Prostatitus

[dddave]

This is pretty much directed at Sheryl: Which doctors in Bangkok are considered to be best concerning prostate issues?

A friend has been suffering from what he believes to be chronic Prostatitus for several years. He has seen numerous doctors in the Philippines and now, a few in Bangkok but he is dissatisfied with the treatments he has received.

He has gotten to the point where he getting overwhelmed with the chronic discomfort and pain and is considering radical surgery, basically removing the entire organ if that is possible. He keeps hoping there is some kind of "Magic Bullet" treatment; like some kind of antibiotic infusion but so far, that option has not been offered by the doctors he has seen.

[ezzra]

Prostatitus?? I'm in the wrong forum, sorry, I thought the subject is about prostitutes.....

[zeichen]

levoflaxacin low dosage for longer periods of time is usually effective. It took over 6 months before it was cleared up for me. What a long painful period of time. It is a long slow process. One quick shot of something doesn't fix it. Surgery would be a last resort for me, so I wouldn't know of the best surgeons.

[Sheryl]

I recommend Dr. Viroj at Bumrungrad https://www.bumrungrad.com/doctors/Viroj-Chodchoy

I note you say that he believes it is chronic prostatitis - if by that you mean that the doctors who have treated him did not share that opinion, have to consider the possibility that his self-diagnosis is incorrect (self-diagnoses usually are, in my experience. Matching one's symptoms to what is listed in Google is not an effective way to reach a medical diagnosis). Chronic pelvic pain can have other causes, and can indeed be very hard to treat. Anyway have him see Dr. Viroj and see what he thinks.

[giddyup]

Prostatitus?? I'm in the wrong forum, sorry, I thought the subject is about prostitutes.....

What a pathetic grab for attention in what is a very serious subject.

[1FinickyOne]

might try permixon or prostagutt if you are talking about swollen prostate...

warning that removing a prostate can lead to incontinence -

good luck to your friend.

[xylophone]

Now this is a subject I know something about because I suffered from it for over 25 years and despite seeing the top specialists in the UK, Australia and New Zealand, they couldn't help much.

There is a reason, and that is because if it is bacterial prostatitis then it is being caused by a bacteria and even though it should be easily treated by an antibiotic, there are not many antibiotics which are able to cross the barrier into the prostate to be able to deal with it. As one other poster suggested, six months is not unusual and I was put on ciprofloxacin (and doxycycline for many months, many times) for six months and this seemed to work for a short while, but it came back again.

The main reason however is that if it is not bacterial prostatitis, then even the best medical research in the world has not been able to find a cause for the nonbacterial prostatitis, so therefore how to treat it. I have screeds and screeds of medical research somewhere in my computer on the subject and there is common agreement that the cause is unknown.

Doxycycline was the most used antibiotic in the old days, and for a good reason, because not only was it an antibiotic, it did have a certain anti-inflammatory aspect to it, so whether or not the prostatitis was caused by a bacteria, the anti-inflammatory aspect helped with the symptoms of prostatitis, sometimes quite markedly so.

I noticed in the OP post that he said his friend had been to the Philippines, and I considered this a one-time because this condition is so debilitating. However this really is considered a last ditch attempt if it is the same Philippine operation that I am thinking about, because it involves direct injection into the prostate of certain antibiotics along with daily prostate massages.

However I have a ray of hope for your friend, because after battling this for decades I finally found a specialist who would discuss the actual problem with me and listen to what I said, so he took a look inside and suggested that the prostate over the years had suffered a few infections and there was some calcification of it, furthermore the neck of my bladder was unusually narrow, which also is another pointer.

Take this last aspect first, because if the bladder does not fully empty, and mine didn't because of this narrowing at the neck, then urine can stay in the bladder and harbour an infection, which can travel down to the prostate, hence the never-ending cycle of prostatitis, antibiotics, cleared up, infection in the urine travelling to the prostate, prostatitis, antibiotics and so on – – I'm sure you can see the picture.

If this is the case, then a bladder neck incision is a simple operation which can help tremendously, increasing the urine flow and flushing out any bacteria.

Now the calcification inside the prostate, probably, according to the specialist caused by organisms/infections over the years which may or may not not been picked up. However now they were causing inflammation which was why I was suffering.

He suggested a transurethral resection of the prostate (Turp). Now this operation has been around for ever and does not mean removal of the prostate, for want of better terminology, just reaming it out. It does not have the same outcome (usually) as the removal of the prostate and leaves everything functioning correctly, although I will say it takes over a month to get back to "normal".

