Prostate surgery

[Randell]

Hi there first let me state that my finances and pension will only be able to handle Government hospitals.

My situation is, I had a bad bout actually my second bad bout of urinary infection. To the point that a rather long more than two week course of Augmentin 3000 mg per day to suprest it. That  gave me relief from debilitating pain and pressure from not being able to pass water and when possible just dribbles. Now am on  4 mgs nightly along with with 5 mg Finasteride. Peeing now pain free but all not normal,  but have a follow up in October 21. But I think the bladder is already starting to percolate again  nothing major but familiar sensations. What I think is happening is my bladder is not emptying fully therefore ending up with some extra bile in there at all time and finally infection again. I am going to ask that some ultrasound or something be done to check condition of bladder. But I am kind of resigned to the fact that I will need surgery due to my age 69 70 april. What kind of options do I have for surgery up here in Chiang Rai and what possible costs are involved. I am very careful of keeping my fluid levels up by drink lots of water  no alcohol and a a good village Thai diet heavy on the veg.

[uncleP]

Firstly u need a PSA score. Cifloxin twice daily for up to a couple of months to clear infections.  And them maybe an alpha blocker to loosen the prostate. Alpha blockers are about 950b a month but work good. an op is generally a last resort. 

Edited July 26, 2020 by uncleP

[Sheryl]

I am confused by your reference to bile. Are you talking about two different things, a urinary infection and a gall bladder problem? Please clarify.

 

Surgery is not indicated for urinary infections per se, regardless of age. Exception might be if the infection was secondary to urinary retention due to enlarged prostate, since you are on finasteride that may the case. However you have not yet maxed out on medical options. First of all, you need to fully resolve the infection. Then if still not able to fully empty your bladder an additional drug like doxazosin might be added.

 

It does rather depend on the size of the prostate.

 

The main government hospital in CR town, Chiangrai Prachanukroh Hospital, is a regional level facility and might (no guarantee) have a urologist. Likely only standard TURP available, no robotic surgery  etc.

 

You might also try Mae Fah Luang University Hospital, though it is rather small so nto sure it will have a urologist

 

 

 

[bkk6060]

Prostate is a pretty radical surgery.

I would avoid it as much as possible.

[Randell]

Hi Sheryl and Uncle P I am already on Doxazosin 4 mgs and Finasteride 5 mgs. . As for the bad use of english word bile. I was just  wondering if that was what kept the infection coming back twice inow  within 12 months . I am just not sure I am emptying my bladder fully. Next visit will get another PSA done. Will pursue  a urologist. I am not eager for surgery and am trying as much as I can but the quality of life sure goes down hill when this flares up. Thank you

[Randell]

BK6060 I do understand this but thanks for input. I am not rushing it just slowly laying the foundation to what may be necessary in the future if treatments current and future don't pan out. Being up in Chiang Rai put quite a limit on options so important to do the groundwork.

thanks again.

[Nero Dog]

Dear Randell, 

I have gone through this 15 years ago. 

If it is not cancerous (which is a different matter) then the prostate will increase in size and problems will slowly get worse. In the end severe kidney problems will occur. 

Best to see a specialist and let him explain the way forward. 

Sooner the better. Tablets help but are not the solution. 

You will probably need a TURP procedure (Transurethral Resection of the Prostrate). 

If you can get back to your country of origin (once some sort of normality returns) so much the better. 

It might be helpful to Google TURP and learn about this problem. 

 

[xylophone]

As Sheryl has said, you need to clear up the infection first, and Augmentin is a pretty good antibiotic for that, and IMO you should stay away from Cifloxin (ciprofloxacin) because it can have some fairly nasty side-effects for as old uns with regard to the tearing and weakening of tendons, not to mention heart valve problems in some cases.

 

This antibiotic has been "black boxed" in the USA which means it comes with some severe warnings.

