Drugs as an alternative to surgeries for BPH ???
Posted , 10 users are following.
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. 
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
0 likes, 50 replies
derek76 hank1953
Posted
hank1953 derek76
Posted
derek76 hank1953
Posted
breeze61 hank1953
Posted
Hi Hank, You've started an interesting topic. In my case, at age 66, Ive been on tamulosin and dutasteride for ten years. At first I was put on both for six months which worked a treat. Then I read up on the subject and wondered how safe the long time use of the two drugs are. I still dont know what long term damage they can do so am interested if anyone on here can quantify the damage over the years.
As, I said, I had 6 months on both tablets and then stopped taking the dutasteride because I didnt like the backward ejeculation. After a few months of not taking the dutasteride my prostate would enlarge again and I would start trickling again and so I would go back on to both pills for another 3 or 4 months until my prostate shrung again and repeated the process until now. I must admit during the ten years Ive not seen my original consult who I thought was not a nice man. a few months ago after not being on dutasteride for 3 months I was trickling again and having to get up 5 to 7 times a night to pee so went to see the consultant. I've had a MRI, with no obvious cancer and found out I have a 70 mg prostate, with psa of 4.2. Im on both tablets again until I find out what the consultant is going to suggest. At the moment he wants to do more tests but for why I cant understand as Ive had all the systems of BPH for the last ten years. I also get the feeling that if the consultant thinks I am coping on the two tablets then he is not going to carry out an operation. Perhaps its because Im a NHS patient because I know of lots of people whove had green lazer surgery without ever being put on drugs in the first place.
What really scares me and annoys me is that I cant drink alcohol but especially beer is it reduces my flow considerably and two years ago had to get catheterised at 3 in the morning. The other thing is that I'm worried about inot emptying my bladder fully and that taking the two pills will cause worse damage in the future than having a green lazer or turps.
Anyway, thanks for the opportunaty to add to your thesis and I am learning to understand a bit more about the problems for and against.
keith42667 breeze61
Posted
I'm not surprised that you know others who went directly to GL laser w/o any drugs. All I've had is the gloved finger up the anus to see if prostate is swollen; and it is. The next step, if I'd have accepted it, was GL. They were going to have me ready to go in two weeks. A pre-op was scheduled but I was researching and learning to self-cath in that week beforehand and I never did find out what they had planned for me in preop. I don't think they were going to do a cystoscopy because the Urologist himself was not there. I told them I wanted to watch & wait and they were ok with that for now, but told me they wanted me to do something about the BPH if i was going to have their blessing for self-cathing. They prescribed me the Flomax stuff but I never picked it up. I just figure if some drug relaxes the bladder neck muscles, what other muscles does it relax?? It doesn't sound to me like medicine yet has a good solution for this problem. I may have to self-cath for the forseeable future if that is possible. No side effects; completely empty bladder, free catheters through medicare, a procedure I can get more efficient at... I'm happy for now.
hank1953 breeze61
Posted
Hi breeze, thanks for sharing. As far as long term range of using drugs, they are well known, in terms of sexual side effects and low blood pressure. If you can cope with them than I think you are good. It's very interesting in the way you use them off and on, few months at a time. As long as drugs work, I am hesitant to have surgery, unless they come up with something with less potential pitfalls.
Drugs help you emptying your bladder, but not often completely. Neither can surgeries guarantee that either. It's why I self cath once a day before bedtime.
There are two studies that may interest you.
One is that you take dutasteride (or finasteride) for a year, after that you can halve the pill, still with the same results.
Two is you take dutasteride (or finasteride) for a year, with an alpha blocker like flomax, after that you can just quit the alpha blocker, still with the same results.
Hank
hank1953 breeze61
Posted
breeze61 keith42667
Posted
Hi Keith and Hank,
Thanks for your replies. First of all I must tell you that I had to pee 7 times last night and about 90mg per pee, Ive been averaging 2 or 3 times just recently. I dont normally drink much alcohol, just a glass of wine with a meal occasionally but yesterday had 1/2 pint of beer at 5pm and then a small whisky with ginger at 8pm. Hopefully it was a one off.
Ive ordered some catheters as recommended andwill give then a go. I presume that when I go to bed
my bladder is swishing around with pee which I can only release in 100mg per couple of hours. So is it true to say if I self cath at night I should get rid of far more liquid. I've only ever managed to pee a pint even when younger and without the problems.
I must say that apart from eye sight weakness and dry and retrograde ejeculation Ive not done badly on the two drugs. I was swimming a mile and cycling 50 miles until recently and its bad hips that put an end to those activities.
I do look forward to trying self catheterising but wonder if I need someone to show me how or utube.
Im a bit shy to ask for a nurse to show me how but will if necessary. What are your thoughts about doing it myself?
Also good info about the halfing of the dutasteride and the stopping of Alpha blockers after a year
of taking dutasteride.
I dont see myself going for much longer without an op but hopefully can buy time until I know what is best for me. My current uro wants to give me a hormone to stop me building up water at night but to me that is only a side issue because the way I see it, it is the large prostate which is blocking my pee tube and has been for ten years. Solve that and peeing through the night should go away.
What I find is bloody annoying is that you cant find out any info about any consultant other for them advertising for private patients. When I google my consultants name I get nothing and unfortunately have only recently moved to south yorkshire so dont know anyone to ask. Is there a site where one can research your consultant. Or, can anyone recomment any consultant in s yorks.
Thanks again your helpful advice.
derek76 breeze61
Posted
You mentioned in an earlier post that you knew people who had GL laser. Did their results not fill you with confidence ?
jimjames breeze61
Posted
I'm sure the alcohol late in the afternoon and evening made the difference. What are the void volumes when you only go 2-3 times per night? If you don't know, do a couple of 24 hour void logs. Self cathing (cic) will empty your bladder completely as opposed to letting out just what the potentially compromise detrussor muscles will push out through the prostate. As to technique and what catheters to use, etc, lots of info here in the self cath threads or feel free to send me a private message.
Jim
hank1953 breeze61
Posted
I would not trust a nurse to show me how to do it due to my personal experience with an ignorant uro nurse, which resulted in some scary bleeding. At least, cathing will let you know how much retention you have at various times of the day.
From that, you can decide whether or not to do it longer, instead of drugs or surgeries, or with drugs. In my case, even with Doxazosin and finasteride, my retention before bedtime is about 200cc. During the day, my retention is about only 100cc. So I chose to cath only once, at bedtime.
Surgery is more of a gamble. I would take my time on it.
Hank
hank1953 breeze61
Posted
urine -> Utube
Hank