I have a surgeon friend in New Zealand who doesn't do this sort of operation, but suggested that my best bet was to find a surgeon who not only specialised in it, but who had carried out this operation on a regular basis. In the end I went to the Epworth Hospital in Melbourne, which is a hospital specialising in these sort of operations and all has been well since.

I did see a specialist here at Bangkok Phuket hospital just recently when I thought the condition was coming back again, however he was little better than useless and was definitely an old school doctor, prescribing one antibiotic after another, and the levofloxacin he prescribed caused me no end of tendon problems, however he just dismissed it and said in that case, "there's nothing more I can do for you". A great response from a caring doctor – yeah right.

I know how debilitating this problem can be and how it can absolutely drive you mad, so if your friend wants to contact me via a PM, then I will gladly pass on any other information I have and perhaps can help him with his quest.

[dddave]

Thanks all for the thoughtful replies...I have passed them all to my friend.

[rak sa_ngop]

I have recurrent problems with what might be prostatatis. The last time I visited a doctor the recommendation was that as I had tried several courses of antibiotics already (one month durations) that the infection was probably dealt with, and therefore he prescribed an anti-inflammatory drug to help the symptoms of discomfort to subside.

I took Celebrex 200 mg for about a month and during that period the problems I was experiencing did gradually subside completely. However they do tend to reappear after 3 to 6 months maybe due to the infection route as suggested in the posting above by Xylophone.

However I do find that Celebrex does help me, but I am careful not to continue using this drug for lengthy periods as I am aware of the risks.

[Mike555]

dddave, thanks for posting this on my behalf. I've read through the comments -- always good to hear what others have been though.

Xylophone -- amazing response. Thanks so much for taking the time to post that. I'll PM you after I post this. For now, here's a few bits of info for others who might be in the same boat.

First, my case is definitely bacterial. I know this because it all started a day after sex that involved a condom breaking. Hate it when that happens. And in fact, EVERY one of the times I've dealt with this -- and there have been many over the last decade, it's always bacterial. So in my case, rather than being "chronic," it's chronically recurring. But in the times when I've killed the infection and I'm not sexually active -- which would happen when I was back in Japan for a few months working -- I was not taking any antibiotics had zero issues. Didn't matter what I did or ate or how many times I did gland-in-hand combat, my prostate was a non issue. Until I had sex again. Or oral sex. Either can start off the chain. And so the next cycle begins.

So for those of you who have this, just know that in many cases it _is_ possible to beat it if it's bacterial, but it depends on getting the right combo of antibiotics and staying on them, often for months. Usually, if I start feeling funky, I just carpet bomb myself with a big dose of Azithromycin. Then if I'm with a woman for a longer period, I tend to take a regular dose every few days just to make sure nothing is sneaking up there. And yes, I know all about how bad it is to be taking antibiotics. But if you've ever had serious prostatitis, you don't care. You're terrified of the bacteria getting in there and hiding away so deep that the usual antibiotics can't reach it. In fact, the reason this all started is I got something from a Japanese woman about 12 years ago, and I just left myself feeling funky for a week or so hoping it would go away. It didn't. It became a deeply set-in case of prostatitis. For that, I was on Cipro for 6 months. But the thing that really seemed to weaken the bacteria was regular doses of Azithromycin. But that was a decade ago. Most of the major prostatitis players like E.Coli and Ureaplasma are resistant to it. I finally went over to the Philippines and got it treated at the Genito Urinary Clinic with Dr. Feliciano and Dr. Davero.

So did the treatment work? Yes. But not for all the patients there. A few guys I kept in touch with didn't recover. But they also had been living with it for years, which I've been told makes it much more difficult to cure -- there are just too many places for the bacteria to hide. In my case, I'd been on antibiotics most of the time, so maybe that helped. But anyway, that clinic kind of saved my life. The downside is that they really charge a fortune for drainages -- almost $200 a time (as opposed to about $30 at a hospital in Bangkok). But if ever things seem truly hopeless, at least go there and spend the $2000 it will take for them to do a few drainages and do up all the lab work. A few years ago I got something nasty that didn't react at all to the usual antibiotics. After testing, he said it was highly resistant E. Coli -- but it was susceptible to Levofloxacin. I started taking that, and it did the trick. I definitely trust them in terms of finding out what is inside of you and what that is resistant to.