 

As has been stated, you need to get more checks done on the state of the prostate, and a flow test would be one of them, along with a digital rectal exam (finger up the bum for want of better terminology) along with perhaps a PSA test. All this will determine the state of the prostate and whether surgery would be necessary.

 

A transurethral resection of the prostate (TURP surgery) is commonly done these days and robotic surgery is not needed for that, only for a complete removal of the prostate, which is absolutely a last resort and would be perhaps indicated in the case of cancer.

 

You have a few more options up your sleeve yet, so make sure you take advantage of them.

Good luck.

[izod10]

Had surgery on mine few years ago,needed it too. 5 days in hospital,2 more than normal because of size.  Had it done in India,laser,but you do not know what they are sticking up your pipe

Edited July 26, 2020 by izod10

[Sheryl]

4 hours ago, Randell said:

Hi Sheryl and Uncle P I am already on Doxazosin 4 mgs and Finasteride 5 mgs. . As for the bad use of english word bile. I was just  wondering if that was what kept the infection coming back twice inow  within 12 months . I am just not sure I am emptying my bladder fully. Next visit will get another PSA done. Will pursue  a urologist. I am not eager for surgery and am trying as much as I can but the quality of life sure goes down hill when this flares up. Thank you

 

No, bile has nothing at all to do with the urinary tract.

 

It is possible the infection was not completely eradicated the first time, leaving a few bacteria there which then multiplied over time (at which point one is often resistant to the original antibiotic).  This is nto uncommon.

 

I am not totally clear if you have a bladder  infection due to chronic urinary retention from benign prostatic enlargement OR prostatitis. If prostatitis, this will temporarily enlarge the prostate and enlargement will decrease once the infection resolves. If it is the first case, another story and as you are already on both dox and finasteride you may be right that surgery will be needed.

 

There are some newer and less invasive treatments for enlarged prostate e.g. prostatic urethral lift  implants (UROLIFT) and aqua ablation Not available in Thailand but may be in your home country, something to consider if you have access to free health care there.

 

In the meantime once the infection clears up you might ask the urologist about taking the drug nitrofurantoin prophylactically, it can help prevent UTI recurrence. And you should also practice "double voiding" especially before bedtime, that means after peeing you wait a few minutes and then try to pee again t better empty the bladder of residual urine.

 

The above two measures may enable you to put off more definitive treatment for a while...especially helpful if getting treatment in your home country is an option since you'd need to wait until COVID travel restrictions are lifted.

[BritManToo]

5 hours ago, Randell said:

Now am on  4 mgs nightly along with with 5 mg Finasteride. Peeing now pain free but all not normal,

I have the same problem, got off a flight last year, couldn't wee at all.

 

Did you miss out Doxazocin?

Took me 8 months to a year to get my weeing back to normal, 4mg had the same effects as you're having, I have to take 6mg. The extra 2mg made all the difference (I'm 64), you have to tailor the dose to your body.

I find I can wee properly when my BP is 90/60 or less, once I'm up to 100, there's a problem.

 

Finasteride doesn't help you with weeing, that's not what it's for, supposedly it will stop the prostate growing.

5mg every other day is just as good as 5mg every day according to many reports.

 

UTI is usually from careless contamination of the catheter when fitting, I assume you had one fitted at the start?

It's normal to monitor your BP when taking Doxazocin.

 

They ain't cutting me open ......

I don't want either common side effect of surgery, erectile dysfunction or incontinence.

How common are the side effects? Too common for me to take the risk!

Edited July 26, 2020 by BritManToo

[BritManToo]

5 hours ago, uncleP said:

Alpha blockers are about 950b a month but work good. an op is generally a last resort. 

Alpha Blocker,

OP is taking Doxazosin ......... 2mg costs 1bht from government hospital, OP will be paying 60bht/ month (not 950bht).

Edited July 26, 2020 by BritManToo

[Randell]

Thank you all for all your input. Much appreciated.

