Problems below the belt. (Prostate).

[swissie]

For about a year I swallow tablets to keep my Prostate problems at bay. First brand of tabletts caused massive dizzieness. New Medicine "Urorec 4mg" I can take without dizzieness. Urge to urinate about every 2 hours. I can live with that.

BUT:
Penis erection = not taking place anymore. Ejaculate not exiting penis, but being re-directed into bladder??!!?? What causes the ejaculate to be re-direczed into the blatter instead of seeing the light of day or ending up in a place where the sun never shines???

Question(s): Would Viagra/Cialis at least restore "erection" (I take blood-pressure meds). Would a medical invasion (hospitalisation), restore former "sexual-normality"?. Like natural erection and "ejaculate" exiting where nature intended it to exit?

Or is it that "prostate-poblems" generally are  basically a "death-sentence" for "male-activity below the belt"?

I am sure that a couple of elderly Farangs are confronted with the same problem(s). Thanks for input. Also: Thanks Sheryl.

[olfu]

Before anything--whats your age?

Anything unusual events like catching cold, allergy?

Is medicine causing problems?

What doctor says.

[Sheryl]

What you describe is "retrograde ejaculation" and it is a known side effect of Urorec (silodosin). Occurs in more than 40% of men taking it.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507909/

 

Viagra etc will probably help with erection but is not likely to change hte retrograde ejaculation

 

Is that the only medication you are on, or are you also on finasetride or something like it?

 

Are you also on any medications for your blood pressure? As the dizziness you had with other medications may have been due to the combined effect on your blood pressure. Did you take your BP when feeling dizzy at that time?

 

Peeing every 2 hours is not good - the issue is not just the inconvenience but the risk of infection (which can be very serious, even leading to sepsis) due to the bladder never completely emptying.

 

If/when you reach the limits of what can be done via medication then it may be time to consider more definitive treatment.  Surgery (TURP) carries some risk of impotence, though if nerve-sparing technique is used, this will usually be temporary.  Another, less invasive, treatment now available in Thailand is water vapor therapy which seems to have no effect in sexual function. (see here  https://www.bumrungrad.com/en/packages/water-vapor-therapy)

 

Nerve-sparing surgery is available in only a few places in Thailand (mainly Bangkok and private hospitals)  and water vapor therapy is available in only a handful of private hospitals in Bangkok. Costs of both will be significant i.e. 200-300K. If it is feasible you might prefer to return to your home country for this treatment. In the West there are, additionally, a wider range of treatment options.

 

Do not have surgery (TURP) done upcountry if your priority is preserving sexual function. With possible exception of a few university hospitals, nerve-sparing technique is usually not available outside of Bangkok.

 

However before thinking of surgery or water vapor treatment (or a return to your home country where there may be other treatment options as well) this you should make sure you have maximized what can be done via medication. The silodosin you are taking gives only a temporary symptomatic relief by relaxing the outlet of the bladder (and, as you have learned, at the price of retrograde ejaculation). Drugs in the finasteride,dutasteride group actually reduce prostate size over time. They do sometimes cause reduction in libido but only in about 10% of  men. I suspect it is a drug of this type that you may have previously taken and stopped due to dizziness. However, this could have been due to interaction with medication for your blood pressure. If so, reducing the dose of your BP medicine might solve the problem.

 

The usual approach is to initially prescribe finasetride or dutasteride  (drugs that, over time, reduce the size of the prostate)  plus a drug in the "alpha blocker" class (tamsulosin, doxazosin, silodosin etc) for immediate relief. It may become possible to stop the second drug after a few months as the finasteride/dutasteride kick in and reduce prostate size (not always, but some times). Both of these drug types tend to lower blood pressure so adjustment in dosage of any other BP medications may be necessary. And people not on BP medictaion who tend to have low blood pressure to begin with, might nto be able to tolerate these drugs

 

Please do post the name and dosage  of:

 

1 - all medications you currently take, for any reason

2- name of the medication you took before that made you dizzy

 

 

[swissie]

7 hours ago, Sheryl said:

What you describe is "retrograde ejaculation" and it is a known side effect of Urorec (silodosin). Occurs in more than 40% of men taking it.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507909/

 

Viagra etc will probably help with erection but is not likely to change hte retrograde ejaculation

 

Is that the only medication you are on, or are you also on finasetride or something like it?

