Enlarged Prostate/BPH - What is the best/most effective operational procedure ?

[Pumpuynarak]

18 hours ago, xylophone said:

I have posted before on this subject and I had similar conditions after my Turp many years ago, which initially seemed to improve, but then after having a bladder neck incision done here in Phuket, things went downhill and now I have to use a catheter twice a day to empty my bladder, because it won't work, and constipation is still something I have to deal with.

 

I know I'm not emptying my bladder because I use a catheter and measure the amount of urine I pass each time (twice a day, sometimes once a day) and that can be up to 800 to 900 ml, far more than the everyday bladder should hold.

 

The fact that you do urinate 3 to 4 times a day is good, but may I suggest you pee into a measuring jug and measure how much urine you extract each time. I say this because the urologist here has said that I need to keep the urine level in my bladder below 400ml, and if I don't I am susceptible to an infection.

 

I have managed to stave off infections in the main by taking a tablet called Hiprex or Uramet, both of which contain methenamine hippurate and are taken twice a day, and this acidifies the urine making it difficult for bacteria to take hold (or so the literature says) however I have to say it works for me.

 

May I wish you all the very best in your improvements and, as I said before, please keep us informed as to your progress.

 

Many thanks for your post, great info. Well my urination frequency has increased to 5/6 times a day but remained at a couple of times a night but i am constantly concerned regarding infections as i'm only peeing small amounts so my bladder never gets anywhere near emptying.

I think i might start taking the tablets you mention as a safeguard.

 

At the end of the day i believe i will have to undergo another procedure and am thinking of trying Dr Suntchai at Bangkok Nursing Home Hospital as they/he do carry out 4 different procedures rather than my local private hospital or any hospital in Korat as they only do the Turp. My Turp was not a success as a friend here in Korat who had the Turp with the same urologist is pissing like a horse. I have lost all confidence in this urologist and the Turp procedure as he has never given me despite my questioning a satisfactory explanation, he just replies like a politician when questioned. I have now obtained a copy of my medical records of the procedure to take to Dr Suntchai at BNH for his perusal (records are obviously in Thai)

 

I am all geared up for any emergency appointment to Dr Suntchai, i have a driver ready at anytime of the day or night but might have to visit a urologist locally first if i can't pee to put a catheter in before my Bangkok journey.

 

God getting old sucks.

 

PS - What MG are you taking for the Hiprex or Uramet tablets ?

Edited September 5 by Pumpuynarak

[simon43]

Although no-one wants a UTI, I think any detriment of this depends on the individual.  I have symptomatic UTIs, which means that I effectively have permanent E.Coli infections in my prostate, (probably as a of 2 prostate stones which seem to encourage UTIs).

 

I've got used to the mild stinging as I pee and the fishy smell! Analysis of the infection indicates that it is not treatable by 'standard'  antibiotics and Hiprex didn't help.  Apparently only some very expensive antibiotic 'might' help, and my medical insurance doesn't cover this, so I've learn to live with the UTIs.  Their presence does play havoc with my PSA values, but it stays steady at about 9, so as long as it remains steady, I'll just get on with life.

 

 

[xylophone]

3 hours ago, simon43 said:

Although no-one wants a UTI, I think any detriment of this depends on the individual.  I have symptomatic UTIs, which means that I effectively have permanent E.Coli infections in my prostate, (probably as a of 2 prostate stones which seem to encourage UTIs).

 

I've got used to the mild stinging as I pee and the fishy smell! Analysis of the infection indicates that it is not treatable by 'standard'  antibiotics and Hiprex didn't help.  Apparently only some very expensive antibiotic 'might' help, and my medical insurance doesn't cover this, so I've learn to live with the UTIs.  Their presence does play havoc with my PSA values, but it stays steady at about 9, so as long as it remains steady, I'll just get on with life.

 

 

Sorry to hear that Simon43, however Hiprex will not cure a UTI, just prevent one from occurring, so if you have a "symptomatic UTI" then you will need to go on to something like I had to a while back before I discovered Hiprex, which was a Carbapenem antibiotic, delivered intravenously once a day for 10 days or 14 days (can't remember now). It was expensive but I considered it worth the outlay.

[simon43]

2 minutes ago, xylophone said:

Sorry to hear that Simon43, however Hiprex will not cure a UTI, just prevent one from occurring, so if you have a "symptomatic UTI" then you will need to go on to something like I had to a while back before I discovered Hiprex, which was a Carbapenem antibiotic, delivered intravenously once a day for 10 days or 14 days (can't remember now). It was expensive but I considered it worth the outlay.

Yes, Carbapenem antibiotic, that's the one. Not cheap, and in my current location (Khao Lak), I doubt if the local small hospital has such a medicine. The UTIs don't bother me too much - I wonder if there are some dietary ideas which might help (I drink pomegranite juice and cranberry juice when I can find this in the local shops).

[xylophone]

3 hours ago, Pumpuynarak said:

 

Many thanks for your post, great info. Well my urination frequency has increased to 5/6 times a day but remained at a couple of times a night but i am constantly concerned regarding infections as i'm only peeing small amounts so my bladder never gets anywhere near emptying.

I think i might start taking the tablets you mention as a safeguard.

