This was the topic of Dr. Niti Navanimitkul, M.D.,
Urologist at Bangkok Hospital Pattaya, in his presentation to the Sunday,
January 12 meeting of the Pattaya City Expats Club.
Dr. Niti received his medical education and degree from the Faculty of
Medicine at Chiang Mai University from 1997 to 2003 and did his residency at
the Department of Urology, Chiang Mai University from 2006 to 2010. His
professional experience has been as a Urologist at Phranakorn Sri Ayutthaya
Hospital from 2010 to 2012 and at Bangkok Hospital Pattaya since 2012.
MC Roy Albiston opens the 12th
of January PCEC meeting by welcoming all, and inviting new members & guests
to introduce themselves.
First, he displayed a diagram of the male reproductive
tract and explained how the prostate gland functions in this process. He
then said as men grow older, the prostate gland grows larger. The medical
name for an enlarged prostate is Benign Prostatic Hyperplasia (BPH), also
known as Benign Prostatic Hypertrophy. It is “benign” in the sense that it
is not a cancerous condition, and so BPH should not be confused with
prostate cancer.
The symptoms of BPH include interruptions in the urinary stream, frequent
urination (especially at night), an urgent need to urinate, a weak urinary
stream, and problems starting urinating. Also, he explained that an enlarged
prostate can lead to acute or chronic urinary retention, which can cause
bladder infection, a stone in the bladder or damage to the kidney.
Dr. Niti Navanimitkul, M.D.,
Urologist, of Bangkok Hospital Pattaya, was the guest speaker for the
Sunday, January 12 meeting of the Pattaya City Expats Club.
Further, to diagnose BPH and its severity, doctors will
check your symptoms and may perform one or more of the following tests:
digital rectal examination, a urine fluid test, a PSA blood test, a urine
flow test or an ultrasound scan. Depending on its severity, there are three
treatment options; lifestyle changes, medicines, or surgery.
Dr. Niti described the lifestyle changes which include (1) drinking less
alcohol, caffeine, artificial sweeteners and carbonated beverages; (2)
drinking less in the evening; (3) eating more fruit and fiber; (4) emptying
your bladder; (5) double voiding (urinate, relax for five minutes, and
repeat urination); (6) checking your medicine; and (7) bladder retraining.
MC Roy Albiston presents Dr Niti
with a Certificate of Appreciation from PCEC as thanks for his presentation,
which was of benefit to over half the audience.
There are three kinds of medicines used to treat BPH: (1)
alpha-blockers; (2) 5-alpha reductase inhibitors; and (3) herbal treatment.
Alpha-blockers include tamsulosin, alfuzosin, doxazosin and terazosin. These
drugs relax smooth muscles, especially in the bladder neck and prostate. The
5-alpha reductase inhibitors include Proscar (generic name: finasteride) and
Avodart (generic name: dutasteride). These block the conversion of
testosterone to dihydrotestosterone, the male hormone that stimulates the
prostate; they are better for men with significantly enlarged prostates.
Some symptoms may be treated effectively with over-the-counter herbal
remedies (saw palmetto, red clover, soy, African tree bark).
Member Ed chats with Dr Niti
following the meeting.
There are several surgical options for treating BPH.
Surgery is usually done only for the most severe cases. One surgical option
is an open prostatectomy. The surgery does not remove the entire prostate,
as is done in a prostate cancer operation, but removes just the obstructive
part of the prostate that blocks the flow of urine.
Another is the transurethral resection of the prostate, commonly known as
“TURP.” In this procedure a combined visual and surgical instrument is
inserted through the tip of the penis and into the tube that carries urine
from the bladder (urethra). The urethra is surrounded by the prostate. Using
this resectoscope, the doctor trims away excess prostate tissue that’s
blocking urine flow and increases the size of the channel that allows you to
empty your bladder.
Finally, patients can opt for an operation performed using laser (there are
several kinds) - Thulium laser, PVP (green-light laser), and Diode laser.
The advantages noted by Dr. Niti for laser surgery over the TURP are (1)
fewer complications during the surgery; (2) less erectile dysfunction
post-operation; (3) shorter time for catheter to be inserted; and (4)
shorter hospital stay. Green-Light Laser Prostatectomy allows vaporization
of tissue and simultaneously seals the tissue resulting in an almost
bloodless field.
