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 ?

[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.

[olongapo]

Hi this sounds like me, I had aquablation 7 years ago now due to scarring associated with that, turp they say is my only option, a few squirts as you say a few times a day so I must be retaining a lot of urine im worried about damaging the kidneys did they warn you about this? but not sure if I go back to UK private or here as same price!.

I have had no infections.

[Pumpuynarak]

5 minutes ago, olongapo said:

Hi this sounds like me, I had aquablation 7 years ago now due to scarring associated with that, turp they say is my only option, a few squirts as you say a few times a day so I must be retaining a lot of urine im worried about damaging the kidneys did they warn you about this? but not sure if I go back to UK private or here as same price!.

I have had no infections.

 

I have exactly the same issue but it does'nt appear to be causing me any problems at the moment, how long that will continue nobody knows. I'm not suffering any infections so i just carry on regardless. My thinking is until i have infections i'll just carry on but like you say i don't know if i'm damaging my kidneys. I had a kidney check a few months ago and they were fine.

I'll be off to BNH hospital in Bangkok to see Urologist Dr Suntchai if i ever need to, they at least do more corrective procedures than just TURP which is the case where i live here in Korat.

 

Going back to the UK is indeed an option, at least you can trust the advice you will receive, i have my doubts here after my experience in January 2022.

 

Good luck, please keep us informed. 

[rumak]

On 9/5/2024 at 10:54 AM, 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).

 if you are the "alternative natural remedy type" ........ open and read many ideas on many ailments at https://www.earthclinic.com/ .

 

works for me .........

[Pumpuynarak]

On 9/5/2024 at 11:22 AM, xylophone said:

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

 

Well i finally got to the point where my urine retention was a big problem so i went to my local urologist and he advised a camera up my willie to see any problems, no issues other than my bladder was showing signs of inflammation so he advised a catheter for two weeks. He did state like you @xylophone that it would appear my bladder is not functioning correctly and he prescribed meds for 4 weeks that are supposed to improve your bladder function, I'm due to see him again tomorrow, i'll report back. 

[xylophone]

2 hours ago, Pumpuynarak said:

 

Well i finally got to the point where my urine retention was a big problem so i went to my local urologist and he advised a camera up my willie to see any problems, no issues other than my bladder was showing signs of inflammation so he advised a catheter for two weeks. He did state like you @xylophone that it would appear my bladder is not functioning correctly and he prescribed meds for 4 weeks that are supposed to improve your bladder function, I'm due to see him again tomorrow, i'll report back. 

Thanks for the feedback @Pumpuynarak and let's hope that whatever he's given you helps with your problem. However if he has given you tablets called "Ucholine" (Bethanechol) then don't build your hopes up too much, as the two urologists I visited, even one in Bumrungrad, both gave me the same tablets and none of them worked for me. I think it is a stock standard procedure (giving out these tablets).

 

However, having said that, I doubt whether these tablets would be given for inflammation, so fingers crossed for you and please keep me/us in the loop with your progress. Good luck.

[Pumpuynarak]

7 minutes ago, xylophone said:

However if he has given you tablets called "Ucholine" (Bethanechol) then don't build your hopes up too much, as the two urologists I visited, even one in Bumrungrad, both gave me the same tablets and none of them worked for me. I think it is a stock standard procedure (giving out these tablets).

 

Yep thats exactly the tablets he's prescribed 😒

[xylophone]

1 minute ago, Pumpuynarak said:

 

Yep thats exactly the tablets he's prescribed 😒

Well they may work for you, so keep your hopes up!

[rumak]

On 12/27/2022 at 2:33 PM, Tracyb said:

TURP utilizing a laser is the treatment I had in Chiang Mai at Bangkok Hospital here a couple of years ago.  Out of the hospital in four days….no catheter when I went home.  My urologist is first rate.  After care consisted of rest. pain was minimal to non existent after I went home.  Even in hospital I didn’t require pain meds after the first day.  No painkillers, no opioids, nada.  Oddly, it was about two weeks or so before I was comfortable  sitting in and traveling in a car for more than a few minutes.  Reclining at home was fine.  No follow on symptoms and no negative effects.  Fully continent and functional.  
 

(your results may vary)

name of your urologist please .....

[simon43]

I relocated back to Myanmar a few weeks ago.  I took with me about 2 months supply of Alfuzosin, a medication that I've been taking daily for quite a few years.

 

However, since local supply in Myanmar of this drug is probably difficult to source, I tested whether I could reduce my intake of this drug to every other day, and then perhaps only 1 tablet per week.

