Drugs as an alternative to surgeries for BPH ???

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In real life, whenever I met an older man, if the situations allowed, I always asked about their health experiences, and recently the questions have been about prostate problems. To my surprise, most of them chose medications over surgeries. 

  Leo, my neighbor, in his 80's, has been taking meds for over 20 years, never had a need for surgeries. 

  Oscar, my bus friend, also in his 80's, had TURP when he was in his 60's. "It was so horrible. I will not do it again." He has been taking alfuzosin since. 

  An, 78, a family doctor, has also been on meds for years, including finasteride. I asked him about surgeries. His answer was: "I will not have surgery unless my situation is life threatening."

  On this BPH forum, where I have learned so much, meds takers are like a dying breed. The usual comments are like "Meds are poison. Do not take it. It will destroy you and your sex life." Or "I took meds for a while but I started to lose its effectiveness, so I opt for surgeries." I am sure drugs cause side effects but some did not even give it a try because of these statements. 

  I don't know why but there is tremendous pressure for men on this forum to recommend surgeries. Not any particular surgery. As long as it is surgery, it is better than meds. Is there a conspiracy, since meds are cheap and surgeries are where the money is ? Despite the facts that most medical web sites put drugs as first line of defense for BPH.

 Though well intentioned, this macho man attitude may have caused numerous needless pain and suffering for many people. People are so excited with posts of successful surgeries like "now I can pee like a 20 year old" and overlook the failures. One fellow had 3 surgeries within the last 2 years, the second to fix the first, the third to fix the second, and is still worse off than before. I am sure there are sadder stories out there. Any problems people have, they immediately blame their meds and seek surgeries.

  Then the CIC (self cath) movement picked up steam, helping people from rushing onto the cut tables. However, again well intentioned, some CICers started to advise people to get off meds for CIC. 

   The pressure got to me as well. So much that I have been looking at different procedures, with FLA currently as my first choice. However, now I question myself whether or not I really need any surgery.

   I am 63, with 200ml urinary retention and some hesitancy, stop-and-start stream. Sleep all night, mostly thanks to my liquid intake management. I have been on Doxazosin for about 6 years. Just started finasteride 4 months ago to experiment. The side effects so far have been acceptable. A little RE which I care less. A little loss in libido but Viagra will more than compensate for. Also, with the above symptoms, my main problem maybe the bladder, not the prostate, as more and more people on this forum recently found out and unveiled. Surgeries may not help at all.

   I also do CIC once a day before bedtime, to empty my bladder for my kidney's sake, and to sleep longer. I actually did go the CIC way for a few months, 4-5 times a day, no meds. However, at the end, I prefer meds over CIC. Some people compared CIC with brushing teeth. smile For me, I would rather brush my teeth. I always have anxiety every time that long catheter was pushed near my prostate, perhaps due to some earlier bleeding I experienced. For me, drugs are easier, more convenient. 

   I am not against surgeries. I think some people really needed them. I just think that too many people rushed into surgeries without actually searching for an alternative first. CIC is one. Medication should be another. After that, if you indeed need it, which surgery is the right one for you. Surgeries are not reversible. Meds usually are.

  So my suggestion to long-time med takers out there on this forum: "It is time to get out of the closet. Please come forward and share your success (or failure) stories. Perhaps your stories will balance out somewhat the frenzy out there, and perhaps helping others in the process."

Hank

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  • Posted

    My take is that it's not so much we're more "macho" on this forum, but that the natural progression is that in general, urologists first recommend drugs and then if the drugs aren't working, then they recommend surgery. I think the reason why so many here are talking about surgery is because  most here in this forum are at the point where the drugs have stopped working well. In other words, here we have more advanced bph/luts than the average older person you might talk to. Of course there are some exceptions to this and some of them you will find posting here. 

    But in general, I again don't think it's so much as drugs versus surgery, as it is what to do if the drugs stop working. At this point most men get funneled by their uros into a surgery or procedure that their particular practice offers. Others, go beyond this, do research on their own, and look into procedures offered outside their uro's office, or even outside the uro's domain, procedures such as PAE and lately FLA. 