 

Are you also on any medications for your blood pressure? As the dizziness you had with other medications may have been due to the combined effect on your blood pressure. Did you take your BP when feeling dizzy at that time?

 

Peeing every 2 hours is not good - the issue is not just the inconvenience but the risk of infection (which can be very serious, even leading to sepsis) due to the bladder never completely emptying.

 

If/when you reach the limits of what can be done via medication then it may be time to consider more definitive treatment.  Surgery (TURP) carries some risk of impotence, though if nerve-sparing technique is used, this will usually be temporary.  Another, less invasive, treatment now available in Thailand is water vapor therapy which seems to have no effect in sexual function. (see here  https://www.bumrungrad.com/en/packages/water-vapor-therapy)

 

Nerve-sparing surgery is available in only a few places in Thailand (mainly Bangkok and private hospitals)  and water vapor therapy is available in only a handful of private hospitals in Bangkok. Costs of both will be significant i.e. 200-300K. If it is feasible you might prefer to return to your home country for this treatment. In the West there are, additionally, a wider range of treatment options.

 

Do not have surgery (TURP) done upcountry if your priority is preserving sexual function. With possible exception of a few university hospitals, nerve-sparing technique is usually not available outside of Bangkok.

 

However before thinking of surgery or water vapor treatment (or a return to your home country where there may be other treatment options as well) this you should make sure you have maximized what can be done via medication. The silodosin you are taking gives only a temporary symptomatic relief by relaxing the outlet of the bladder (and, as you have learned, at the price of retrograde ejaculation). Drugs in the finasteride,dutasteride group actually reduce prostate size over time. They do sometimes cause reduction in libido but only in about 10% of  men. I suspect it is a drug of this type that you may have previously taken and stopped due to dizziness. However, this could have been due to interaction with medication for your blood pressure. If so, reducing the dose of your BP medicine might solve the problem.

 

The usual approach is to initially prescribe finasetride or dutasteride  (drugs that, over time, reduce the size of the prostate)  plus a drug in the "alpha blocker" class (tamsulosin, doxazosin, silodosin etc) for immediate relief. It may become possible to stop the second drug after a few months as the finasteride/dutasteride kick in and reduce prostate size (not always, but some times). Both of these drug types tend to lower blood pressure so adjustment in dosage of any other BP medications may be necessary. And people not on BP medictaion who tend to have low blood pressure to begin with, might nto be able to tolerate these drugs

 

Please do post the name and dosage  of:

 

1 - all medications you currently take, for any reason

2- name of the medication you took before that made you dizzy

 

 

Here is the situation.

I live in Switzerland and next week I will have a major talk at a clinic to adress "my issue".

I am very happy to say that your info will be of great help for me. Not only do I now know about possible remedies/treatments, but I will also be able to understand "what the medics are talking about". Thanks Sheryl.

 

[Sheryl]

39 minutes ago, swissie said:

Here is the situation.

I live in Switzerland and next week I will have a major talk at a clinic to adress "my issue".

I am very happy to say that your info will be of great help for me. Not only do I now know about possible remedies/treatments, but I will also be able to understand "what the medics are talking about". Thanks Sheryl.

 

If you are in Switzerland then there should be many options. Have a thorough discussion with your doctors.

[Lacessit]

Be extremely careful with Viagra, it was originally developed as a blood pressure medication. If you are taking other BP medications, it could be dangerous.

 

I have weaned myself off BP meds, apart from cardura where I take 1 mg every second day. It's intended to assist finasteride, as Sheryl said.

 

If I take Viagra, my BP drops significantly. My record is 80 systole/40 diastole, and I usually stay in the diastolic mid-forties for up to 18 hours. For obvious reasons, I have ceased using it.

[Saanim]

8 hours ago, Sheryl said:

Do not have surgery (TURP) done upcountry if your priority is preserving sexual function. With possible exception of a few university hospitals, nerve-sparing technique is usually not available outside of Bangkok.

