Symptoms don't seem too bad, I get up 2-3 times at night, just get used to it, better than kicking off drugs and ops at a youngish age

2 hours ago, Globenauta said:

 

Since your last reply, I’ve started tracking my urination frequency more precisely. It turns out I’m averaging about every 2.0 to 2.5 hours while awake, which is more reasonable than the 1–2 hours I initially estimated. That said, I still get that uncomfortable “need to hold” sensation and urgency, even shortly after going.
 

 

Still seems odd for such small enlargement. 26 ml is almost normal dize. I continue to suggest ruling out infection. 

10 hours ago, scubascuba3 said:

Symptoms don't seem too bad, I get up 2-3 times at night, just get used to it, better than kicking off drugs and ops at a youngish age

 

what supplements or drugs (if any)  have you tried ?     Any other changes you have made to alleviate urgency, or tightness at times ? 

On 5/25/2025 at 12:11 PM, Lacessit said:

Rezum was one of the options I discussed with my urologist.

 

 I prefer the advice of someone with the qualifications of FRCS, FRACS over your statistical sample of one.

I underwent Aquablation which is simular to Rezum last January, and five months later things are much better.  

4 hours ago, rumak said:

 

what supplements or drugs (if any)  have you tried ?     Any other changes you have made to alleviate urgency, or tightness at times ? 

I don't have urgency or tightness, I just get up 2-3 times at night, women with no prostate can get up more times than that

On 5/27/2025 at 2:17 PM, connda said:

TURP is brutal and I've seen too many bad outcomes.  However, the options for surgery and competent surgeons are few and far between here in Thailand.  If I ever decide to go the surgery route I'd go with laser surgery, but only with a surgeon who has a lot of these surgeries under his belt and can provide patients who would provide testimonials.  Imho, surgery is the last option.  Not the first for mild BPH.

I agree that surgery is the last option and TURP would be the last of the last options in my experience. I had tried everything from the medicines available as well as the "natural remedies" and none worked, hence settling for a TURP at Epworth Hospital in Melbourne by a top urological surgeon, but it hasn't been smooth sailing ever since and now it's come to the point that my bladder has stopped working and I put that down to a bladder neck incision operation I had here in Phuket.

 

That's why I said in my previous post that if I had my time again I would look at Urolift or iTind, which are considered minimally invasive.

 

As regards "competent surgeons" in Thailand, well that's the reason I chose Melbourne, however I do know of a guy here who had a TURP done locally and he is "peeing like a racehorse", in his words, and as I said, my Melbourne operation wasn't a great success.

On 5/23/2025 at 6:58 PM, Globenauta said:

• Did your symptoms improve over time, stay stable, or eventually require treatment?

• Has anyone regretted or benefited from doing UroLift or similar procedures relatively early?

• Did anyone find alternatives to tamsulosin that helped without sexual side effects?

As your prostate keeps growing, things will never improve long-term.  However, in the initial phases of BPH things might sometimes improve/sometimes deteriorate on a kind of random basis.   And many people die before they have any need for operations.

UrloLift does not really last very long.  So if you have it already at your age and your prostate keeps growing, you are highly likely to need a further operation later on.

Tadalafil also helps, so if you took off the tadalafil things might be worse.

Did you see a doctor in Thailand or in the West?

 

57 minutes ago, K2938 said:

UrloLift does not really last very long. 

 I recall looking at this when doing my research and it looked promising.........

How long does UroLift last for BPH relief?

Like almost any treatment or procedure, the results (and their longevity) of UroLift for BPH can vary somewhat from patient to patient. Generally speaking, however, most men who are otherwise in good urologic health can expect their UroLift results to last for many years and, in some cases, indefinitely. The UroLift implants themselves are typically considered safe and appropriate as lifelong devices. Should a patient's BPH symptoms worsen or change over time, a revision procedure may help restore their initial results, or Dr. Kasraeian may recommend another treatment mechanism to provide the most adequate level of relief possible.

 

source: https://kasraeianurology.com/blog/how-long-can-the-results-of-a-urolift-procedure-last

9 minutes ago, xylophone said:

 I recall looking at this when doing my research and it looked promising.........

How long does UroLift last for BPH relief?

Like almost any treatment or procedure, the results (and their longevity) of UroLift for BPH can vary somewhat from patient to patient. Generally speaking, however, most men who are otherwise in good urologic health can expect their UroLift results to last for many years and, in some cases, indefinitely. The UroLift implants themselves are typically considered safe and appropriate as lifelong devices. Should a patient's BPH symptoms worsen or change over time, a revision procedure may help restore their initial results, or Dr. Kasraeian may recommend another treatment mechanism to provide the most adequate level of relief possible.

