Bladder problems

[BangkokHank]

About three weeks ago, I started having urinary problems: frequent urination; sometimes difficulty urinating even when feeling the strong urge to; blood in urine, etc. A visit to a urologist revealed that I had a bladder infection, cause unknown. I was prescribed Ciprofloxacin and my symptoms started improving immediately. After the course of antibiotics was finished, I had my urine checked again and it showed no sign of infection. A few days later, however, the symptoms returned. It was clear to me that we had attacked the symptoms, but that we hadn't addressed the underlying cause of the problem.

I went to a different urologist for a second opinion and he said that my symptoms were those of stones. I then returned to my original urologist and told him what the other doctor had said. He then suggested an IVP and an ultrasound, which I had done yesterday. These tests showed numerous large stones in my bladder. The tests also indicated that my prostate is of a normal size. (18.9cm3)

My doctor has suggested a cystolitholapaxy to eliminate the bladder stones. He mentioned that this would entail a 3-day hospital stay. He also said something about there being a (more expensive) laser option and a less expensive (but still expensive) non-laser option. Have any ThaiVisa members had either of these procedures done before? If so, any thoughts / suggestions / recommendations? Is it possible that the non-laser option entails a 3-day hospital stay but that the laser option would involve a much briefer stay?

One thing that confuses me is that my doctor suggested that my bladder stones were caused by urinary retention resulting from an enlarged prostate. But my KUB ultrasound clearly states that my prostate size is normal - even unremarkable. (The first time I've ever been pleased with any part of me being unremarkable.) My doctor went on to say that he would decide during the bladder stone removal whether or not I needed work done on my prostate. He mentioned possibly needing to do a TURP procedure during the cystolitholapaxy. This scares me, as I have read horror stories about the TURP. Why would he suggest messing with my prostate if it is of normal size? (I wonder if he even read the report about my prostate size? I requested copies of all tests and reports and only just discovered this myself a few minutes ago!)

I am scheduled to meet the urologist again on Thursday to talk about doing the procedure to eliminate the bladder stones. I hope there are people out there who can help me to make sure I ask the right questions and get the right things done.

Thanks in advance for any advice or answers.

[h90]

please also check if the stones maybe can be destroyed with ultra sonic.

Take a few different opinions....

[pmarlin]

If it was me I would go with the cystolitholapaxy it is the most common method and kind of routine. and like you said cheaper. also done as an outpatient.

How it is done

A tool called a cystoscope, a tiny flexible probe with a camera attached to the end, is inserted into the patients bladder. The cytoscope is then used to deliver ultrasonic waves or laser to break up the stones into tiny pieces. These small pieces can then be flushed from the bladder with fluids.

The surgeon may place a stent into the patients urethra to help protect the lining and allow the fragments to pass out of the body.

[h90]

If it was me I would go with the cystolitholapaxy it is the most common method and kind of routine. and like you said cheaper. also done as an outpatient.

How it is done

A tool called a cystoscope, a tiny flexible probe with a camera attached to the end, is inserted into the patients bladder. The cytoscope is then used to deliver ultrasonic waves or laser to break up the stones into tiny pieces. These small pieces can then be flushed from the bladder with fluids.

The surgeon may place a stent into the patients urethra to help protect the lining and allow the fragments to pass out of the body.

aaahhhh good...I confused that with a surgery.....

Friend of mine at university told me a long time ago that his father (Doctor) isn't doing it as there isn't as much profit in it. So only for the money he prefers to cut open.....

Someone who had something like that told me that peeing out the stones hurt a lot (if you are male, easier for females), but the operation itself wasn't bad.

(but that was a long time ago, sure there are some additional improvements)

[BangkokHank]

If it was me I would go with the cystolitholapaxy it is the most common method and kind of routine. and like you said cheaper. also done as an outpatient.

How it is done

A tool called a cystoscope, a tiny flexible probe with a camera attached to the end, is inserted into the patients bladder. The cytoscope is then used to deliver ultrasonic waves or laser to break up the stones into tiny pieces. These small pieces can then be flushed from the bladder with fluids.