Sheryl

I will have to check on my urine to see if the bacteria comes back and how quickly. To see if I am using the wrong drug or not  using it for long enough. I do do that double voiding at night time. Thing are slightly better. Best of all the pressure and slight burning are gone although pop up occasionally.  But am for the most part able to pee freely, if often. Getting back to home country is not an option. So will purse all option here finding a urologist  for consult. And try all non invasive options first. Thank you I value your responses.

Britmantoo  

I will consult on the follow up appointment  in Sept about raising the dosage of the Dox But I am still just in the first couple of week at the new dosage now so will let this reach its levels. Thank you very much for your personal info that is very beneficial for me to have it from the horse's mouth so to speak.  

by the way haven't had to have a catheter .

Thank you

 

Xylophone thanks for your input as well I was only too aware of the cipro cause it cause me quite a problem with a achilles tendon flare up very nasty like you said in N america black box warning for older men.

Thank you all for your quick and informative responses. I will be sure to update the progress as it happens. Randell

[BritManToo]

16 minutes ago, Randell said:

Britmantoo  

I will consult on the follow up appointment  in Sept about raising the dosage of the Dox But I am still just in the first couple of week at the new dosage now so will let this reach its levels. Thank you very much for your personal info that is very beneficial for me to have it from the horse's mouth so to speak.  

by the way haven't had to have a catheter .

Thank you

They advise 2 weeks between changing dosage.

You really should monitor your blood pressure daily, when using Doxazocin, BPM under 400bht, not expensive.

https://www.lazada.co.th/products/blood-pressure-monitor-i265816435-s414269674.html

 

If you don't feel too dizzy, you can up the dosage by 1mg, wait 2 weeks and see how it's going.

I only see the doctor every 3 months, it would have taken forever to get the dosage right if I'd left it to him.

Edited July 27, 2020 by BritManToo

[xylophone]

21 minutes ago, Randell said:

Xylophone thanks for your input as well I was only too aware of the cipro cause it cause me quite a problem with a achilles tendon flare up very nasty like you said in N america black box warning for older men.

Thank you all for your quick and informative responses. I will be sure to update the progress as it happens. Randell

No problems Randell, as I have had a bit of experience with prostate problems for around 30 years or more, eventually ending up with TURP!!

 

However there is some good information on here, and as has been said, it's quite possible that if you were taking Augmentin for that period of time, and the infection is still recurring, then a change of antibiotic might be on the cards.

 

Another type of antibiotic for consideration is Fosfomycin, which is available here over the counter, but you may have to order it, and this was the antibiotic which was recommended to me by a couple of professors in Australia and the UK who had been doing a lot of research into prostate problems, infections and prostatitis, and after using other antibiotics, found that fosfomycin (very often in conjunction with doxycycline) worked extremely well, and you only have to take it for a number of days.

 

The Urolift mentioned by Sheryl is something I did follow a while ago, along with the Rezum treatment, however I did find quite a few unsettling reports regarding Rezum and it appears that it is not always as quick and "safe", or should I say fool-proof, as was originally made out. Although Urolift seems to be a pretty good option by all accounts.

 

It's a bummer when these sort of things happen later on in life, but keep trying different things and as I have said previously, surgery is the last option.

 

[Surelynot]

I would do some serious research before going in for surgery.....which sounds almost inevitable. 

 

I read there is a new technique that involves super heat steam (?), others that incorporate radioactive implants etc.

 

I was supposed to have a TURP op' last year....but putting it off for as long as possible...........live 5 minutes from Nana Plaza and want to make the best use of what time I have left.

[mokwit]

If the problem is infection then I would try Roxithromycin (Rulid, Thai generic is Rothricin) as this is a uniquely potent antibiotic for Prostate infections as it somehow penetrates the Prostate capsule. Two 150mg tablets a day for 10 days.

 

The bladder not fully emptying is associated with enlarged prostate (not exclusively) , either through infection or BPH. Having the infection come back within a year is not unusual - due to the difficulty of antibiotics penetrating the prostate residual bacteria and subsequent flare up are a common occurrence.

