Prostate surgery

[Klong Song]

I went to see my urologist on September 3rd and my current PSA is 2.1 and the ultrasound showed my prostate to be over 5cm. I am getting tired of getting up 2-3 times a night and have decided to have something done. I would appreciate a recommendation for a doctor in BKK to discuss the possibility of having a DaVinci procedure. A ballpark number on the cost would be appreciated if someone has current information.

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[Sheryl]

http://www.si.mahidol.ac.th/th/department/surgery/urogicalWebsite/

 

http://www.si.mahidol.ac.th/th/department/surgery/urogicalWebsite/team.html

 

Prof. Sittiporn Srinualnad there is a key person, you can see his bio here as he also has hours at Bumrungrad (where you don't want to go if paying out of pocket, but good dr bios)  https://www.bumrungrad.com/doctors/Sittiporn-Srinualnad

 

HOWEVER, I suggest you question closely re number of procedures done as I don't think there have been that many in Thailand and this makes a big difference. Robotic surgery is not a magic bullet, it is only as good as the operator is experienced and skilled. They will be eager to do it as they want more cases but you really don't want to be part if someone's learning curve IMO...so ask specifically how many cases they've done. I believe it started here just some 8 years ago or so.

 

No idea of cost, can't help you there.

 

Another option to consider is HOLEPs, in India (or elsewhere but India would be least expensive option and they have a lot of experience). Not much if any experience with it in Thailand yet.

I assume you've already maxed out options with meds?

[Klong Song]

Thanks for your help!


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[offset]

Over 7 years ago I spoke to Prof. Sittiporn Srinualnad about having Robotic Prostate surgery and as Sheryl said it was very new here then so I decided to not to go that route and have an open surgery carried out if I remember correctly the cost then was about 460000 baht for the Robotic and the operation was to be carried out in Siriraj hospital which is a Government hospital (the only one at that time had a machine) I hope this is of some help

[Klong Song]

Thanks Sheryl, HOLEPS may be a good alternative for me. Not keen on going to India at the moment and would like to research costs in BKK first. I have been seeing a urologist at Bumrungrad but since this will be out of pocket for me I would appreciate learning of a good doctor at another hospital. As for the med's, I have taken both Harnal and Xatral which help but do not provide much relief. My urologist hasn't mentioned other meds.


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[Klong Song]

offset, thanks for the info. Much appreciated!


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[Sheryl]

AFAIK no one doing HOLEPS in Thailand yet.It is a very new technique, onl;y developed in the past 10 years.

 

If you want HOLEPS you would need to travel for it.

 

Besides India, it is available in Singapore but just a few doctors and not sure how many cases they have done. http://bkpohurology.com/clinical-services/holep-holmium-laser-enucleation-of-prostate/

 

Also available in Hong Kong  and in China, in fact was first developed in China. From page 40-ish onward in this link has some info and names of doctors/hospitals  http://www.hkcs.hk/member/2010_ASM/Surgical_Tx_BPH.pdf

 

 

[ScotBkk]

Thanks for your help!


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I had exactly the same problems. Dr in UK prescribed these. Problem Solved!!


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[al007]

I had Holeps in India three and a half weeks ago

 

Cost US $3500

 

But beware, despite putting everything in writing five mins before the procedure I was advised by spinal injection, not general anaesthetic and with my low pain threshold they had me screaming while administering the anaesthetic

 

whilst there two different types of cancer were found and then I was in the wrong place

 

I understand there may be a couple of hospitals in BKK that can do Holeps, I heard a price from the most expensive one around 800,000batt

 

Next week i start radiology and chemotherapy, in BKK for six weeks 

 

If you want to talk about India pm me and I will give you my phone number

[1FinickyOne]

4 minutes ago, ScotBkk said:

I had exactly the same problems. Dr in UK prescribed these. Problem Solved!!


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Do you know if that is available in Thailand? 

[ScotBkk]

 
Do you know if that is available in Thailand? 

I don't know I'm in UK at moment but I went through all that urinating nightmares and within 2 days everything is completely normal.


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[1FinickyOne]

1 minute ago, ScotBkk said:

I don't know I'm in UK at moment but I went through all that urinating nightmares and within 2 days everything is completely normal.


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ok, thanks - I have been taking Permixon, which helps but does not eliminate the issue... 

[ScotBkk]

 
ok, thanks - I have been taking Permixon, which helps but does not eliminate the issue... 

Ken, I know the hell your going through. Go do a bit of research in Thailand and see if you can get it prescribed for you it really is a Godsend mate


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[Sheryl]

It is, and OP is already taking it (brand name Harnal)

[ScotBkk]

It is, and OP is already taking it (brand name Harnal)

Well' Sheryl

Maybe doesn't work for everyone but did wonders for me !!!

No disrespect.

However, I don't trust pharmacies drugs in Thailand or on the Net unless direct from the hospitals

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[Klong Song]

Bumrungrad advertises a procedure called PVP (Photoselective Vaporization of Prostate). How does this compare to HOLEPS?


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[kannot]

My Grandfather died of prostate cancer and last year my Father aged 85, the last 12  months he had terrible pain and even morphine did little to help,

Im only 53 but  will be looking at prostate removal when Im older as seeing my own Father in such agony was almost unbearable thats if I get it but odds are  higher than normal so i would  be interested what you find out for this type of work here.

Cost would not be an issue  for me but not being left incontinent would although I have 3  reports from this work done in the Uk with great success.