The surgeon may place a stent into the patients urethra to help protect the lining and allow the fragments to pass out of the body.

Thanks for your comment. I wonder why the hospital where I am thinking of having it done is telling me that I need to spend three days in the hospital: The first day for "preparation"; the second day for the procedure; and the third day for recovery. That seems a bit much to me. I researched it a bit on the internet and found information suggesting that it can be done on an outpatient basis, but I also found information from equally credible sources suggesting that the average hospital stay for the procedure is FIVE days! How can it be so different? Does anyone here have personal experience with this? How long did you stay in the hospital? Thanks.

[Issangeorge]

Is it a government hospital? They seem to want you to stay in the hospital. The same for cataract surgery.

[BangkokHank]

Is it a government hospital? They seem to want you to stay in the hospital. The same for cataract surgery.

Yes it is a government hospital. So that must be it. I was talking to a Thai nurse friend today who confirmed what you said - that it is the norm at Thai government hospitals to have patients stay for several days beyond what seems necessary. It would be fine with me if I weren't paying for it although the government hospital is a third of the price of the private hospital where I was diagnosed. (After I balked at the price at the private hospital, the doctor there, to my utter surprise, told me that he also works at a cheaper government hospital and I could do the procedure there with him! My Thai nurse friend said that having her there with me probably contributed to his willingness to make that kind offer.)

[Robby nz]

There is a topic on here from someone who had this done, He had it done at the air force hospital at Don Muang.

I haven't looked it up but he PM'd me at the time and if the OP wants to MP me I can put you on to him.

[BangkokHank]

There is a topic on here from someone who had this done, He had it done at the air force hospital at Don Muang.

I haven't looked it up but he PM'd me at the time and if the OP wants to MP me I can put you on to him.

I am in touch with him by PM already. Thanks very much.

[BangkokHank]

Back to one of the point brought up in my original post: Based on my research, it would appear that this procedure (the cystolitholapaxy) should be able to be done on an out-patient basis. Does anyone happen to know a hospital in Bangkok where this is possible? Work commitments make it difficult for me to spare the three to four days required by the Thai government hospital where I was looking to have it done.

[Sheryl]

Should be able to have it as same day surgery in a private hospital but costs will be at least 3 times higher than the inpatient version in a govt hospital. They will probably expect you to stay 2 days or so but if you strongly state a preference otherwise, can likely be accomodated.

Note that after the procedure, the broken up stones still need to pass and this can be painful - i.e,. you may be unable to work for a few days. Assuming the Thai govt hospital was going to have you come in one day before the procedure, the difference in time lost from work may really be just one day.

That it can be done as an outpatient does not mean you will be up and about and able to work right afterwards. I'd plan on a week off.

BTW if once the procedure is done, by the next day you feel up to it can ask to go home. 3-4 days is just an estimate and influenced by among other things the expectation that you will need pain meds afterwards. Thai doctors and hospitals are hesitant when it comes to prescribing narcotics for outpatient use. Not only that, but they also expect people to be knocked out cold by them, even in low doses -- and indeed, Thai patients usually are. I have literally seen Thais unconscious for hours from as little as tylenol plus codeine. Hence the logic to assuming someone will need to stay a few days after many procedures.

About a year ago I had a procedure done in a Thai hospital that would be outpatient in the West. The all inclusive price included a one night 2 day hospital stay. Told the surgeon I wanted to go home right afterwards, he said whether I could or not would depend on whether I was needing narcotics for pain relief.

I refused post-op pain meds and went home within 2 hours of leaving the OR.

[BangkokHank]

Thanks very much for your response, Sheryl. You are a treasure to the Thai Visa community. Please see my specific responses to your comments below in red:

Should be able to have it as same day surgery in a private hospital but costs will be at least 3 times higher than the inpatient version in a govt hospital. You do seem to be rather well-informed: The price quoted to me by the private hospital was 100,000 to 150,000 baht, but I don't know how much time this would have included in the hospital, and the price quoted by the government hospital was 30,000 to 60,000 baht. They will probably expect you to stay 2 days or so but if you strongly state a preference otherwise, can likely be accomodated.

