ever parts of the system are exposed to the external environment would provide a warm and moist environment for whatever bacteria got there to start growing and the more time it has to grow the greater the risk of an infection possibly occurring.

Also, bacteria that may be on you when you put on the catheter are similarly now in an environment that is now also warm and moist and again if allowed to grow over a longer period are in a much better position to find entry and cause an infection.

I don't change them between dives, assuming they stay stuck, but I do remove them as soon as I am done with the last dive of the day. In the post infection from hell era, I also clean things rather well before putting on a condom cath - which I have found also ensures it will stay well stuck all day long.

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Originally Posted by DA Aquamaster

Urine is sterile when it comes out (assuming you don't already have a UTI) but it won't stay that way long. I think leaving a catheter on more than one day is really asking for an infection as what ever parts of the system are exposed to the external environment would provide a warm and moist environment for whatever bacteria got there to start growing and the more time it has to grow the greater the risk of an infection possibly occurring.

Also, bacteria that may be on you when you put on the catheter are similarly now in an environment that is now also warm and moist and again if allowed to grow over a longer period are in a much better position to find entry and cause an infection.

I don't change them between dives, assuming they stay stuck, but I do remove them as soon as I am done with the last dive of the day. In the post infection from hell era, I also clean things rather well before putting on a condom cath - which I have found also ensures it will stay well stuck all day long.

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Agreed. I like the dry. I will admit that there are times where I will forget to remove it until I hit the bathroom at the post-dive eatery. But usually no longer than that.

As for cleaning beforehand, I do that as well. The alcohol wipes found near the insulin supplies in the pharmacy work really well and are dirt cheap.

This little pesky organism is found pretty much everywhere and is well known in some cases of UTI's and other infections, very opportunistic:

http://www.pseudomonas.com/p_aerug.jsp

Dive safe,

Celia

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Originally Posted by amphipod06

This little pesky organism is found pretty much everywhere and is well known in some cases of UTI's and other infections, very opportunistic:

http://www.pseudomonas.com/p_aerug.jsp

Dive safe,

Celia

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That is the one we suspect causes P-valve induced UTIs, but we are having trouble collecting enough results of culture tests, to prove it :(

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Originally Posted by FW

That is the one we suspect causes P-valve induced UTIs, but we are having trouble collecting enough results of culture tests, to prove it :(

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You know.... you could easily do something that does not involve getting culture results from actual UTI's... you just have to prove that the organism is present in the pee valve at any given time. You could just go to a dive site, let's say Peacock, and ask if it would be ok to obtain a swab from the pee valves after dives. Nothing invasive at all.... not even embarrassing...

P. aeruginosa grows easily in petri dishes (I used to grow it in the lab) and all you'd need is an incubator (and a microscope) for a few days...

I am sure you can come up with those...

Dive safe,

Celia

I can't imagine how anyone using the most basic hygiene can get a urinary infection in a dry suit pee valve.

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Originally Posted by amphipod06

You know.... you could easily do something that does not involve getting culture results from actual UTI's... you just have to prove that the organism is present in the pee valve at any given time. You could just go to a dive site, let's say Peacock, and ask if it would be ok to obtain a swab from the pee valves after dives. Nothing invasive at all.... not even embarrassing...

P. aeruginosa grows easily in petri dishes (I used to grow it in the lab) and all you'd need is an incubator (and a microscope) for a few days...

I am sure you can come up with those...

Dive safe,

Celia

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...and Pseudomonas can also easily survive in a refrigerator, as well as at basal body temp. It is also seen in human infections in association with rubber catheters in patients - indwelling Foley (urinary) catheters, percutaneous drains, chest tubes, etc. Dive equipment like P-valve tubing that looks inert and not likely to harbor infectious organisms still needs a good cleaning if used for what it's intended.

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Originally Posted by amphipod06

P. aeruginosa grows easily in petri dishes (I used to grow it in the lab)

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And people say I have weird hobbies...

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Originally Posted by Slüdge

And people say I have weird hobbies...

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ah, but that is what makes us all interesting, no? ;-)

Dive safe,

Celia

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Originally Posted by divindoc

...Dive equipment like P-valve tubing that looks inert and not likely to harbor infectious organisms still needs a good cleaning if used for what it's intended.

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Precisely, ergo my suggestion to try to isolate offending organisms by swabbing peevalves post dives instead of trying to collect post-facto information on UTI's that may or may not have been cultured (also more difficult to get a large enough sample for the study).

It would likely answer Forrest's questions regarding most common organisms responsible for UTI caused while using a peevalve... I'm thinking we could design a study for this guys...

Dive safe,

Celia

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Originally Posted by amphipod06

...It would likely answer Forrest's questions regarding most common organisms responsible for UTI caused while using a peevalve... I'm thinking we could design a study for this guys...

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I agree, prevention is the key, but having the right information to give a physician is also very helpful. Knowing the symptoms will also get some people to a physician sooner.

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Originally Posted by FW

I agree, prevention is the key, but having the right information to give a physician is also very helpful. Knowing the symptoms will also get some people to a physician sooner.

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You can find that information on articles about UTI symptoms that have already been published. Bacterial infection of the lower urinary tract (UTI), one of the most common infectious processes, occurs in all age groups, from the newborn to the elderly. However, presentation and treatment of UTI varies according to the age of the patient, and that is the tricky part....

Anyway, it'd be interesting to do the study with the pee-valve population...

Dive safe,

Celia

Pseudomonas is relatively non-pathogenic, present in the environment in large numbers, and will undoubtedly colonize wet places like pee valves even if they have been rinsed. It's a relatively rare organism to cause a UTI in the absence of an immunocompromised host or foreign material in the bladder. That's why it would be great to do both studies. It will be no surprise if we find it in pee valves, but if we find it as the cause of infection as well then we can start looking at how the normal defense mechanisms that men have against UTIs have been compromised by using a pee valve underwater.

Andy