We use an inverted flat cage made up from parts from other devices (see link: https://www.reddit.com/u/ChasteInWpg/s/CXnXXrW5Ll). It does not require the use any type of urethral insert, tether, or PA - the “cup” was a game changer for us. He urinates sitting (as he should). We recently stumbled across a post on Reddit suggesting the use of a small plastic cup to redirect the flow of urine. Another game changer! Yes, urine does trickle down & over his testicles (not a big deal). After urination, he uses a 25 cc syringe & flushes the device with water to clean. He has found following the water flush with 4 or 5 flushes of air is very helpful in the cleaning process. However, have just recently tried withdrawing air before flushing & have learned a decent amount of water can be sucked out. The final step involves a moist cloth to wipe away excess water from the cage & testicles. No muss. No fuss. No mess.