Most ageing men sooner or later notice they have problems when urinating, or trying to, or become aware that prostate disease is a menace in today’s world. Ancient physicians were aware of several urinary tract problems and circumcision was probably the first surgical procedure performed on a regular basis. The 17th century diarist Samuel Pepys described his own operation to remove a bladder stone (which he luckily survived) but it wasn’t until the 19th century that technology played an important part in diagnosis and treatment. Today, urology is a specialized discipline using the latest technology for investigation and treatment.
The Inspector, by no means in the first bloom of youth, made an appointment in the recently expanded urology center at the Bangkok Hospital Pattaya for an introductory examination which lasted around two hours and cost about eight thousand baht including the consultant’s fee. The session began with a doctor asking general health questions and noting any medications already being used by the patient. She also performed a brief digital rectal examination with a surgical glove to assess initially any irregularities in the size of the prostate.
The next step was to sit again in the waiting area and fill in a detailed questionnaire about benign prostate hyperplasia, a non-cancerous increase in size which can be indicated by frequent urination, trouble starting to urinate, weak stream, loss of bladder control, etc. A nurse explained this was a very common condition in men of the Inspector’s age. Next came comprehensive blood tests including kidney function and an important PSA reading, followed by the requirement to drink a lot of water to facilitate an imaging bladder examination which can show up cystitis and other infections in that region.
Then it was back to the consulting doctor to discuss the results. She went through the blood tests and the PSA reading was 1.2ng/nl which was regarded as no problem. Kidney function was fine but the bladder test showed an early sign of cystitis.
Excessive night time visits to the lavatory were highlighted by the patient and daily medication to assist was prescribed. The doctor also made a note on her computer about the number and length of daily urinations for future reference. There was no sign of cancer in the tests conducted and it was recommended that the patient return for a repeat session of all the tests in one year’s time. This is normal procedure, unless other disease is suspected to be present.
Many men, including the legion of mature male expats in Pattaya, are nervous of any suggested inspection of the nether regions. Yet the whole experience is conducted in a matter-of-fact way and any feeling of embarrassment is actually both unnecessary and inappropriate. Given that American statistics reveal that 25 percent of all GP consultations over there are for urological disorders, it is obvious that they merit a large and specialist department in this hospital too. It should be noted that precise cost of a routine urological examination may vary according to the precise problem(s) identified and the tests which then follow. The sole issue presented by the patient in this report was frequent urination at night.