I strongly disagree...

[swissie]

2 hours ago, Lacessit said:

Be extremely careful with Viagra, it was originally developed as a blood pressure medication. If you are taking other BP medications, it could be dangerous.

 

I have weaned myself off BP meds, apart from cardura where I take 1 mg every second day. It's intended to assist finasteride, as Sheryl said.

 

If I take Viagra, my BP drops significantly. My record is 80 systole/40 diastole, and I usually stay in the diastolic mid-forties for up to 18 hours. For obvious reasons, I have ceased using it.

As said, I will have a major "pow-wow" with the medics next week. Surely the interaction(s) between different medications in combination with Viagra/Cialis will be discussed. A major issue will be "how to restore some sort(s) of sexual normality", while having to deal with "the Prostate problem at the same time". We shall see.

- At any rate, as mentioned above, the info I got from Sheryl puts me in a position to understand "the mechanics of prostate illness" and enabeling me to follow and understand the "lingo" of the medics as far as this is concerned.
-----------------------------
Primary goal is to keep this "illness" at bay. Secondary: Sometimes I would still like to invite a nice lady to my room. Currently, I could only show her my stamp collection and not much else.????????????

 

[cdemundo]

Using 5 mg of Cialis daily (google it for prostate problems) and supplementing with Saw Palmetto.

My doctor recommended because did not contribute to ED.

Managing my main problem which was control of urination and I got an infection as Sheryl warned about.

The infection was a nightmare, yikes, fever,  altered consciousness, bladder control was almost non-existent.

No problems since using this.

Sounds like your problems may be more advanced, but posting for others who may be interested in options.

 

[The Hammer2021]

23 minutes ago, cdemundo said:

Using 5 mg of Cialis daily (google it for prostate problems) and supplementing with Saw Palmetto.

My doctor recommended because did not contribute to ED.

Managing my main problem which was control of urination and I got an infection as Sheryl warned about.

The infection was a nightmare, yikes, fever,  altered consciousness, bladder control was almost non-existent.

No problems since using this.

Sounds like your problems may be more advanced, but posting for others who may be interested in options.

 

altered consciousness - how severe?

[Lacessit]

11 hours ago, swissie said:

Primary goal is to keep this "illness" at bay. Secondary: Sometimes I would still like to invite a nice lady to my room. Currently, I could only show her my stamp collection and not much else.????????????

 

I am in a trade-off, AFAICT the finasteride is working in keeping my prostate under control, BUT it is also suppressing my libido. As I have always enjoyed a healthy libido, a PITA.

[BritManToo]

On 6/26/2022 at 10:30 PM, swissie said:

Or is it that "prostate-poblems" generally are  basically a "death-sentence" for "male-activity below the belt"?

 

Had prostate problems in 2020, couldn't wee at all, catheter for 6 weeks, Doxazosin, Finasteride ..... for 2 years.

Several courses of antibiotics (Norfloxstar 400), stinging nettle root every day. 

Now in 2022 it's completely gone.

I'm still taking the stinging nettle root pills.

 

As for lack of libido,

Chocolate milkshake every night sorts that out for me.

1 heaped teaspoon in a glass of milk and blend  ...........

https://www.lazada.co.th/products/ccs-100-m1-17-19-75250-500-premium-cocoa-powder-m1-fat-17-19-size-75250-500g-special-price-i2746549180-s10273852287.html

 

 

Edited June 28, 2022 by BritManToo

[JimmyJ]

@swissie - 

 

What is the 1st medicine that made you dizzy?

[JimmyJ]

@swissie - And all readers -

 

Whatever medication your doctors recommend, I strongly urge all to read user reviews of these medications - at drugs.com and other sites - unfortunately the strongly negative experiences of users outnumber the positive ones.

Negative results affecting sexual activity among other issues.

 

One review summed up my overall impression - 

"The cure is worse than the issue".

 

As I wrote earlier - Unfortunately.

Edited June 28, 2022 by JimmyJ

[Sheryl]

17 hours ago, Saanim said:

I strongly disagree...