Note that after the procedure, the broken up stones still need to pass and this can be painful Ouch! I was under the impression that the stones would be sucked out by some kind of instrument during the procedure. I guess it's better to be prepared for reality! - i.e,. you may be unable to work for a few days. Assuming the Thai govt hospital was going to have you come in one day before the procedure, the difference in time lost from work may really be just one day.

That it can be done as an outpatient does not mean you will be up and about and able to work right afterwards. I'd plan on a week off. Okay. Thanks for that.

BTW if once the procedure is done, by the next day you feel up to it can ask to go home. 3-4 days is just an estimate and influenced by among other things the expectation that you will need pain meds afterwards. Thai doctors and hospitals are hesitant when it comes to prescribing narcotics for outpatient use. Not only that, but they also expect people to be knocked out cold by them, even in low doses -- and indeed, Thai patients usually are. I have literally seen Thais unconscious for hours from as little as tylenol plus codeine. Hence the logic to assuming someone will need to stay a few days after many procedures. Your comments about the pain medication answered another one of my questions: I asked my Thai nurse friend why there was such a huge range in the prices quoted by the hospitals for a single procedure. She told me that it depended on how much medicine one uses. I didn't understand this because I thought that the amount of medicine used for any given procedure wouldn't vary much. But apparently, it must be the large possible variance in the usage of the pain medication that would account for the huge difference in prices quoted for the procedure. (My initial assumption was that the lower price was for Thais and the higher price for foreigners.)

About a year ago I had a procedure done in a Thai hospital that would be outpatient in the West. The all inclusive price included a one night 2 day hospital stay. Told the surgeon I wanted to go home right afterwards, he said whether I could or not would depend on whether I was needing narcotics for pain relief.

I refused post-op pain meds and went home within 2 hours of leaving the OR. I will keep that in mind, Sheryl, and just go by how I am feeling.

To tell you the truth, I am a bit apprehensive about doing this procedure in a government hospital. It's not the operation that I'm concerned with - because I'm sure that will be done in an operating room. Rather, I am concerned with sharing a room with a dozen other people during my recovery. I have never spent a single night in a hospital in my life, much less three consecutive ones in a Thai hospital. My most similar experience was sharing a large room with 20 other backpackers in a youth hostel in Europe during my youth. And I was unable to sleep in a room full of snorers. Should I bring my own sleeping pills? Also, what do I do with my personal effects (toiletries, electronic devices like mobile phone, Kindle, laptop, clothes, etc.)? Will I be given a locker? If so, do I need to bring a lock? What about showering? In a private room there is a private bathroom, but in a shared room, will I be expected to go without showering for three days? Is there anything else I should know about staying in a hospital in general, and a Thai one in particular? Thanks in advance. And thanks again for your helpful comments, Sheryl.

[Issangeorge]

They have private rooms in Government Hospitals, some are quite good. I prefer the ward, I find it quite entertaining. There is a shower room in the ward. There is a locker of sorts beside your bed in the ward, can't remember if it has a lock. The only valuable thing I took was my phone. Take an extension cord for charging. Take your own towel, and toiletries, and a pillow.

[Robby nz]

No problem with private rooms in any Govt hospital, just tell them what you want.

Sometimes the beds can be hard, designed for Thai, some OK, best to go look before you make any decision, they wont mind.

Cost for a private room is a bit more than a ward but not up to private hospital costs.

Private rooms usually have a couch that can be a second bed and rellies are allowed to stay overnight.

I have been on both sides, as a patient and as overnight support staff for a patient..

Meals are also designed for Thai Jok or Kao Dom for breakfast but most will cater for you if you ask, they came up with toast and eggs for me. If you have someone staying with you or visiting they can bring food of your choice.

Clear all these things with the DR before you make a final decision, look and ask.