    And then there are those, like myself, who when the drugs stopped working, decided to self cath instead of whatever surgical offering was available. I have no doubt that if the drugs had worked for me, I probably would be on them and not self cathing. But that scenario would probably have had more to do with how the system works and not which would have been better for me -- drugs or self cathing. Because now that I know what I do, I would probably choose self cathing over the drugs, especially Proscar. In fact, knowing what I do now, I probably would have started self cathing fifteen years ago.

    Jim

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    • Posted

      Good points Jim. I am not against surgeries. I am just against so from recommending them haphazardly to someone who may not actually needed them.

      BTW, I did not know that drugs failed you before. I remember you mentioning taking Cialis once. But Cialis did not help me either.

      Hank

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    • Posted

      I certainly agree that as a whole, and not just with prostates, we are too quick to jump to surgery. I think this also applies to being to quick to jump to drugs when sometimes a change in lifestyle or a more natural cure might work. 

      As to "drugs failing me", like most here, my urologist suggested both Flomax and at one time Proscar. Flomax, like with many here, didn't really help all that much. Proscar I passed on because of the side effects. 

      Later, after I started CIC, I did use Daily Cialis from time to time, to complement the CIC, but it would never have worked for me in and of itself as an alternative to CIC. When I started CIC, I was both in chronic and near acute retention at the same time. I was carrying around over a liter of urine in my bladder and had to literally pump it out with my hands. A whole bottle of Flomax wouldn't have made much of a difference at that point!

      Jim

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  • Posted

    Going back to CIC, as it was somewhat prominent in your post, as I mentioned before, if I could have gotten things under control with acceptable levels of Flomax or Daily Cialis, I probably would have chosen the drugs. However, in my case, as in the case of many here, the drugs are not enough to overcome their BPH/LUTS. So, I think the comparison of CIC versus drugs is not a good one although I could see a point where I'd choose CIC over too many drugs, depending on the side effects. 

    But the better comparison, is CIC versus surgery. CIC can protect both your bladder and kidneys as well as any surgery, all the while buying you time to wait for better procedures or surgeries. Or, it can be a long term solution in and of itself if you decide against a surgery. Or, as in my case, it can rehab your bladder to the extent that your symptoms have diminished to the point where a surgery probably isn't worth it on the risk/reward equation.

    Jim

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    • Posted

      " ...urologists first recommend drugs and then if the drugs aren't working, then they recommend surgery. "

      You are too kind to urologists here. My uros, knowing fully well that my symptoms are mild with drugs, pushed for TURP and then Urolift anyway, without any tests or exam. Hank

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    • Posted

      I had better luck with my uros. They let my bladder expand nicely, before they pushed for TURP. So I can't fault them for pushing surgery too early. What I can fault them for is not offering me CIC as an alternative to extend watch n' wait, but then again, hardly any uro offers that option unless you press them. 

      Off topic -- are you or anyone else having trouble getting on this forum when you click on an email, especially when responding to a new thread? I'm getting all kind of "bad url" messages. The only way I'm able to get on is to respond to an older post, then navigate my way to the new thread. 

      Jim

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    • Posted

      BTW - I don't think Jim James is crazy about self-cathing; I didn't get that impression at all.  Why would one be?  And I know Hank you are probably just teasing him.  At this point I feel that i owe the man a debt of gratitude for his advocacy.  He is the only one in all my experience with this that encouraged me to keep on with self-cathing when my future looked bleak.  When my Uro doctor, on my first visit to him ever, wanted to rush me into pre-op in two weeks and GL the following week, I was OK with it.  He referred to it as reaming me out and said he was glad I came to him.  That seemed a little bit odd to me but I figured he just meant that something needed to be done immediately.  My ultrasound of my bladder about a week earlier had shown I was retaining about 1 1/2 liters, even though no one seemed to understand that I needed to be drained.  I later talked to a PA that was at my local little drs office who told me to come in and cath.  Later when I got an appointment with the Uro, I wasn't able provide a sample at all with an NV; couldn't get out a drop.  I'm not defending my Urologist; just trying to put it in the correct light.  I'm sure this doctor did not consider CIC as a long term strategy.