Which brings me to now. I'm now fighting this again and I am not sure if the Levofloxacin I'm on now is going to work. I've been through the other usual floxacins and after 3 or 4 days they just stop working and I'm suddenly in excruciating pain once again. And it's the kind of deep-seated pain I haven't felt since I first got it -- which is terrifying. I'm on day 6 now with Levo and each day is getting a bit better. So I'm hopeful. But I also know that this could all come back in a matter of hours any time over the next week or so. And if this doesn't work, I'll be back to square one with no meds to run to. And that scares the hell out of me, as it always does. Again, if you've had serious prostatitis, you're fully aware of what this does to your life. You can't sleep at all, and you're in constant pain. So I really need these drugs to work or I'm screwed.

Over the last week, I've been to both Sukhumvit Hospital and Bumrungrad to make sure they have the lab facilities to do antibiotic resistance assays of bacterial cultures. So the plan, if this Levofloxacin fails, will be to go off meds for a week or so, try to stay drunk enough not to want to eat a bullet from the pain, then go to both hospitals for a work up. Once I know what's in me (assuming they can find it and culture it, which is not always possible) and get me on meds, I'll find a doctor to do drainages a few days a week and hope for the best. But...

If all else fails, then I need to consider surgery. So Xylophone, one thing I'll be asking you is about the TURP. I've read a lot about the fact that the calcium deposits and scarring left from infection serve as a breeding ground for new bacteria. This seems to explain why people who have had it bad once just seem to get it more easily and seriously each time. I spoke with a doctor at Siriraj Hospital last week -- one of the best in Bangkok for DaVinci laparoscopic prostatectomy surgery. They told me they wouldn't remove it, but would do TURP if necessary. The fact that yours was a success is definitely good news for me. Once again, I hope to beat this with meds as I have done before...but if that fails, I'll have to take more drastic measures and consider surgery.

Thanks again for the info and posts! It definitely helps knowing I'm not alone in this.

[xylophone]

Hi Mike555,

Well, you've really been through the mill as they say, and I can sympathise and associate with much of what you have been through although my level of pain seems to have been a bit lower than yours, but it never went away for many many years and living with something like this is a nightmare.

First of all, I have received your PM. and will get back to you very shortly, however I will strongly advise against the full prostatectomy because it is not necessary IMO and although they have the da Vinci machine these days, it can still leave you with some pretty serious side-effects.

Also, you don't need an MRI to ascertain the calcium deposits in your prostate (if indeed there are any) because a trained urologists will be able to see the state of the inside of the prostate with a cystoscope, and also I would suggest he looks at the bladder neck.

Anyway I will be covering this and a lot more In a PM to you later today and I will also attach some very interesting research on this which does suggest a different regimen of antibiotics and goes into this prostatitis area a lot deeper than just about any other research I've ever seen.

I've only ever known one doctor/surgeon who was prepared to sit down and listen and his response was something along these lines, "I understand what you're going through and I want to help you, so although you "own this", together we will work something out, and I'm always open to suggestions if you want to try them and I will support you in this".

Unfortunately many doctors/specialists, and especially those I have found here just want to spend 15 minutes with you and not listen, but try the same old thing over and over again – – antibiotics, more antibiotics, longer courses of antibiotics, different antibiotics and the last one I saw didn't even know of a couple of antibiotics which were sometimes used to treat this debilitating problem.

Anyway no more rambling here and I will get back to you a little later today when I have found the research I'm looking for.

Thank you for your kind words and hang on in there because I managed to beat it, so you can.

[xylophone]

Just to clarify something in my last post, when I said you don't need an MRI, what I should have said is you may not need an MRI scan because a good specialist will be able to see evidence of calcification/infection/inflammation via a cystoscopy.

[Mike555]

Xylophone. I can't reply to your PM just yet as I can't get in from mobile, but I read it and appreciate it and will PM tomorrow. But your advice on not doing a radical prostatectomy is well taken. If I can't sort it medically here, I'll head back to see Dr. Feliciano for a lab workup first to make damn sure that the bacterial culprit is well defined. They make that the launch point of everything they do, which is the right way to go IMO. I've just been putting off due to the cost issue. But that's where I'll head before going under the knife, rest assured! More to follow tomorrow!

[xylophone]

Xylophone. I can't reply to your PM just yet as I can't get in from mobile, but I read it and appreciate it and will PM tomorrow. But your advice on not doing a radical prostatectomy is well taken. If I can't sort it medically here, I'll head back to see Dr. Feliciano for a lab workup first to make damn sure that the bacterial culprit is well defined. They make that the launch point of everything they do, which is the right way to go IMO. I've just been putting off due to the cost issue. But that's where I'll head before going under the knife, rest assured! More to follow tomorrow!

Ok Mike555, when you reply by PM, please let me know what the Phillies clinic isolated/cultured in your previous visit as well as the other info I asked for.