If you know of nonuniversity-affiliated upcountry hospitals which perform TURP with nerve-sparing technique by all means please list them.

[swissie]

7 hours ago, JimmyJ said:

@swissie - 

 

What is the 1st medicine that made you dizzy?

finasteride

[Fore Man]

After suffering for a decade with BPH, taking harnal/silodosin/finasteride for all those years, I started reading up on a newer technique which is quickly replacing the TURP as the BHP gold standard surgical procedure. I was in the States and signed up to undergo a TURP by my local urologist.  Then after doing some serious reading about that procedure and warned off of it by several patients who for the vast part we’re not pleased with the aftermath of the operation and/or the long term results.  
 

I became very attracted to a much newer and far less invasive technique known as Holmium Laser Enucleation of the Prostate (HoLEP), which uses special laser energy to enucleate (zap, essentially) prostatic tissue and then morcellate (grind) the removed tissue and backflush it out of the bladder through a unique surgical catheter.  I underwent my HoLEP at the Mayo Clinic in Jacksonville, FL on 30 April 2022, was discharged from the ward 13 hours later, drove home 400+ miles and with a few minor but temporary issues, was urinating like a teenager immediately.  At no time did I experience any post-surgical pain. Unlike the aftermath of a TURP, there was very little post-op bleeding or bladder leakage and no sphincter damage.  I felt completely healed 6 months post-surgery and have never regretted it.  
 

it’s unlikely that you will find a Thai surgeon qualified and experienced in performing HoLEP, but I do know that there are urologists elsewhere in the SEA and Australasia region who perform the procedure.  
 

I was also very pleasantly surprised to find that U.S. Medicare covered 100% of my bill.

 

There are several other available procedures to treat BHP that vary in the method to reduce prostatic pressure on the urethra, ranging in cost, difficulty, length of time that the results remain effective and side effects. Not all prospective patients will be accepted for these procedures and each case must meet certain physiological requirements that pertain to the size, volume and shape of the candidate’s prostrate gland. 
 

Good luck!

[Lacessit]

9 hours ago, BritManToo said:

Had prostate problems in 2020, couldn't wee at all, catheter for 6 weeks, Doxazosin, Finasteride ..... for 2 years.

Several courses of antibiotics (Norfloxstar 400), stinging nettle root every day. 

Now in 2022 it's completely gone.

I'm still taking the stinging nettle root pills.

 

As for lack of libido,

Chocolate milkshake every night sorts that out for me.

1 heaped teaspoon in a glass of milk and blend  ...........

https://www.lazada.co.th/products/ccs-100-m1-17-19-75250-500-premium-cocoa-powder-m1-fat-17-19-size-75250-500g-special-price-i2746549180-s10273852287.html

 

 

If only it was as simple as chocolate. Perhaps finasteride only cut your libido back to what others would accept as normal. Or perhaps ceasing to take finasteride brought your libido back.

Edited June 28, 2022 by Lacessit

[Sheryl]

2 hours ago, Fore Man said:

After suffering for a decade with BPH, taking harnal/silodosin/finasteride for all those years, I started reading up on a newer technique which is quickly replacing the TURP as the BHP gold standard surgical procedure. I was in the States and signed up to undergo a TURP by my local urologist.  Then after doing some serious reading about that procedure and warned off of it by several patients who for the vast part we’re not pleased with the aftermath of the operation and/or the long term results.  
 

I became very attracted to a much newer and far less invasive technique known as Holmium Laser Enucleation of the Prostate (HoLEP), which uses special laser energy to enucleate (zap, essentially) prostatic tissue and then morcellate (grind) the removed tissue and backflush it out of the bladder through a unique surgical catheter.  I underwent my HoLEP at the Mayo Clinic in Jacksonville, FL on 30 April 2022, was discharged from the ward 13 hours later, drove home 400+ miles and with a few minor but temporary issues, was urinating like a teenager immediately.  At no time did I experience any post-surgical pain. Unlike the aftermath of a TURP, there was very little post-op bleeding or bladder leakage and no sphincter damage.  I felt completely healed 6 months post-surgery and have never regretted it.  
 

it’s unlikely that you will find a Thai surgeon qualified and experienced in performing HoLEP, but I do know that there are urologists elsewhere in the SEA and Australasia region who perform the procedure.  
 