[BangkokHank]

Well, my appointment at Ratchawithi Hospital yesterday did not go at all as I expected. I went there expecting to do nothing other than set up my cystolitholapaxy appointment. Instead, the purpose of the appointment turned out to have been to set up a cystoscopy - which, as I have now learned, is required prior to the cystolitholapaxy. From speaking with another member of Thaivisa who has had many cystoscopies done at Thai government hospitals, I was expecting it to cost around 2,000 baht and to be done on an outpatient basis. Instead, they are asking for 20,000 baht - and and overnight hospital stay. I have since checked with Samitivej and that's about the same that they (Samitivej) charge for the same procedure, albeit without an overnight stay.

I didn't understand it at the time but now, with the help of my Thai nurse friend who accompanied me, I have learned that some Thai government hospitals have two "tracks". The cheaper track apparently requires longer waits; the more expensive one, shorter waits - if I understood it correctly. (I actually encountered this same phenomenon earlier this year at another Thai government hospital when I was looking for cheaper medical care. My Thai nurse friend brought me to Ramathibothi Hospital - and we were both disappointed to learn that foreigners have no choice but to use their so-called "Premium Clinic".) Does anyone else have experience with this dual-track (some might say "dual-pricing") system at Thai government hospitals? I personally see no point in using a Thai government hospital if the price is the same as a private hospital. Am I missing something here?

In any case I feel like I'm back to square one in trying to find a hospital where I can have a cystoscopy done, followed by a cystolitholapaxy - for a reasonable price. One Thaivisa member is already helping me on this, but any other thoughts / suggestions are welcome and appreciated.

ase I

[JDGRUEN]

OP - you have done very good research. And it seems like you have a good solution and understand it... Thanks for the education..

I have had bladder stones in the past ... two different occasions. I passed the stones both times at home with no medication... except ibuprofen and maybe I took a Darvon available at the time... It was the most horrible long lasting pressure pain I have ever experienced ... I am told it is a pain similar to unmedicated childbirth... But the pain has a lot to do with the size of the stone and whether is has jagged edges that make micro cuts... I imagine your doctor will administer a medication that basically numbs the urethra. There is such a drug... From your report I would expect everything to be okay... Considering the alternative is constant infections going on and off for years - a week of being uncomfortable sounds like a good trade off.

As for the suggestion for prostate surgery by one of the doctors... I strongly suggest - "Don't Do It!!!

Best Wishes...

[Robby nz]

Well, my appointment at Ratchawithi Hospital yesterday did not go at all as I expected. I went there expecting to do nothing other than set up my cystolitholapaxy appointment. Instead, the purpose of the appointment turned out to have been to set up a cystoscopy - which, as I have now learned, is required prior to the cystolitholapaxy. From speaking with another member of Thaivisa who has had many cystoscopies done at Thai government hospitals, I was expecting it to cost around 2,000 baht and to be done on an outpatient basis. Instead, they are asking for 20,000 baht - and and overnight hospital stay. I have since checked with Samitivej and that's about the same that they (Samitivej) charge for the same procedure, albeit without an overnight stay.

I didn't understand it at the time but now, with the help of my Thai nurse friend who accompanied me, I have learned that some Thai government hospitals have two "tracks". The cheaper track apparently requires longer waits; the more expensive one, shorter waits - if I understood it correctly. (I actually encountered this same phenomenon earlier this year at another Thai government hospital when I was looking for cheaper medical care. My Thai nurse friend brought me to Ramathibothi Hospital - and we were both disappointed to learn that foreigners have no choice but to use their so-called "Premium Clinic".) Does anyone else have experience with this dual-track (some might say "dual-pricing") system at Thai government hospitals? I personally see no point in using a Thai government hospital if the price is the same as a private hospital. Am I missing something here?

In any case I feel like I'm back to square one in trying to find a hospital where I can have a cystoscopy done, followed by a cystolitholapaxy - for a reasonable price. One Thaivisa member is already helping me on this, but any other thoughts / suggestions are welcome and appreciated.

ase I

I have been having cystosope done at Pramonkutklau hospital, the army hospital now for several years, for cysts in the bladder, had one recently and am now on once a year appointments.