FYI (and others) it can be caused by a combination of many things, some of which I will detail in my PM.

Another poster takes Celebrex from time to time and there has been research on a similar Cox 2 pain reliever which has worked well for some folk, but there can some serious side effects!!

[bkk6060]

Unless the Doctor is irresponsible, they will not remove that thing unless it is full of cancer.  Being fat, smoking, drinking, sitting extensively, medications can all add to this affliction.  I had it about 10 years ago.  Lost weight, got off my butt, and stayed active. Also, drink a lot of water.  To add, I think keeping it "cleaned out" helps also. But if a poor sole is married that may never happen.  Good luck to your friend.

Edited August 5, 2016 by bkk6060

[Sheryl]

1 hour ago, bkk6060 said:

Unless the Doctor is irresponsible, they will not remove that thing unless it is full of cancer.  Being fat, smoking, drinking, sitting extensively, medications can all add to this affliction.  I had it about 10 years ago.  Lost weight, got off my butt, and stayed active. Also, drink a lot of water.  To add, I think keeping it "cleaned out" helps also. But if a poor sole is married that may never happen.  Good luck to your friend.

 

It is a last resort, but surgery is sometimes indicated for chronic prostatitis that does not respond to other measures.

[xylophone]

12 hours ago, Sheryl said:

 

It is a last resort, but surgery is sometimes indicated for chronic prostatitis that does not respond to other measures.

 

True, and in my opinion it should never be considered although as Sheryl has said, some specialists will discuss surgery (transurethral resection of the prostate, TURP) as a last resort, however this does leave your prostate to generally intact.

 

Looking back over my years of battling this and with my subsequent TURP (which I'm pleased I had and has left me with very little in the way of side effects) I would never recommend prostate removal but would urge sufferers to try every known avenue including long-term low-dose antibiotics such as doxycycline (known for being effective for this condition and also for having anti-inflammatory effects and I would be on this for 3 months at a time, time after time) and anti-inflammatory painkillers in an effort to "manage" this condition and although it may not entirely go away, it can be livable.

 

Bkk6060 has posted some interesting information and I will go along with much of this, especially the advice about staying active (and fit if possible) and drinking a lot of water, and although I can find no evidence to support this, other than my own experience, I do believe that sitting extensively does aggravate the problem.

 

Actually I have been in touch with Mike555 via private messages and he is trying just about everything that the doctors/specialists/research recommends although I will say that the lack of definitive proof as to what actually causes the problem is still unclear, or for that matter how to successfully treat it. This because getting an antibiotic which can successfully penetrate the prostate barrier and be effective deep within the prostate has proven damn near impossible, even with today's medical knowledge, and of course this is presuming that it is in fact a bacterial problem and not an inflammatory response to something else!

 

According to one of the top specialists in the USA, this area of medicine is, "a medical wasteland" and despite millions of sufferers in the USA alone, no real breakthroughs have been found.

 

In summary, I don't believe removal of the prostate should ever be considered for this condition.

[Mike555]

Hi all,

 

Just back with an update. I've been on Levofloxacin for 3 weeks now and it seems to be working (aside from a few major flareups where I thought it was just no longer being effective). So I might have dodged a bullet on this one. Thanks to everybody who has posted so far. As fellow sufferers know, this is a condition that benefits greatly from sharing info, given that the average doctor will openly admit that a) they have no real idea of what is going on in the prostate and b ) that a patient who has been actively involved in the researching and treatment of their own condition is more of a specialist than a doc will be on an initial visit. So thanks again.

 

Just a bit of intel on doctors here in Bangkok for those who may be looking.

 

I have actually been to several over the years, including the Bumrungrad Doctor -- Dr. Viraj -- whose name tends to get shared a lot. Honestly, I got the same kind of questions at Bumrungrad about "do you eat spicy food...do you ride a bike" and so on that you get from many doctors. Plus, it's an insanely busy hospital. So they aren't going to take complex histories. It's more about, OK, you need antibiotics and if that doesn't work, we can do a TURP. Next! So they wouldn't be my first choice. In fact, they were my go-to place for everything 10+ years ago, but they have become the conveyor-belt-sushi version of a medical tourism hospital. Prices are through the roof, and doctors and staff are overworked. This is not a good combination for people with a relatively complex condition like prostatitis, which requires fairly lengthy doctor-patient consulting times and potentially quite a few regular visits.

 

Bumrungrad does, however, have decent (albeit very expensive) lab facilities for bacterial culturing, so that's a plus.

 

In terms of the doctors I spoke with, two are outstanding.