I was also very pleasantly surprised to find that U.S. Medicare covered 100% of my bill.

 

There are several other available procedures to treat BHP that vary in the method to reduce prostatic pressure on the urethra, ranging in cost, difficulty, length of time that the results remain effective and side effects. Not all prospective patients will be accepted for these procedures and each case must meet certain physiological requirements that pertain to the size, volume and shape of the candidate’s prostrate gland. 
 

Good luck!

HoLEP is indeed not available in Thailand. But as OP is now in Switzerland, good chance he can get it there.

[LosLobo]

Benign prostatic hyperplasia(BPH) or enlarged prostate has a lot of advantages though some disadvantages over other treatments. It is available in Switzerland.

Prostate enlargement: Urolift | Uroviva

[Saanim]

8 hours ago, Sheryl said:

If you know of nonuniversity-affiliated upcountry hospitals which perform TURP with nerve-sparing technique by all means please list them.

Perhaps you had your own experience when a up-country hospital performed a prostate surgery on you? Please disclose it to us. 

 

My experience was a painless medical intervention - I do not know whether it was a TURP or another miraculous surgery - the details I trustfully leave to the attending physician). When I woke up laying prepared in the queue for the theater, asking when I will be on, I was said that was made already, knowing nothing, neither days afterwards.

 

So far,  another 7 years knowing nothing, thinking on the troubles I had had the years before, hurrying few times after midnight for a urgent catheter inserted by a nice nurse, hearing scaring stories about surgeries.

 

And yes, the state hospital is not affiliated to a university, however, assuming that the medical personal get surely some knowledge from a university as usually the case of physicians is.

 

And that good experience with a state hospital has been also with others - not always so easy - medical interventions on me when I was always wondering how with such case I would fare in another world.  

 

Quite surprised by your strong statement about up-country hospitals. Where did you get your knowledge about them? Hope that not from some falangs forums similar like this one?

    

    

[cdemundo]

22 hours ago, The Hammer2021 said:

altered consciousness - how severe?

confusion, disorientation during fever, it was of short duration, hours not days

[scubascuba3]

5 hours ago, Saanim said:

Perhaps you had your own experience when a up-country hospital performed a prostate surgery on you? Please disclose it to us. 

 

My experience was a painless medical intervention - I do not know whether it was a TURP or another miraculous surgery - the details I trustfully leave to the attending physician). When I woke up laying prepared in the queue for the theater, asking when I will be on, I was said that was made already, knowing nothing, neither days afterwards.

 

So far,  another 7 years knowing nothing, thinking on the troubles I had had the years before, hurrying few times after midnight for a urgent catheter inserted by a nice nurse, hearing scaring stories about surgeries.

 

And yes, the state hospital is not affiliated to a university, however, assuming that the medical personal get surely some knowledge from a university as usually the case of physicians is.

 

And that good experience with a state hospital has been also with others - not always so easy - medical interventions on me when I was always wondering how with such case I would fare in another world.  

 

Quite surprised by your strong statement about up-country hospitals. Where did you get your knowledge about them? Hope that not from some falangs forums similar like this one?

    

    

We can't really learn anything from your post, you're kinda selling ignorance is bliss

[Boomer6969]

15 hours ago, Sheryl said:

TURP with nerve-sparing technique

I don't think nerve-sparing is a concern for any TURP, even simple prostatectomy (enucleation) doesn't cause ED in most cases. The nerves-sparing technique is relevant to the radical prostatectomy which is a prostate cancer treatment.

 

ED resulting from BPH treatment in most cases just an acceleration of the sexual deterioration occurring in every ageing man. Anxiety will play an important role too; we must understand that at 70 we are not the studs we were in our twenties, and just be happy when we can have satisfying sex two or three times a week, instead of two or three a day.