Cost is 2000b per, as an out patient.

If I can be of any help let me know.

[NancyL]

I didn't understand it at the time but now, with the help of my Thai nurse friend who accompanied me, I have learned that some Thai government hospitals have two "tracks". The cheaper track apparently requires longer waits; the more expensive one, shorter waits - if I understood it correctly. (I actually encountered this same phenomenon earlier this year at another Thai government hospital when I was looking for cheaper medical care. My Thai nurse friend brought me to Ramathibothi Hospital - and we were both disappointed to learn that foreigners have no choice but to use their so-called "Premium Clinic".) Does anyone else have experience with this dual-track (some might say "dual-pricing") system at Thai government hospitals? I personally see no point in using a Thai government hospital if the price is the same as a private hospital. Am I missing something here?

I've had a fair amount of experience assisting foreigners at Chiang Mai University Hospital -- the gov't part of the hospital is called Suan Dok and the private part is called Sripat. Both use the same operating rooms, doctors, MRI/CTs, etc. Some buildings in the complex have some floors that are considered Sripat floors and other floors for Suan Dok services.

Foreigners are able access the services of the cheaper gov't hospital (Suan Dok) and expected to wait in the same queues as the Thai people. The services are cheaper, but recently they did institute a slightly higher room charge (even for the ward rooms) for foreigners at Suan Dok. The other services seem to be charged at the Thai rate. They do offer a "western menu" at Suan Dok that's twice the price of the basic Thai menu, but still responsibly priced. (Not very good, but at least you get eggs and toast vs. khao tom for breakfast) There are rumors that you can get private rooms at Suan Dok, but every time a foreigner asks, he is told to go to Sripat. I've never known of a foreigner who has been able to get a private room in the gov't hospital. There's always some excuse -- they'll all full, you have to be a gov't employee, etc, etc. Why not go to Sripat? Of course, at Sripat, it's not just that the room rates are higher, but so are all the charges -- nursing, meals, MRI, CTs, PT, everything.

In answer to the other questions about the wards. I wouldn't mind staying in a Suan Dok ward during the cooler time of year. My biggest complaint would be the lack of aircon. I wouldn't mind going down the hall to shower or use the toilet or sharing the room with 7 - 8 others. But the lack of aircon would be a killer.

[BangkokHank]

Nancy: Thanks very much for the explanation. It seems that Thai government hospitals are wanting to share in the bounty of treating farangs by essentially charging a lot more for pretty much the same service (with the main difference being the waiting times). Your explanation was very enlightening and very helpful for my future encounters with the Thai medical world. Thanks.

And Robbynz: I have just sent you a PM requesting details. Thanks to you too.

[Sheryl]

Did you ask about using the regular public channel? Should be possible at much lower cost though there will be waits.

Suggest you also contact Phyathai Hospitals re cost, if it turns out to be affordable let me know and I wil suggest which doc as there are several very good urologists there. [email protected] It's private but medium sized and mostly catering to middle class Thais.

Cystoscopy is not a test done before actual stone removal. Stone removal is done via cystoscopy. If the stones are too bug to remove intact then they do cystolitholapaxy which is delivered through a cystioscope. In other words, when yo uarrived at Ratchawithi they were set up to do the fukl procedure and that is what would have cost 20,000 Baht which is frankly a pretty reasonable cost.

[rajyindee]

It depends on the size of the stones and their position in the bladder. The flexible option camera may indicate that the size and/or position of the stones requires the rigid procedure, in which case you'll end up paying twice. Elect to go with the rigid option and you can kill two birds with one stone, so to speak.

Regarding private rooms, I have been offered a private room previously at Prince of Songkla Uni Hospital in Hat Yai - less than 1k Baht per day and every bit as good as those offered at Bangkok Hat Yai (and the exact same doctors). The other difference was it was a requirement that you arranged for someone to stay in the room with you, rather than an option. Priority for the rooms normally goes to uni employees ... the arrangements are laid out on the hospital's website.