 

Depends on your age.  But if you already have prostate problems as young as the OP, then you are virtually guaranteed to need a further operation as the prostate keeps growing and growing.  You can look up what the independent guidelines in the U.S. or Europe say rather than some doctor who wants to sell you something and you will see this.  But depending on your age and prostate size, it might well be ok for you.

 

25 minutes ago, xylophone said:

 I recall looking at this when doing my research and it looked promising.........

How long does UroLift last for BPH relief?

Like almost any treatment or procedure, the results (and their longevity) of UroLift for BPH can vary somewhat from patient to patient. Generally speaking, however, most men who are otherwise in good urologic health can expect their UroLift results to last for many years and, in some cases, indefinitely. The UroLift implants themselves are typically considered safe and appropriate as lifelong devices. Should a patient's BPH symptoms worsen or change over time, a revision procedure may help restore their initial results, or Dr. Kasraeian may recommend another treatment mechanism to provide the most adequate level of relief possible.

 

source: https://kasraeianurology.com/blog/how-long-can-the-results-of-a-urolift-procedure-last

I added the source, please do not post unsourced quotes.

 

Urolift has not been around enough to have data on very long term use.  To date studies show only 5 year use data:

https://pubmed.ncbi.nlm.nih.gov/28646935/

 

Basically, about 14% of patients required and receive additional surgical intervention within a 5 year period.  (Study only tells what percent had surgery, could have been additional ones with an indication for surgery who did nto receive it for one reason or another).

 

Note that improvements were statistically significant but not as complete &  dramatic as some might expect, i.e. average 36% improvement in International Prostate Symptom Score, 52% improvement in BPH Impact Index Score. These  are averages, and likely conceal considerable variation among patients i.e. there may have been some with dramatic improvement and some with little to none. 

There are likely individual factors that may help predict which patients will get the most benefit from this, and that should be discussed in detail with a urologist with extensive experience in it. It is nto a panacea nor suitable for everyone. 

16 minutes ago, Sheryl said:

Urolift has not been around enough to have data on very long term use.  To date studies show only 5 year use data:

https://pubmed.ncbi.nlm.nih.gov/28646935/

 

Basically, about 14% of patients required and receive additional surgical intervention within a 5 year period.  (Study only tells what percent had surgery, could have been additional ones with an indication for surgery who did nto receive it for one reason or another).

Thank you for this.  And please also kindly note that this is a manufacturer sponsored study which sometimes clouds the results a little even with the best of intentions.  The lead author for example is paid by Neotract, the manufacturer of Urolift.

Nevertheless, it is also undeniable that Urolift has a lower sexual function impairment risk.  So everything has its pluses and minuses.

 

I have moderate BPH, and CKD. Finally got fed up with the slightly increased urinary frequency, urgency(once i feel a need to go, i have to go if standing up VERY soon) and weak flow. Urologist put me on Duodart. Didn't notice much change at first - but after a month or two flow had improved; subsequently I have found that ejaculation takes a lot longer and volume decreased, but if anything erections are better and no effect on Libido.

I can get through the night without urinating, as long as i go after midnight before sleeping - wake up around 5 a.m., when i get up have to go quickly and usually again two times in next 2 hours. After that frequency is ok. Urgency is still an issue when i do need to go and emptying bladder not wonderful, get some leakage if too quick afterwards.

 

On the whole, i can live with it.

Hi everyone,

just wanted to share an update, especially for those who kindly shared insights and support with their messages.
 

I had a second ultrasound (done for unrelated reasons, but covered by insurance) and this time my prostate was reported at 36 grams, compared to 26 ml in the previous. I understand these units are roughly comparable, so the 10 ml-g increase surprised me. I am not sure if this is due to the approximation of the US tools.
 

In terms of symptoms, they’re still there: mainly frequent urination and urgency but I’m learning to manage and adapt:

• Cut caffeine after noon

• Reduced fluids in the evening

• Multiple trips to the toilet before bed

• Mental focus (work, etc.) seems to reduce the sensation, so I suspect a psychological component too

I still plan to follow up with a urologist recommended by Sheryl (thank you again!), but appointments are tricky, she sees patients only for 1 hour on Saturdays at Sukh8umvit hospital.
 