 

For @swissie I'd strongly recommend to look at Prostate Artery Embolisation, which treat BPH somewhat less effectively than other treatment, but fully preserves erections and sometimes improves them.

Edited June 28, 2022 by Boomer6969

[LosLobo]

13 hours ago, LosLobo said:

Benign prostatic hyperplasia(BPH) or enlarged prostate has a lot of advantages though some disadvantages over other treatments. It is available in Switzerland.

Prostate enlargement: Urolift | Uroviva

APOLOGIES - TYPO.

 

Post should have read:

For Benign prostatic hyperplasia(BPH) or enlarged prostate Urolift has a lot of advantages though some disadvantages over other treatments. It is available in Switzerland.

 

https://www.uroviva.ch/en/urology/treatment-and-diagnosis/prostate-enlargement-urolift

 

[Sheryl]

8 hours ago, Boomer6969 said:

For @swissie I'd strongly recommend to look at Prostate Artery Embolisation, which treat BPH somewhat less effectively than other treatment, but fully preserves erections and sometimes improves them.

Yes, along with Urolift and HoLEP,  PAE is one of several options for treating BPH likaly available in his home country but not available in Thailand.

 

@swissieAs you cvan see your options in Switzerland are better than in Thailand so I would encourage you to get this sorted out before coming back

[Sheryl]

14 hours ago, Saanim said:

Perhaps you had your own experience when a up-country hospital performed a prostate surgery on you? Please disclose it to us. 

 

My experience was a painless medical intervention - I do not know whether it was a TURP or another miraculous surgery - the details I trustfully leave to the attending physician). When I woke up laying prepared in the queue for the theater, asking when I will be on, I was said that was made already, knowing nothing, neither days afterwards.

 

So far,  another 7 years knowing nothing, thinking on the troubles I had had the years before, hurrying few times after midnight for a urgent catheter inserted by a nice nurse, hearing scaring stories about surgeries.

 

And yes, the state hospital is not affiliated to a university, however, assuming that the medical personal get surely some knowledge from a university as usually the case of physicians is.

 

And that good experience with a state hospital has been also with others - not always so easy - medical interventions on me when I was always wondering how with such case I would fare in another world.  

 

Quite surprised by your strong statement about up-country hospitals. Where did you get your knowledge about them? Hope that not from some falangs forums similar like this one?

    

    

My statement was specific to one procedure: TURP.

 

Upcountry hospitals can be fine for many things but I cannot recommend for that specific procedure.

 

Based on experiences of dozens of TV members over the many years I have moderated the health forum, and my own knoweldge of the Thia health system and capacbilitiers and equipment at different levels of care.

[riclag]

Op Please keep us posted on your next visit to the DR.

good luck

Edited June 29, 2022 by riclag

[Saanim]

20 hours ago, Sheryl said:

Based on experiences of dozens of TV members over the many years I have moderated the health forum, and my own knoweldge of the Thia health system and capacbilitiers and equipment at different levels of care.

Knowing that the general attitude of majority TV members is rather negative to anything of Thai conditions and Thainess anyway, I would recommend rather a personal sightseeing tour and a 1st-hand experience. 

 

Then, I could introduce you (with help of my wife) to few lead physicians in an up-country hospital, they would be happy and quite proud to present their facilities and procedures.

 

A report of such tour would be very useful for TV members having to live here and suffer for rest of their life.  

[Fore Man]

16 minutes ago, Saanim said:

Knowing that the general attitude of majority TV members is rather negative to anything of Thai conditions and Thainess anyway, I would recommend rather a personal sightseeing tour and a 1st-hand experience. 

 

Then, I could introduce you (with help of my wife) to few lead physicians in an up-country hospital, they would be happy and quite proud to present their facilities and procedures.

 

A report of such tour would be very useful for TV members having to live here and suffer for rest of their life.  

Good, thoughtful post, Saanim.  When I lived in Chiang Mai for 16 years, I found truly excellent healthcare for an assortment of maladies.  But the rub is that you truly get what you pay for.  Top class medical and dental care comes at a higher cost but the services rendered are on par with any first class medical facility elsewhere around the globe.