      He didn't offer me drugs at this time; just scheduled me surgery.  When I looked into what this surgery entails I was really depressed.  A hospital stay from 1 to 3 days???.  Pain, bleeding, not a very high percentage chance of success.  I backed off.  When I started reading Jim James well thought out and written advocacy I felt much better about continuing this; especially since it was such a relief and, of course, the overflow incontinence stopped immediately.  Thank God.  I am so very grateful to you JJ.  

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    • Posted

      Hi Keith,

      Thanks for the nice words and I'm glad that CIC has made a difference in your life. It's certainly not for every situation, or even for everyone, but in many cases it is the right solution. The unfortunate part is that unless you're lucky, you almost have to stumble upon the self cath option, as Uro's tend not to promote it at all except in some cases for pre-op short term rehab, or when the surgery fails. 

      No, I'm not "crazy" about CIC, and everything being equal, I would prefer to void the old fashioned way, but as many here have come to understand, it's really not that big a deal, and in most cases it becomes a non-issue in one's life after a period of adjustment. 

      No one was more squeamish about CIC than I was at the very beginning. Thankfully, the alternative was a Foley and a bag for six weeks before a scheduled TURP, which made me even more squeamish smile And fortunately, by the time that six weeks rolled around, CIC was not the horrid experience I initially thought it to be. And now, as I've said before, it's really become as routine as brushing my teeth. The mind and body are amazing things in how they adjust. 

      Jim

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    • Posted

      Heh heh Keith. Where did I say that Jimjames is crazy about self-cathing ? Are all you drummers this quick to jump to conclusions ? 😀 Because Jim is such a nice guy, I just like to pull his legs once a while. Didn't know you'll become so protective. Hank

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    • Posted

      I know you're kidding, you know you're kidding, but sometimes people new here don't know and it can confuse certain topics and issues. I'm guilty of the same myself at times but something to consider.

      Jim

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    • Posted

      Just click on "report this" which you will find at the bottom of every post. Then just explain the problem. This is the fastest way to reach the moderator I've found.

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    • Posted

      Yes, I went in for my pre-op appoint as scheduled but I'd already made up my mind I was going to refuse the surgery.  I'd been cathing and adjusting to that for about 2 wks and was hoping I'd get their blessing to "watch & wait".  The surgeon wasn't there for this but his PA seemed OK with it.  They said it was OK as long as I treated the BPH, i.e. take the Flomax and the other drug whatever it was.  They prescribed me the Flomax and it was at the pharmacty but I never picked it up.  And they wrote me a prescription for 120 catheters a month.  I thought it was interesting you mentioned Urolift.  This PA I was talking to was very, sort of disinterested and routine talking to me.  I asked her about Urolift and she seemed very interested in that and said she could make an appointment to see about this.  It surprised me; I had gotten the impression that Urolift was sort an exotic procedure or something... not a routine thing.  It  appears it IS available at this clinic if I want it.  Of course, I don't know if it would be right for me or not.

      Yes, I try not to let me knee jerk drummer temperment get the best of me.  I know one time Buddy Rich came out on stage & slapped Deonne Warwick because she wouldn't get off the stage or something.    

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    • Posted

      Keith, you did the right thing. Even if you decide on getting a procedure that would be OK too. Just make sure you take your time and find out which one is best for you. For example, to get  the best out of Urolift, the best candidate would have a small prostate ( < 80cc or so ) and with no or small median lobe. Hang around on this site, you will learn a lot. CIC gives you time, and Jim is a great help, even beyond CIC. Hank

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    • Posted

      Hi Jim, I just realized that for some people, CIC alone is not enough: those with  OAB. They have urges so often that they would have to self Cath 20 times or more a day. These people need meds or surgery. 

      On the other hand, people with busted bladder or with high retention can only  be helped with CIC. 

      I don't know where I am now but I used to belong to both groups, therefore I needed both meds and CIC.

      Hank

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    • Posted

      Self cathing isn't intended for OAB, unless of course OAB coexists with BPH/LUTS, and then it's case by case. OAB shouldn't necessarily need surgery as bladder retraining (different from bladder rehab) and kegels can often solve the problem and if not, there are medications. 

      Jim

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