Around three years ago the rigid procedure (3 day stay and including post-op chemo (inserted directly into the bladder via catheter)) was around 25k (excluding pre-op bloods etc) at the hospital mentioned above. The price quoted privately in Bangkok (Bumrungrad and Vejthani) was circa 60-80k as a day patient (no post-op chemo).

Edited October 5, 2014 by rajyindee

[BangkokHank]

Did you ask about using the regular public channel? Should be possible at much lower cost though there will be waits.

Suggest you also contact Phyathai Hospitals re cost, if it turns out to be affordable let me know and I wil suggest which doc as there are several very good urologists there. [email protected] It's private but medium sized and mostly catering to middle class Thais.

Cystoscopy is not a test done before actual stone removal. Stone removal is done via cystoscopy. If the stones are too bug to remove intact then they do cystolitholapaxy which is delivered through a cystioscope. In other words, when yo uarrived at Ratchawithi they were set up to do the fukl procedure and that is what would have cost 20,000 Baht which is frankly a pretty reasonable cost.

Let me explain again what has transpired up to now: I first went to my doctor at a private hospital (Sikarin) near my home. He did several tests (ultrasound - twice, and an IVP), from which he concluded that I have many large stones in my bladder. He said I could have them removed by cystolitholapaxy right there at Sikarin. When I was told that it would cost 100,000 to 150,000 baht, I told him that was too expensive. He then told me that he also works at a government hospital (Rachawithi) where it could be done for much less. I had my nurse friend call Rachawithi for me and they quoted a price of 30,000 to 60,000 baht for the cystolitholapaxy, with a three night stay in the hospital.

I then went to Rachawithi to see my (same) doctor for what I thought was an appointment to set up the cystolitholapaxy. I was surprised when he told me that he would have to do a cystoscopy first (requiring an overnight stay at a total cost of 20,000 baht using the private channel of the hospital), as a separate procedure, to determine how to proceed with the cystolitholapaxy. (I was under the impression that the two ultrasounds and the IVP had given him enough information to know what he needed to do with the bladder stones, which he described as being many and large, but apparently I was wrong.) Then I would have to set up another appointment to discuss the results of the cystoscopy and treatment options for my bladder stones - as well as to decide what to do about my prostate, which is probably the cause of the stones. And then I would have to set up an appointment about two months in advance to finally do the cystolitholapaxy. The doctor also indicated that he would also do what he needed to do with my prostate to fix it then and there. He mentioned doing a TURP. Since I have not yet tried any of the other, less invasive options for my prostate (I'm not even sure that it is enlarged - the ultrasound/IVP report said that it is completely normal although I have heard elsewhere that it is not possible to know the size of it without doing a cystoscopy - is that correct? - and if so, what was the point of mentioning in the report that it is normal-sized?) I am extremely reluctant to have him cutting on my prostate during the cystolitholapaxy, which I told him. He said that whether or not he did anything on my prostate would depend on what he saw during the cystoscopy.

So, Sheryl, I would agree with you that 20,000 baht would be a great price for a cystolitholapaxy, but from what I described above, I am almost certain that that is not what is being proposed. I will have my nurse friend confirm this one more time tomorrow - before I cancel the appointment and go elsewhere for a solution.

Thanks also for the information about the Phyathai Hospital. I will look into that and get back with you should it prove to be a viable option for me.

As for asking about the public channel at Rachawithi, I didn't - because I didn't know that there were two channels while I was meeting with my doctor there. It was all a bit rushed - and not explained to me very clearly. It was only after I had left and discussed it more thoroughly with my nurse friend that I realized what I had signed up for - and that it was the expensive option. (They really seemed to be wanting to push me onto the more expensive track - as described by Nancy in Chiang Mai in a previous comment on this thread.)

[Sheryl]

Sounds very odd to me. No reason to do 2 separate procedures - cystolitholapaxy has to be done through a cystoscope anyhow.

Between that and what you report this doctor saying re prostate surgery you'd best avoid him anyhow.