Edited July 27, 2020 by mokwit

[KhunBENQ]

20 hours ago, xylophone said:

As Sheryl has said, you need to clear up the infection first, and Augmentin is a pretty good antibiotic for that,

Is Augmentin easily available in Thailand?

In what form and price?

[xylophone]

6 minutes ago, KhunBENQ said:

Is Augmentin easily available in Thailand?

In what form and price?

Yes it is available over the counter and costs around 600-800 baht a course.

 

26 minutes ago, mokwit said:

If the problem is infection then I would try Roxithromycin (Rulid, Thai generic is Rothricin) as this is a uniquely potent antibiotic for Prostate infections as it somehow penetrates the Prostate capsule.

Roxithromycin seems to have that capability as does the antibiotic Fosfomycin, as there is a problem with prostate penetration due to the presence of bacterial biofilms, under which the bacteria are shielded. That is the research that the two Professors I liaised with, have been working on and trying many antibiotics, esp as to why these infections keep recurring.

 

Another antibiotic which has shown good results is Azithromycin (aka Zithromax) though two courses can be the norm for stubborn cases.

 

Don't want to frighten you, but as we get older UTIs are very common and can be due to a number of things, like a deep-seated infection in the prostate, retained urine, or a hospital-acquired infection if you have had some sort of procedure, not to mention something which is sexually transmitted.

 

Sometimes, the cause of such an infection is never really found and it's very much trial and error, as you can see by the number of antibiotics which have been suggested here and used over the years.

 

As I mentioned previously, the professors in London and Sydney were working on this very thing because of repeated UTIs in males and why it was becoming more commonplace, and I have some correspondence from them, explaining what they were doing, and why, and the treatment they were advising, although some of the treatments did vary, however did contain one or two similar antibiotics.

[Randell]

Again thank you all for your help.  I do have and use a BP cuff and oxygen, pulse gizmo. My now 92 year old Dad told me a few years ago. Old age isn't for sissies. It may have not been PC but I sure got his drift ala the perseverance necessary to cope with the GOLDEN YEARS 555

[Sheryl]

2 hours ago, Surelynot said:

I would do some serious research before going in for surgery.....which sounds almost inevitable. 

 

I read there is a new technique that involves super heat steam (?), others that incorporate radioactive implants etc.

 

I was supposed to have a TURP op' last year....but putting it off for as long as possible...........live 5 minutes from Nana Plaza and want to make the best use of what time I have left.

Radioactive omplants ate for cancer treatment not benign enlargement.

 

As i mentooned previously there are newer treatments such as Urolift and aqua (water/steam) ablation. Also robotic techniques that can reduce risk of nerve damage.

 

But except for robotic these ate not available in thailand.

[izod10]

Keep kicking the can down the road will not help,gets worse.  Kept record before and after op at hospital,pissing using a flow gadget. first up flat line,after ,like a rocket,hurt it was so rapid.

   Get it done,no big deal

[Randell]

Thanks again very helpful.

Now armed with a few new antibiotic names and some new information. It's all help the way forward. I certain appreciate all your sharing. 

Randell

[BritManToo]

23 hours ago, izod10 said:

Keep kicking the can down the road will not help,gets worse.  Kept record before and after op at hospital,pissing using a flow gadget. first up flat line,after ,like a rocket,hurt it was so rapid.

   Get it done,no big deal

If you've had a TURP, it would be interesting to know if you can still have sex, or if you have incontinence problems.

There was a poster on this forum in the past 6 months who claimed his life was destroyed by TURP.

He's disappeared now, but that sort of post discourages me.

 

A pal of mine had TURP, can wee fine, but no longer has sex.

 

I'm fine with the drugs, Doxazosin enables normal weeing, taking Finasteride so it doesn't get worse.

Drugs work fine for me, can do everything, but only around 18 months, so no long term opinion as yet.

