Any updates to recommended urologists (BKK or PTA)?

[MeaMaximaCulpa]

Hello @Sheryl,

 

Is your August 2016 thread about urologists still up-to-date, or do you have any new and bright additions or perhaps deletions?

 

I have moderate BPH, and have used different herbal supplements to keep it in reasonable check until recently, where I became aware that one ingredient (beta-sistosterol) may have a negative effect on the optic nerve. I do in fact have a thinning of the optic nerve sheat as seen on OCT scans, but without any increased eye pressure. I don't know if beta-sistosterol really is bad and if it did cause the thinning or not, but I discontinued the supplement right away, just to be on the safe side.

 

I would like to find an excellent urologist to discuss potential treatments, both medication (if I find it acceptably safe) or some kind of TURP procedure, steam, ...?

[Sheryl]

4 hours ago, MeaMaximaCulpa said:

Hello @Sheryl,

 

Is your August 2016 thread about urologists still up-to-date, or do you have any new and bright additions or perhaps deletions?

 

I have moderate BPH, and have used different herbal supplements to keep it in reasonable check until recently, where I became aware that one ingredient (beta-sistosterol) may have a negative effect on the optic nerve. I do in fact have a thinning of the optic nerve sheat as seen on OCT scans, but without any increased eye pressure. I don't know if beta-sistosterol really is bad and if it did cause the thinning or not, but I discontinued the supplement right away, just to be on the safe side.

 

I would like to find an excellent urologist to discuss potential treatments, both medication (if I find it acceptably safe) or some kind of TURP procedure, steam, ...?

 

The list is current.

 

Invasive procedures like TURP, Rezum, laser (usually preferrable IMO to the former two, but less widely available in Thailand) are to be considered only after medical therapy alone has failed.

 

From what you say, you have not yet even tried medications other than supplements.

 

Medical treatment of BPH is something any urologist can manage but as it sounds like you want one with particularly good interpersonal manner/willingness to talk at length about potential side effects etc, I suggest  https://www.bumrungrad.com/en/doctors/Charuspong-Dissaranan

 

Usual  medical management of BPH consists of a combination of these 2 classes of drug:

 

Alpha blockers like doxazosin, tamsulosin, alfuzosin and silodosin. These work by relaxing the neck of the bladder to make it easier to urinate and effect is very fast, what it has not done for you in a week or two, it likely won't.  These drugs tend to lower blood pressure, so if on a BP med may need dose adjustment.  Retrograde ejaculation may occur especially if prostate is very large. Thus is harmless and does nto affect sexual sensations or performance, but some men dislike it for psychological reasons.

 

Alpha-reductase inhibitors like finasteride and dutasteride. These work very slowly by actually reducing prostate size over time. Takes 6-12 months to see full result. As this class of drug works by partially blocking the action of testosterone, reductions in libido and sometimes (about 10%) erectile dysfunction may occur. On the plus side, they promote hair growth.

 

 

 

 

[MeaMaximaCulpa]

Thanks @Sheryl for very detailed and swift answer! And you are of course spot on in your assessment of me as well . Difficult patient for sure! 🙃

 

The herbals I have used (saw palmetto, stinging nettle root extract, pygeum, lycopene, beta-sistosterol, ++) I believe are (mostly?) of the 5-alpha-reductase inhibitor type, and I do feel (but cannot prove) that they did help to if nothing else slow the growth of the prostate, and keep the flow ok (but low), except if I wake up 2-3am with a full bladder, then flow is VERY slow indeed. Therefore I am worried that one day (or rather night) I may not be able to pee at all, and have to go to the emergency room. But I was not aware that one can actually shrink the prostate, I thought that once the tissue had grown, it would either continue to grow or stop. But not shrink?

 

I have also heard (in a podcast with Dr Peter Attia and a famous urologist) that this type of drugs (herbal or otherwise) may suppress the PSA to give a too low reading, potentially masking a warning flag for e.g. prostate cancer. Is this your experience as well? My PSA has been in the 2.5 to 3 region for quite a few years, and I have no other indications of cancer so far. Touch wood.

 

I will study the above mentioned drugs and therapies, and get an appointment with your recommended doctor for next time I am in BKK.

 

So thanks again, you really are a valuable resource on this forum!