[Klong Song]

I'm 73 so ending up impotent would not be the end of the world but I agree being incontinent would certainly be inconvenient.


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[Sheryl]

15 minutes ago, Klong Song said:

Bumrungrad advertises a procedure called PVP (Photoselective Vaporization of Prostate). How does this compare to HOLEPS?


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It is a different procedure.

There are a number of surgical procedures that are alternatives to tradition TURP.

 

PVP is similiar in outcomes to HELOPS but same caveat as earlier applies: beware of having it done by doctors who have limited experience.

 

Another consideration is that both PVP and HOLEPS are not suitable if the prostate is too small - but not likely a problem in your case.

 

[Klong Song]

Thanks Sheryl, the doc's last words were "that's big". Will go back to see him soon to try to pry some more information out of him.


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[ScotBkk]

Thanks Sheryl, the doc's last words were "that's big". Will go back to see him soon to try to pry some more information out of him.

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Hope he was looking at your prostate - hahaha

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[Klong Song]

Good one 555


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[CharlieK]

When I first came to Thailand had food poisoning from the flight, They did a full body scan MRI, Not that I was looking for other medical conditions. They said I had  an enlarged prostate  which is normal as you get older. They told me it was calcified.  They gave me a course of drugs called Cardurox or some such name? Anyway it cleans out the pipes down there, and have had no problem since.

 

Surgery is a bit extreme IMO, unless there is worry of cancer?  

 

 

Edited October 13, 2016 by CharlieK

[Sheryl]

People who opt for surgery are generally ones for whom constant urination and inability to completely empty the bladder has become intolerable...and it can.

[Blue bruce]

I think volunteeringfor prostate surgery just to stop waking up to  go to the bathroom is bit radical. 

[xylophone]

Klong song........I'm not sure exactly what you are looking for and if my understanding is correct you may be mixing up a few procedures?

 

Firstly your PSA score of 2.1 is not a worrying figure, but would be if it has increased to this from a much lower figure, over relatively small period of time.

 

The Da Vinci procedure is great for removal of the prostate and usually results in much less "collateral damage" than normal procedures, but do you need the prostate removed? This is normally done when cancer is detected.

 

If however you have an enlarged prostate on its own, with no other signs of cancer or the like, then there are drugs to help that, and also the TURP (transurethral resection of the prostate) is the gold standard procedure, which basically "reams out" the prostate, allowing proper urination and bladder emptying.

 

The Holep (laser) procedure will also do the same thing and is less invasive than the TURP and usually results in quicker recovery although retrograde ejaculation is pretty well standard with this procedure, whereas with the Turp procedure this is not necessarily the case.

 

So if removal of the prostate is your goal, then the Da Vinci procedure, in the right hands as Sheryl has said, is probably the best option, however if you are basically looking to alleviate the symptoms caused by an enlarged prostate, then the Holep or Turp procedures should be investigated.

 

When I was investigating the very same thing about 10 years ago, my doctor said exactly what Sheryl has said in as much as I should seek out the urologist/surgeon who has undertaken the most procedures, and this is particularly the case with the da Vinci procedure because it does entail operating in areas where nerves can be inadvertently severed by the "inexperienced" hand.

 

This was also the case with the TURP I had and if I had to do it again, and this can happen, then I would certainly investigate the Holep procedure although I'm not sure that I would relish the retrograde ejaculation aspect of it.

[Sheryl]

It is a lot more than just waking up to go to the bathroom. Nobody undergoes surgery just for that.

 

It is:

 

having to go to the bathroom pretty much all the time.

 

constant pain due to inability to empty the bladder

 

frequent urine infections (which can become quite serious)

 

predisposition to bladder and kidney stones and sepsis.

[Klong Song]

Thanks everyone for your replies. At this point it has not been determined if any cancer is involved. The situation is I have to get up 2-4 times to urinate every night and sometimes it is difficult to pass urine causing some pain, no problems during the day. Now I am experiencing some back pain and am aware of my kidneys when lying in bed at night so I think it is time to do something. The purpose of my original post was to start the learning process to decide what will be the best course of action and I think I am well on the way. Will be seeing the urologist tomorrow to gather more information.


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[SaintLouisBlues]

2 hours ago, Blue bruce said:

I think volunteeringfor prostate surgery just to stop waking up to  go to the bathroom is bit radical. 

I couldn't agree more. Does the OP realise that he'll likely be wearing incontinence gear for the rest of his life? http://www.dailymail.co.uk/health/article-2163640/Dont-rush-prostate-operation--worst-thing-do.html

[xylophone]

8 minutes ago, SaintLouisBlues said:

I couldn't agree more. Does the OP realise that he'll likely be wearing incontinence gear for the rest of his life? http://www.dailymail.co.uk/health/article-2163640/Dont-rush-prostate-operation--worst-thing-do.html

 

It's not that simple – – please read Sheryl's post, and anyway if cancer is not involved then it's very unlikely that the prostate will have to be removed, more probably "reamed out" with an operation which is very commonplace these days and has been for many, many years.

 

If this is done, and done well, then side-effects can be kept to a minimum.

 

I've been through years of what Klong song describes, with the infections as a result of this going from the bladder to the kidneys and then to the prostate and they were never-ending, and resulted in prostatitis which is very, very hard to clear, not to mention about 25 years of antibiotics in one form or another.

 

I only hope that the OP doesn't have any other problems and that he can get his situation cleared up as I described in my previous post.

 

Good luck to the OP.