 

At the end of the day i believe i will have to undergo another procedure and am thinking of trying Dr Suntchai at Bangkok Nursing Home Hospital as they/he do carry out 4 different procedures rather than my local private hospital or any hospital in Korat as they only do the Turp. My Turp was not a success as a friend here in Korat who had the Turp with the same urologist is pissing like a horse. I have lost all confidence in this urologist and the Turp procedure as he has never given me despite my questioning a satisfactory explanation, he just replies like a politician when questioned. I have now obtained a copy of my medical records of the procedure to take to Dr Suntchai at BNH for his perusal (records are obviously in Thai)

 

I am all geared up for any emergency appointment to Dr Suntchai, i have a driver ready at anytime of the day or night but might have to visit a urologist locally first if i can't pee to put a catheter in before my Bangkok journey.

 

God getting old sucks.

 

PS - What MG are you taking for the Hiprex or Uramet tablets ?

Yes, getting old does suck!

 

Anyway onto your post, whilst I wasn't exactly "pissing like a horse" after my TURP, at least some water was flowing, although it never achieved my expectations and many years later I did consider going for another one, but decided against it for one reason or another.

 

Then after the bladder neck incision, which was carried out after a cystoscopy, when the urologist said that I had scar tissue at the bladder neck and that needed to be removed as it was impeding urine flow, however after that procedure things were never the same for me, what with retrograde ejaculation and later on the bladder ceasing to work at all!!!! Hence the reason I use a catheter twice a day now – – I will state that it is not particularly painful, just uncomfortable, but I would much rather do without it as you can imagine.

 

I did go to see the best urologist at Bumrungrad, and despite a couple of hours or so of tests, probes and measurements, he wasn't able to give me an explanation as to why the bladder wasn't working, so here I am!

 

The Hiprex or the Uramet tablets really do work for me and they only come in 1 mg size, so one in the morning and one in the evening is sufficient for me. However here is the rub......I haven't been able to find them in Thailand, however I have found a couple of pharmacies in Australia who will ship them to me here, and I use those, but be warned the cost of shipping is as much as the tablets themselves, so now I order four bottles at a time, which incur import duty of about 120 baht, so no big deal in that respect.

 

I have seen them on eBay and Amazon, but they are almost always out of stock, but could be worth a try.

 

I too have all of my test results with me and I have sent a copy of them to my doctor/surgeon in NZ, who has been absolutely brilliant for me over the years and he's going to approach a couple of his urologist colleagues to see if they can shed any light on what might be causing a nonworking bladder? He is a great guy and I am so thankful for his help, however I'm not hopeful that a solution can be found, sadly.

 

If you want I will send you a PM with regards to the particular pharmacy in Oz who will supply and ship the aforementioned tablets if you want.

 

Please stay in touch as I would love to hear your progress, and I'm hoping that whatever they find with your situation can shed some light on mine!!!!

 

All the very best to you,

 

Xylo

[xylophone]

11 minutes ago, simon43 said:

Yes, Carbapenem antibiotic, that's the one. Not cheap, and in my current location (Khao Lak), I doubt if the local small hospital has such a medicine. The UTIs don't bother me too much - I wonder if there are some dietary ideas which might help (I drink pomegranite juice and cranberry juice when I can find this in the local shops).

I did quite a bit of research on this also, but unfortunately the cranberry juice which I can buy here contains only 25% of cranberry juice with the rest being made up of sugar and water (as I recall) so no real use. 

 

The only thing which can work and did for a while for me, is a tablet called D-Mannose, but I don't think they are cheap, but that's getting away from the root cause for you, which is an already established E. coli infection, and no amount of cranberry juice or D-mannose will help I believe, because they won't kill bacteria, just stop it from adhering to the bladder wall BEFORE it becomes established.

 

It would appear that a Carbapenem is your only solution, although it would be worth you having a culture done again at a bigger hospital, because there is at least one new antibiotic on the market, and others do seem to have an effect, and a friend with a recent UTI was prescribed Sitafloxacin, but I don't know if that was for E. coli or E. coli ESBL on which a very limited range of antibiotics will work. Having said that I'm not a fan of fluoroquinolones because of the potential harm to tendons in some people.

 

Just a thought.......it is possible that a small hospital in an outlying area could have Carbapenem (or one of that group) sent to the hospital for use???

 

Good luck with whatever you try, and please keep the posters here informed, as we seem to be in the same boat sometimes!
 

 

 

[Pumpuynarak]

Great post once again, yes indeed i will keep you informed. I take my hat off to you in dealing with your problem having to use a catheter twice a day, that must be difficult to deal with but as you say you get used to it. I've only used a catheter after my Turp for 7 days and i really did'nt have any problems, no real pain etc, it really did'nt bother me and i was very surprised at the fact that every morning the bag was full of urine and i'm deffo not peeing that amount of urine the 2 times each night so lots of urine retention.

 

Yes indeed please send me a PM with the details for me to obtain the tablets as i really don't want any infections to add to my problem. Great to hear you have a Doc in NZ looking out for you, i wish i had in the UK.

 

And the very best to you Sir.

[xylophone]

3 hours ago, Pumpuynarak said:

Yes indeed please send me a PM with the details for me to obtain the tablets

PM sent.