 

Right now, I have completely stopped taking the drug and I haven't noticed any reduction or change in my ability to pee.  Yes, it takes me 5 minutes to slowly pee, and yes I have to pee 2-3 times at night and yes I still have my E-coli infection 🙂. But nothing has changed from previously.  I can live with my current condition and will only have to do something about it if I find myself in the future totally unable to pee...

[Pumpuynarak]

Update - Well life goes on, i seem to be dealing with my urinary problems even though i'm not peeing any significant amounts but its obviously doing the job, no infections and urinating a couple of times a night and 5/6 times a day.

 

 

On 11/10/2024 at 10:31 AM, xylophone said:

However if he has given you tablets called "Ucholine" (Bethanechol) then don't build your hopes up too much, as the two urologists I visited, even one in Bumrungrad, both gave me the same tablets and none of them worked for me. I think it is a stock standard procedure (giving out these tablets).

 

On 11/10/2024 at 10:40 AM, Pumpuynarak said:

 

Yep thats exactly the tablets he's prescribed 😒

 

Now i've been taking these tablets for a few months now and like you i don't really think they are doing anything, maybe i should stop taking and see what happens, what do you think ?

[xylophone]

24 minutes ago, Pumpuynarak said:

Update - Well life goes on, i seem to be dealing with my urinary problems even though i'm not peeing any significant amounts but its obviously doing the job, no infections and urinating a couple of times a night and 5/6 times a day.

 

 

 

 

Now i've been taking these tablets for a few months now and like you i don't really think they are doing anything, maybe i should stop taking and see what happens, what do you think ?

Well, I'm not a doctor so I can't offer medical advice, and as I said they didn't work for me, but there again everyone is different. 

 

I did some quite extensive research on them and the results were not encouraging, and that's putting it mildly, with some research suggesting that some urologists had stopped prescribing them because the results were poor.

 

In my opinion, based on my own experiences, it would not hurt to stop this medication for a period of time to see if you notice any change in your urinary problems and it helps if you keep a record of any changes.

 

You did say in your post that "I'm not peeing any significant amounts, but it's obviously doing the job" so I'm not quite sure what you mean by this – – what is doing the job? The tablets or your bladder?

 

For the record I'm still researching ways to treat my neurogenic bladder, ranging from neuro modulation to peripheral/percutaneous tibial nerve stimulation and I will also give hyperbaric chamber oxygen treatment a look.

 

However for the first two I may well have to travel to Malaysia or similar to get the treatment, but I'm still waiting on a response from my urologist in Bumrungrad, after I asked him if my underactive detrusor muscle was fixable – – still waiting for a reply after three weeks so I'll try again tomorrow.

 

I think the main point for you is that you are dealing with your problems, and I can't say the same about mine, still having to use the catheter every night, and even if I miss that out, I can't sleep and just getting out of bed to have a pee is impossible because my bladder won't work – – Catch-22.

 

Good luck and keep looking into it and doing your research and I will post anything of any note that I find.

[BritManToo]

On 9/5/2024 at 10:54 AM, 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).

Smoke high Indica cannabis every evening before bed, then a big wee 20-30 minutes later, and again when you wake up at sunrise.

[xylophone]

52 minutes ago, xylophone said:

Good luck and keep looking into it and doing your research and I will post anything of any note that I find.

PS. I forgot to mention that I have also been investigating stem cell treatment and even visited a clinic which treats various ailments with different sorts of stem cells, but even though there have been some good results when the selected stem cells are injected into various sites (such as tendonsetc) it appears that stem cells delivered intravenously are a bit hit and miss.

 

That is to say that if I received IV stem cells for my neurogenic bladder, there is no method by which they can be directed to the bladder, so this avenue is a no-go for me, and even if I wanted to try it on the very, very slim chance there might be an improvement, it's a big risk to take because it's very expensive. Hence the reason I'm exploring other avenues.

[Pumpuynarak]

23 hours ago, xylophone said:

You did say in your post that "I'm not peeing any significant amounts, but it's obviously doing the job" so I'm not quite sure what you mean by this – – what is doing the job? The tablets or your bladder?

 

I'm not getting any urinary infections but i am sure i'm suffering urinary retention as i'm not peeing any significant amounts so. My comment ''but its obviously doing the job'' is because i'm not suffering any issues causing problems.

 

 

 

23 hours ago, xylophone said:

In my opinion, based on my own experiences, it would not hurt to stop this medication for a period of time to see if you notice any change in your urinary problems and it helps if you keep a record of any changes.

I think i'm going to stop taking these meds and see what happens.