Low grade varicocele surgery options?

[Top718]

Hi, I am local Thai age30 living in Thailand

I had bilateral varicoceles, grade1 on the left, grade 2 on the right.

Visit a urologist at Bumrungrad last year, but he said it was mild, no need surgery.

 

I would like to get it fix because of the pain and symptoms of low testosterone.

Currently I took antidepressants for almost 2 years, believe that the root cause was low T.

Got testosterone checked several times average of around 350,

low normal, but not out of normal range.

In the near future I would like to try TRT,

but before that, I would like to get varicocele fixed, so that maybe no need TRT.

 

Please help

Any doctors that would treat varicocele even if it is mild(not grade3)

I have no experience in hospitals outside Thailand.

Maybe Mayo clinic, UK, Singapore or any other countries would treat mild varicocele?

 

Thank you, your help is very appreciated.

[Sheryl]

Before thinking of other countries I suggest you get more opinions here in Thailand.

 

Whom did you see at Bumrungrad? I would suggest Dr. Charuspong Dissaranan.

https://www.bumrungrad.com/doctors/Charuspong-Dissaranan

 

 

 

[Top718]

Thank you Sheryl, I really appreciate your help,

I will be seeing Dr. Charuspong in the next few weeks as you recommended.

Maybe before I go to see him, I should have fertility checked.

If it low, I should be able to have surgery done easier.

 

Last year I have a visit with Dr.Premsant

https://www.bumrungrad.com/doctors/Premsant-Sangkum

[Top718]

Just 1 more question Sheryl,
Do Dr. Charuspong have an experience in varicocele surgery?
I know that chance of surgery will be low but will try it anyway.
Thank you, you help is really important for me.

[Sheryl]

yes, he does. Which is why I suggested him.

Also he is comparatively young and did a residency in the US just 7 years ago so morel ikley than most to be up to date regarding this. As you may know, until recently it was nto considered necessary to correct varioceles unless they were severe and/or causing infertility. It is only recently that it has been found that repair even of  asymptomatic grade 2 varioceles  can increase testosterone levels.

 

 

[Top718]

Just read some of your old posts,

seem like you are expertise in selecting doctor.

Just wonder how you know so much doctors detail.

 

Thank you for giving details about Dr.Charuspong.

Your given information makes me confident

and I just make an appointment with him next week.

Just also read a pantip forum commenting that he is very

professional, spend a lot of time in each case, and caring.

And also comment that he is conservative only treat infertility

or severe pain, just the same as your comment

“unless they were severe and/or causing infertility.”

 

You comment that recently grade 2 varicocele maybe

consider treating. Do you know any hospitals in/ outside Thailand?

I am desperate. You can guess, please advise. I will just keep trying.

 

Thank you.

Edited February 6, 2019 by Top718

[Top718]

Sorry for asking for help many times.

Since pain and depression is severe.

Recommended doctors is perfect,

but I need backup plan, just in case.

Can you please recommend a third doctor?

Thank you again, Sheryl

Edited February 6, 2019 by Top718

[Sheryl]

If you are having pain from the variocele there should not be a problem getting it treated -- unless the doctors are convinced the pain is not from the variocele.   Just be clear in your discussion with the doctor that it is painful and you want it treated.

 

The depression is unrelated to the variocele and  I would suggest you seek therapy. See the pinned mental health list in this forum, there are some good psychologists/counselors in Bangkok, both Westerners and Western-trained Thais.

https://forum.thaivisa.com/topic/90910-mental-health-resource-list/

 

But if you absolutely insist on having another doctor's name for "back up" I'd suggest this one, it's down in Pattaya but he's a good urologist and it would be most unusual for doctor at this particular hospital to refuse surgery in a patient who wants it:

 

https://www.bangkokpattayahospital.com/en/doctor-profile?v_id=205&depid=28

 

Do follow through on the counselling, though. I am concerned that you may have unrealistic expectations of what a variocele repair will accomplish for you and might  feel even worse when you have it and it doesn't change things as you expect.

[Top718]

Thank you, Sheryl. Lucky me, I got your help.

If not, this thread will be blank, and I surely have a hard time.

 

For depression, I have a visit montly@Samitivej for 2.5 years now.

I think depression is partially (maybe 40%) arise from varicocele.

From low T and not exercising due to pain, but maybe I might be wrong.

 

Thank you for suggesting a 2nd doctor, I will likely have an appointment with him too.

Not for back up, maybe for comparing the method of surgery.

I just read that microsurgery is better choice even though it takes longer recovery time.

It has higher success rate and lower reoccurrence rate.

Just want to know which doctor do microsurgery.

 

I hope that surgery will make things better, pain free, higher T.

But I would not be too disappointed, if things don’t turn out as expected.

Just want to take a change, didn’t expect much.

Even if surgery went wrong, I still have other options such as painkillers, IVF, and TRT.

Thank you for your concern, Sheryl.

 

Seem like I owe you so much, I don’t know how to pay you back.

But anything regarding powerplant or legal issues, I will try my best to help.

These are only two fields, I am good at.

[Sheryl]

I think Dr. Charuspong  can do minimally invasive surgery.

 

I really doubt your depression (which from your posts is more likely a mixture of anxiety and depression)  is due to the variocele, even though this may be what your mind is focusing on/worrying about now.

 

It feels like we are worried, depressed, or upset by or about something but in fact what more often is the case is that we have the feeling (fear, worry, depression etc) first and then our minds search around for something to attribute the feeling to. It happens so quickly and automatically that we are often not aware of the actual sequence in which it happens.

 

At a hospital all you are likely to get for depression or anxiety is medications, and medication alone is nto the best treatment. It should be therapy or (in severe cases) therapy plus medication. Not medication alone. Therapy may sometimes make medication unnecessary, which us good as all these drugs have their side effects. In other cases medication may still be necessary though perhaps for a shorter time period.