[BangkokHank]

Status update:

I ended up going to see the specific doctor recommended by a Thai Visa member at the Bhumibol Adulyadej Air Force Hospital near Don Muang Airport this afternoon. What a difference it was to the fancy private hospitals - but not in the way you might think: While the wait to see the doctor was rather long(nearly two hours), the hospital staff couldn't have been friendlier, and the doctor couldn't have been better. He spoke good English and seemed pleased to have the opportunity to practice it with a native speaker. He even came out to the waiting room when he had time, just to make smalltalk with me.

As for the service for which I went there: After listening to my story, the doctor agreed to do the cystoscopy right then and there, without the need for another appointment. What the facilities were lacking in modernity they more than made up for by the warmth, humor and compassion of the staff. The procedure was done with only a local anesthetic, took all five minutes, and cost a grand total of 3,200 baht. And for this the doctor at the other hospital wanted me to stay overnight and pay 20,000 baht, of which 5,000 baht was for the general anesthesia that he tried to push me into accepting because he thought the pain would be too great for a wimp like me to bear. The thing is, if a person goes for the general anesthesia, he will never know how painful - or not - the procedure was - and he will have no reason to complain - because he won't have felt anything. But it galls me now to think that I was being asked to pay 5,000 baht extra just to spare myself two minutes of quite tolerable pain.

And now for the results of the cystoscopy: Three decent-sized stones were found in my bladder. From what I understand, normally bladder stones are caused by urine retention which is in turn caused by an enlarged prostate. In my case my prostate appears to be even a bit smaller than normal, so it would seem that the cause of my bladder stones lies elsewhere. Looking at my ultrasound results from my original hospital, this doctor saw small stones in my kidneys as well. He concluded from this that my bladder stones were not formed in my bladder but rather that they started in my kidneys and migrated to my bladder where, over time, they grew. This is how bladder stones can form without the usual enlarged prostate.

After discussing all of this with me, the doctor suggested that I have a cystolitholapaxy to break and remove the stones from my bladder, but that we should not do anything with my prostate. This is exactly how I would have wished to proceed, so we agreed on this plan - and scheduled an appointment for the cystolitholapaxy for about a month from now. (That is the major downside of these government hospitals - the long wait. But that is largely offset by the cost, which is 1/3rd to 1/5th of what it cost at a private hospital, not to mention the infinitely friendlier staff.)

Conclusion: I finally feel like I am making progress on my treatment. (At the other hospitals, all they ever did was test, test, test - for a cost, of course - and with the conclusion always being that I needed to come in again for more testing.) And in the process of being treated for my problem at this hospital, I had the chance to encounter charming, friendly, decent Thais the likes of which I hadn't encountered in a hospital in a long time. In fact, the experience reminded me of the Thailand that I knew when I first came to live here nearly 20 years ago. Given that I will probably spend the rest of my life here, I will consider this to have been a learning experience, the main lesson of which was that from now on, I will go to great lengths to avoid the fancy private hospitals and to the extent possible, I will rely on government hospitals / doctors recommended by fellow Thai Visa members. In view of that, if anyone needs a very good, very reasonably-priced urologist, drop me a PM - and I'll be glad to recommend one.

Thanks to everybody who has helped me through this experience, and while it's not quite over yet, I feel like solutions are in sight.

[Sheryl]

Glad to hear things are now on course.

But I am a little confused re your conclusions about govt vs private -- wasn't your negative experience at a govt hosp also?

[BangkokHank]

Glad to hear things are now on course.

But I am a little confused re your conclusions about govt vs private -- wasn't your negative experience at a govt hosp also?

Well, let's say my my last negative experience was with the private section of a government hospital. And my negative experiences before that were with private hospitals. Okay, I've had some good experiences with private hospitals in the past as well, so maybe I was being a bit harsh. But still, now that I know it is possible to get good care at (certain) government hospitals at a reasonable price, they will be my first choice in the future - rather than starting out at private ones.