 

1. Dr. Umaporn (female urologist) in Sukhumvit Hospital, Sukhumvit.

This woman knows her stuff about prostatitis. For every question I had about antibiotics, alternate therapy,  inflammation, to various forms of TURP and Microwave treatments to cystoscopy, she was incredibly informed about it all. And she didn't once go that route of asking about lifestyle questions when it was clear from my history that this was entirely due to a sexual encounter (ie, it was from a bug, and not from me eating too much chili on my somtam). She seems aware that for the most part, prostatitis that is not due to BPH, tumor growth, or strictures is likely going to involve a pathogen that has set up shop in there. She also knew a ton about which kinds of supplements might help with inflammation.

 

One major plus of Sukhumvit is that they told me they have a full lab set up for doing microbial analysis and antibiotic resistance checking. They can also do PCR (very sensitive tests that aim to find specific bacterial genetic markers), although she said that the low-cost route of culturing bacteria was actually the best way to go, as the point is not just to find what is in there, but to find what can kill it. Moreover, the tests are relatively cheap. Less than 2000Baht for all of it, I was told.

 

The one down side is that Dr. U is only available (at least at Sukhumvit Hospital, I'm not sure where else she works) on Monday in the late afternoon. They have other doctors on during other weekdays, but urology isn't their focus, so getting one doctor as a primary caregiver could be difficult for sufferers, as it's not possible in most cases to just wait a week until the doctor is in. When you get this, it can be sudden and severe. Still, she's good. And because Sukhumvit Hospital is very low volume and is mostly Thai-centered, you are never swamped with a billion health tourism people waiting ahead of you.

 

2. Dr. Suntchai (male urologist), BNH on Soi Convent.

Another amazingly well informed doctor. He also was excellent in researching the past therapy I had done in Manila. After I told him about it on one visit, the next visit he had printed out a bunch of research reports and so on relating to it, which really impressed me. I did a few drainages with Dr. Suntchai about a year ago when I was dealing with this again and he basically did it exactly as it gets done in Manila -- which is with expertise so that it doesn't hurt as much as usual and at the same time just clears out both lobes of the prostate -- which is what you need if you are to collect a proper sample of prostatic fluid. He also knows a great deal about the drug options available, resistance, and so on.

 

Although Dr. Suntchai is one of the best doctors I've talked to (super easy to talk to), the downside of BNH is that they just don't have the lab facilities for the kind of bacterial sensitivity testing that can identify which antibiotics a pathogen is resistant to. This is actually surprising as BNH is one of the leading hospitals in Thailand. What they can do is outsource at least two of the tests. For Chlamydia culture, they connect with the lab at Chulalongkorn Hospital, and for Ureaplasma urelyticum/Mycoplasma hominis, they connect with the lab at Bumbungrad Hospital. But the combined costs of these tests is just under 7,000Baht. (Ouch!). And of course they have the most modern PCR testing available, which aims at the 6 usual suspects: Chlamydia, Ureplasma urelyticum, Ureplasma parvum, Mycoplasma hominis, Mycoplasma genitalium, Tricomonas vaginalis. If you have something that is just not responding, PCR might be good for you to at least try to see what is in there. And if anybody can get a clean sample out of you, it's Dr. Suntchai. PCR is not, however, cheap. It runs at over 8,000Baht for the full set of 6 tests.

 

Finally, regarding surgery, I have to agree with Sheryl that there are cases of absolutely untreatable protatitis where people have finally resorted to DaVinci robot-assisted nerve-sparing radical prostatectomy to find relief. When I was first doing a treatment years ago at the Manila clinic, there was one guy in the group who actually had a morpheme pump installed in his arm as he was in constant agony. Couldn't work, couldn't sleep, and was suicidal. If you get this kind of prostatitis, believe me, if it can't be treated in a few months of doctors trying everything in the book, you'll happily run the risk of impotence or mild incontinence to get your life back. Having said that, I'd try everything under the sun before going that route.

 

Hope this info helps. And thanks again to previous posters. Thai Visa rocks!

 

[Mike555]

And a special shoutout to xylophone for all the of the links to research and further info, plus other stuff via private message. Very much appreciated!!

[Sheryl]

Dear Mike,

 

Thank you for the update and especially the feedback on these 2 urologists, I will add them to the thread on recommended urologists in Bkk.

 

Dr. Umporn is on faculty at Chula so probably (but not definitely) accessible through their after hours clinic

 

Glad to hear you are improving

[Mike555]

Thanks, Sheryl. And thanks also for the heads up about Dr. Umaporn being at Chula. That's good to know! Thanks!