Thanks again to everyone here. Sharing our experiences really helps!

6 hours ago, Globenauta said:

...I had a second ultrasound (done for unrelated reasons, but covered by insurance) and this time my prostate was reported at 36 grams, compared to 26 ml in the previous. I understand these units are roughly comparable, so the 10 ml-g increase surprised me. I am not sure if this is due to the approximation of the US tools...

 

There is something odd with these numbers.

 

The density, aka specific gravity or specific weight, of the prostate gland is 1.05, which means that 36 g (grammes; USA: grams) corresponds to 34 mL (millilitres).

 

Apparently, the ultrasound determination of the volume can vary greatly depending the bladder volume at the time the determination is made:

 

Indian Journal of Urology https://share.google/X28OF817TbrOlZvqL

 

On 5/24/2025 at 4:48 AM, Sheryl said:

Most common cause of prostatitis is E. Coli, which an STD panel would nto detect.

Also, depending on the type of test done, there can be false negatives esp for chlamydia.

 

So you still need to rule out prostatitis IMO. It is just not usual for mild BPH to cause the degree of urinary frequency you describe. Add to that the lack of relief from tamsulosin, and suspicion of an infection rises.

 

This doctor is  not too far from Samut Prakan  and has been recommended by other board members

https://www.sukumvithospital.com/doctorprofile.php?id=188&lang=en

 

Ideally you want toi get a prostate massage to express prostatic fluid then a culture and sensitivity

 

As for your BPH: iti s a progressive condition and it worsens with age, but how fast varies greatly. One of the 2 classes of medication used for it can help reduce prostate size/slow growth. These are the 5-alpha reductase inhibitors, such as finasteride and dutasteride. It takes 6-12 months to see the therapeutic effect of these drugs, and they do unfortunately sometimes worsen ED. When they do, sometimes this effect eases up with continued use and sometimes not.

 

The other class of drugs used for BPH are alpha antagonists, such as tamsulosin and doxazosin.  These do nto affect oprostate size but rather give symptomatic relief from blockage by relaxing the smooth muscles in the prostate and bladder neck. Unlike the first class of drugs, action is almost immediate. You already tried this class of drug without  relief.

 

Cialis is also sometimes used to relax the muscles around the bladder neck and prostate, likewise only symptomatic relief. And of course, for ED. 

 

Since the 5-alpha reducatse inhibitors do, over time, reduce the size of the prostate and slow progression of BPH, you  could ask doctor about a daily regimen of Cialis plus finasteride or dutasteride as a way of  potentially off-setting the negative effect of the latter on erectile function. May or may not work, and may or may nto be suitable i nthe context iof your overall medical history.

 

Urolift is nto widely available here, just a few places and doubt any doctor  would  do it for mild case of BPH. Like all treatments, it has potential side effects. 

 

Some people feel that saw palmetto and/or milk thistle supplements help with BPH, others don't, and there is a lack of clear evidence either way. No harm in trying.

 

But above all, I suggest you rule out potential infection as your urinary frequency is unusual from mild BPH. 

 

 

 

 

 

 

For mild cases like the OP's, what about a short course (7-10 days) of combination of an antibiotic and an NSAID anti-inflammatory, for example tmp-sulfamethoxazole plus celecoxib or etodolac. This is often prescribed in the west by clinicians, even when the urine test are negative for an infection, as it is found to be effective quite often for the initial stages of the BPH. It makes sense to have this trial short treatment, before committing to longer-term medications described above. Is this not a common practice in Thailand?

On 5/30/2025 at 5:54 PM, Sheryl said:

Urolift has not been around enough to have data on very long term use.

I recently read a newspaper article about HoLEP, which stands for Holmium Laser Enucleation of the Prostate.

I personally have never heard of this surgical procedure. What is your take on this?

On 5/23/2025 at 6:58 PM, Globenauta said:

Has anyone else been in a similar “grey zone”?

• Did your symptoms improve over time, stay stable, or eventually require treatment?

• Has anyone regretted or benefited from doing UroLift or similar procedures relatively early?

• Did anyone find alternatives to tamsulosin that helped without sexual side effects?

Any shared experiences would be truly appreciated.

Thanks in advance.

Yeah, I had it for 2 years, then took antibiotics and it went away for 6 months, so I took antibiotics again, and another 6 months free weeing.

Amoxcillin 500, 2 pills a day for 5 days 40bht, every 6 months or so ........

Still have to wee frequently during the day (think it damaged my bladder).