 

Please see a qualified therapist at one of these places:

 

Psychological Services International
9/2 Sukhumvit Soi 43 (near Phrom Pong/Emporium)
Bangkok 10110,
Tel: 02-2591467
Fax: 02-2620505
Languages Spoken: English, French, Thai, Norwegian, Portuguese
PSI offers services from highly qualified and experienced clinicians. Both expatriate and Thai counselors are available.
http://www.psiadmin.com/

 

NCS New Community Services
61/1 Soi Intamara 3
Sutisan Road
Phaya Thai (Sapan Kwai Area)
Tel.: 0-2279 8503
Languages Spoken: Dutch, Thai, German, English, and Japanese
BOTH Thai and foreign mental health professionals.
http://ncs-counseling.com/

[Top718]

Just have a semen analysis done yesterday at a clinic. (I live in Phichit, so traveling to Bangkok is time consuming.) Everything came out normal. I just rethink. Maybe depression is not related to varicocele, like you said.

 

Thank you for sharing your thought, that’s make me change my perspective.

I am now thinking that depression causing me focusing too much on something that is not real. I search for the causes too much that can make me blind. But I still meet Dr.Charuspong as schedule, maybe just for checkup.

 

At Samitivej, I have 1 hour of counseling each time I visit.

I also have met 3 doctors@samitivej, and 1@bumrungrad over last 2.5years

Sometime 2 doctors each visit. I have tried 2 SSRIs, 2 SNRIs, 3 Atypical, 1 tricyclic and 4 other meds in the past. Each try is about 2 months, but all meds did not relieve my depressions, some even make it worse. I am currently on Selegiline for depression, Valdoxan and Rivotril for sleep.

 

Thank you for narrowing to these 2 places. I have a look at NCS and PSI websites, my first impression is that facilities do not look like Samitivej.

Sorry to say that, please don't get me wrong. But because of your recommendation, I will surely try my first counseling at NCS in a few weeks.

Should I request Dr. Johanna, or Dr Rex, or just random is okay? Any recommendation please?

 

Thank you so much, Sheryl.

You are very nice and caring, even though we do not know each other.

Edited February 9, 2019 by Top718

[Sheryl]

These are not hospitals. They are counselling centers. So naturally they look nothing like Samitivej.

In terms of counsellirs consider whether you are more comfortable with a Thai or a Westerner, and a man or a woman and choose accordingly. If you do not feel a good rapport with the first therapist you see, try another.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[Top718]

Thank you for everything Sherly, especially for your recommended doctors. I just met Dr. Charuspong yesterday, he is very caring indeed.

He do microsurgery, he said that it only take about an hour or less. 6 hours rest at hospital, 2 days can go to work, 2 weeks can start exercise.

I already book an appointment for surgery in 2 weeks, only on the left side.

 

For the counselling centers, if my symptoms get worse, I will surely have an appointment a couple of weeks from now.

Edited February 14, 2019 by Top718

[Sheryl]

Thanks for the feedback, glad it worked out.

[sikishrory]

Sheryl I don't suppose you know of any competent Dr in Phuket that can fix these  things?

I am currently working here but thinking of traveling up to bumrungrad.

Urologist I saw in bkk Pattaya hospital for something unrelated turned me off there. Bkk phuket urology also wasn't a great experience but maybe I just got a bad Dr.

[lopburi3]

4 hours ago, sikishrory said:

Sheryl I don't suppose you know of any competent Dr in Phuket that can fix these  things?

I am currently working here but thinking of traveling up to bumrungrad.

Urologist I saw in bkk Pattaya hospital for something unrelated turned me off there. Bkk phuket urology also wasn't a great experience but maybe I just got a bad Dr.

Have had several less than great experiences with urologists myself but can highly recommend the doctor mentioned here as used Dr. Charuspong Dissaranan when he was at Bangkok Hospital several years ago for radical cystectomy.  He talked with people, including nursing staff with none of the common 'I am the doctor' attitude.  And this was done under JCI international inspection team observation so had to calm nursing staff to just take it easy and do as normal.  A calming force well beyond his years. 

Edited January 3, 2020 by lopburi3

[Sheryl]

20 hours ago, sikishrory said:

Sheryl I don't suppose you know of any competent Dr in Phuket that can fix these  things?

I am currently working here but thinking of traveling up to bumrungrad.

Urologist I saw in bkk Pattaya hospital for something unrelated turned me off there. Bkk phuket urology also wasn't a great experience but maybe I just got a bad Dr.

Best to come to Bangkok

[sikishrory]

Yea seems it

[Momofarang]

On 2/14/2019 at 5:21 PM, Top718 said:

He do microsurgery, he said that it only take about an hour or less. 6 hours rest at hospital, 2 days can go to work, 2 weeks can start exercise.

Things have changed, go one done in 1982 at Sydney St Vincent's. Inguinal access, 7 cm cut and 3 days hospital, but fully recovered in two weeks. Worked well; lingering pain was gone and fertility came back.

Will be a piece of cake for you.

[sikishrory]

+1 for Dr. Charuspong Dissaranan.

Finally got to seeing the guy at Bumrungrad yesterday.

Very pleased.

I went for what I thought might be a vericocele. 

Have had it about 5 years.

In Australia I had numerous consultations, an ultrasound and a very painful cystoscopy. That dragged on over a 4 month period and had no conclusion/diagnosis.

This guy is well spoken. Sits and listens and is thorough.

He ruled out vericocele and said it is a cyst that I should just monitor.

Total cost was less than 1,300 baht.

Really very pleased I finally got an answer.

Just wanted to share my experience.

[Sheryl]

Thanks for the feedbak.Glad it worked out.