So far, so good.

[izod10]

Do not think TURP or laser makes difference,all cutting.  I'm OK,can <deleted> for England,sex is OK ,but cannot produce a bucketful when I cum    Ageing is more of a factor to sex too  No incontinence,takes time to settle down  12 months or so.  Nerve damage,maybe but nerve tissue reconnects too

[ThaiPauly]

It took me 6 months to be incontinence free after a TURP operation

[Morty92]

I am not in Thailand, I have visited it a few times only, and have some friends who I met while they were working overseas.    I am just looking for some advice re prostate treatments in Thailand.   I probably need to have my prostate removed - due to cancer.   Where I am based there are no surgeons I would trust to do this.  Does anyone know if there are any excellent options for me to have my prostate removed please? 

Thankyou.   

 

Martin

 

 

 

[xylophone]

On 3/17/2021 at 2:35 PM, Morty92 said:

I am not in Thailand, I have visited it a few times only, and have some friends who I met while they were working overseas.    I am just looking for some advice re prostate treatments in Thailand.   I probably need to have my prostate removed - due to cancer.   Where I am based there are no surgeons I would trust to do this.  Does anyone know if there are any excellent options for me to have my prostate removed please? 

Thankyou.   

 

Martin

 

 

 

If it's prostate removal that you need, then it can be done in Thailand, but you really need to seek out hospitals which use the "Da Vinci" robotic assisted machine as it is far better than the old-fashioned surgical method which often involved incontinence, loss of libido and so on, due to the nerve damage.

The Da Vinci machine is a precision instrument which should alleviate all of those problems, and is usually done through keyhole surgery.

Prostate Cancer Robotic Assisted Surgery - Da Vinci Surgery
 www.davincisurgery.com        

"Robotic assisted prostatectomy is a minimally invasive surgical option for prostate cancer. Talk to your doctor to see if a da Vinci surgical technology is right for you".

Edited March 19, 2021 by xylophone

[LosLobo]

5 hours ago, xylophone said:

If it's prostate removal that you need, then it can be done in Thailand, but you really need to seek out hospitals which use the "Da Vinci" robotic assisted machine as it is far better than the old-fashioned surgical method which often involved incontinence, loss of libido and so on, due to the nerve damage.

The Da Vinci machine is a precision instrument which should alleviate all of those problems, and is usually done through keyhole surgery.

Prostate Cancer Robotic Assisted Surgery - Da Vinci Surgery
 www.davincisurgery.com        

"Robotic assisted prostatectomy is a minimally invasive surgical option for prostate cancer. Talk to your doctor to see if a da Vinci surgical technology is right for you".

Worth the cost? A closer look at the da Vinci robot’s impact on prostate cancer surgery (nature.com)

Articule link :

NB I am being the devil's advocate here.

My urologist will only do "Da Vinci" at a $5,000 out of pocket premium over what open surgery costs so it is highly likely I will go "Da Vinci" if I do need a radical prostatectomy in the future.

Edited March 19, 2021 by LosLobo

[offset]

15 hours ago, xylophone said:

If it's prostate removal that you need, then it can be done in Thailand, but you really need to seek out hospitals which use the "Da Vinci" robotic assisted machine as it is far better than the old-fashioned surgical method which often involved incontinence, loss of libido and so on, due to the nerve damage.

The Da Vinci machine is a precision instrument which should alleviate all of those problems, and is usually done through keyhole surgery.

Prostate Cancer Robotic Assisted Surgery - Da Vinci Surgery
 www.davincisurgery.com        

"Robotic assisted prostatectomy is a minimally invasive surgical option for prostate cancer. Talk to your doctor to see if a da Vinci surgical technology is right for you".

It is the doctor you need to be sure of not the method, open surgeries have some advantages the doctor as In my case can feel for other problems like in my case of hard nerves on one side and some hard limp nodes all was removed

Just out of interest I am still continent and no ED