[Issangeorge]

I have always felt the big private hospitals are more like five star hotels, than hospitals. Not only can I not afford them, I don't feel comfortable in them. I'll take the public hospital any day. However having said that, in the public hospital you really need a support system. I am lucky, my wife and Thai family are really supportive. I would think an enterprising nurse who spoke good English could make good money setting up a business supporting both farangs and middle-class Thais in public hospitals in the provinces, where there aren't any private hospitals, or at least good ones.

[BangkokHank]

I have always felt the big private hospitals are more like five star hotels, than hospitals. Not only can I not afford them, I don't feel comfortable in them. I'll take the public hospital any day. However having said that, in the public hospital you really need a support system. I am lucky, my wife and Thai family are really supportive. I would think an enterprising nurse who spoke good English could make good money setting up a business supporting both farangs and middle-class Thais in public hospitals in the provinces, where there aren't any private hospitals, or at least good ones.

Well said, George. My sentiments exactly. And a VERY good idea for a business! I forgot to mention that I went there with my Thai nurse friend (a former English student of mine) - and I can say with certainty that I would have never been able to manage it on my own. I wouldn't have even known where to start. If my nurse weren't already married, I would propose to her that we go upcountry and set up just such a business. I do, however, have a non-nurse friend who speaks good English - and I might just propose this idea to her someday when the timing is right.

And like you, I felt genuinely comfortable in that hospital yesterday evening. I felt that since they weren't really in a position to charge me a fortune, they shared my objective of solving my problems as quickly and efficiently as possible. They could have easily told me to come back another time for my cystoscopy, but when I told them what I had been through up to now - and how far away I live - they managed to squeeze me in for a cystoscopy on the spot. They even had me do my preparatory blood test, EKG and chest x-ray last night so that I would not have to make another trip to the hospital before my cystolitholapaxy. I'm sure I caused a few people to stay a little later than they should have, but they took it with good cheer.

Oh, and something funny to close: When I was having the chest x-ray, I was given two small pieces of tape - for what I didn't know. The nurse then mumbled a bit of bla bla bla (in Thai) followed by "nippen nippen". Remembering my Thailish, I eventually realized that she wanted me to put the tape on my nipples. Ha.

[Sheryl]

In addition to needing to either speak Thai or have a Thai speaker with you to navigate, the main problem I have with govt hospitals is the time factor. For me, time is money, and the added time it takes to set things up, access a specialist, etc makes them at least as expensive as a private hospital. Often more so given that I have a 5 hour round trip drive to get to Bkk, which means that going to a govt hosp would entail hotel costs for overnight stay as well. So on simple cost grounds, private is actually cheaper for me. But if I were a retiree with more time than money and living in Bkk, the equation would be different.

Other big disadvantage is not being able to choose your doctor (or even in many cases to be consistently treated by the same doctor for the same problem).

But I fully agree with the "5 star hotel" issue. It is grating to have to subsidize the fancy lobbies, valet parking etc.

The private non-profits, like St Louis, are much better in that regard and it shows in much lower costs.

[Issangeorge]

In addition to needing to either speak Thai or have a Thai speaker with you to navigate, the main problem I have with govt hospitals is the time factor. For me, time is money, and the added time it takes to set things up, access a specialist, etc makes them at least as expensive as a private hospital. Often more so given that I have a 5 hour round trip drive to get to Bkk, which means that going to a govt hosp would entail hotel costs for overnight stay as well. So on simple cost grounds, private is actually cheaper for me. But if I were a retiree with more time than money and living in Bkk, the equation would be different.

Other big disadvantage is not being able to choose your doctor (or even in many cases to be consistently treated by the same doctor for the same problem).

But I fully agree with the "5 star hotel" issue. It is grating to have to subsidize the fancy lobbies, valet parking etc.

The private non-profits, like St Louis, are much better in that regard and it shows in much lower costs.

Sheryl, I'm not sure why you would go to Bangkok to go to a government hospital, to me that is one of the reasons not to go to a private hospital, most of the good ones are in Bangkok, but there are lots of good public hospitals in the provinces.