Laser surgery or Alfuzosin + Solifenacin for the rest of my life?

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I'm lucky in that my insurance will pay for this, so unlike some, I do have a choice. I'm 50 (M), and feel like I've had benign prostatic hyperplasia (BPH) (enlarged prostate) for years already, but a recent urinary infection definitely caught my attention.

Found a laser surgeon specialist assuming he would just do it quickly, but (sensibly) he put me on CEFUROXIME AXETIL antibiotics to clear the infection first, along with Alfuzosin + Solifenacin to help with pre-existing BPH (I have been to same hospital about BPH a year ago - so the doctor can see it was a pre-existing condition from before the infection). Need to see this doctor again tomorrow.

So, the drugs have improved the pre-existing chronic symptoms (passing water, unable to empty most of it out, always feeling like I want to go, not being able to start peeing) - they have probably taken me back 10 years, to aged 40 - when things were more manageable - albeit far from perfect.

Question: I don't want to have to take these drugs for the rest of my life - if I find a surgeon who does laser surgery, and have an insurance company to cover this, then if anyone can appreciate these symptoms - surely I get it done under general anesthetic right? Minimal risk from what I understand. Any thoughts appreciated following this first post of mine, especially from long term users of Alfuzosin + Solifenacin .

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  • Posted

    I am not a doctor, but based on the medicines that you've mentioned, it seems that your prostate will continue to grow. As it continues to grow, it seems likely that your urethra/bladder neck will become more compressed and you will no longer see the benefits of alfuzosin. Therefore, I question whether you could just take the alfuzosin (relax prostate and bladder neck) and solifenacin (for OAB) and maintain the status quo with regards to urination for the rest of your life.

    It would seem to me that a protocol for using medicines for the rest of your life needs to included dutasteride (Avodart) or finasteride (Proscar). These will reduce the size of your prostate by about 20 to 25% albeit with some side effects (usually sexual). The idea is that these drugs would keep the prostate from growing. Many men do not like these drugs. I am currently taking alfuzosin and dutasteride and have seen significant improvement as well as a reduced prostate size. By taking measures to reduce estradiol, the original sexual side effects that I experienced have been mostly abated (but I am still experiencing low semen output or perhaps part of the semen is going into my bladder [retrograde ejaculation]; I am not sure).

    But I question whether I can continue to take them. I am looking for ways to get off of the dutasteride but it has been difficult to find natural alternatives. Since it has been 1 year that I have been on dutasteride, in the near future, I'll probably be reducing usage to 3 or 4 times per week instead of every day. Since my prostate is 100 grams in size, I suspect i will need a procedure in the future.

    Even if you do take the pills, there is no guarantee that you won't need a procedure in the future. Even if you do a procedure now, there is no guarantee you won't need one in the future as the prostate will continue to grow and since you are only 50.

    A big question, I think, with regards to your decision is whether or not you have an enlarged median lobe. Although I have no hard evidence to provide, it seems that guys with enlarged median lobes only benefit from procedures (not PAE) and not from dutasteride or finasteride; but I encourage you to do your own research if medications is the avenue you want to pursue. I do not have an enlarged median lobe as verified by 3T mp MRI.

    Good luck in whatever you decided to do.

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  • Posted

    what laser you talking?, some laser procedure have more or less risk?,

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  • Posted

    I'm in the UK and my procedures were done in NHS hospitals. I'm pro laser procedures and provided your median lobe is not the main problem area a good surgeon who does a bladder neck sparing procedure to avoid retro ejaculation they are all good. You can have a general anesthetic or in most cases a spinal if the procedure is less than about two and a half hours.

    I had GL laser in 2004 for my 75 grm prostate. It took less than an hour of lasing time. It was done in late afternoon I had the catheter removed the following morning. I took me till around noon urinate and there was an initial gush of blood but I did not completely void. As I had a long train journey home they kept me another night until voiding fully. The next day life was basically normal and I went to the races without worrying about needing a toilet on the way as I previously did or when there and freely had three large coffees.. My PSA had been 9.8 and came down to 5.0

    Over the next eight years my prostate regrew to 135 grms and I would willingly have again have had GL. but a local urologist did Thulium/Holmium laser surgery that saves tissue for a histology report.

    This procedure in 2013 was evidently more difficult and with a much bigger prostate took about three and a half hours. I was still passing blood when the catheter was removed the next morning though I was voiding OK. and to free up the NHS bed they sent me home with a catheter in.

    The recovery was just as good as from GL with zero retention and this time my PSA came down from 7.8 to 0.74. Six years later I'm still problem free.

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  • Posted

    Cheers for your insights guys - the doctors appointment is now on Thursday so I have a few days to decide. I hadn't really considered continued growing of my prostrate - but I suppose that won't affect my decision, since since it will continue growing in any case - might as well live those years in comfort. My prostrate is 60g I think they said - about double normal from recollection. I now see from your messages that it can get somewhat bigger than this.

    The complication here is that I live in Hanoi, Vietnam, which isn't known for it's excellent medical care. My research a few weeks ago revealed that 2 of the hospitals have relatively new LASER machines for treating BPH - one is at the geriatric hospital (makes sense), and the second is at the most modern hospital in Hanoi (vinmec). The website has a lot of Vietnamese only, but I managed to decipher that the "Level 2" specialist (higher level) who is more familiar with this machine is the one I'm seeing.

    I feel comfortable having the laser surgery, even with the knowledge that in another 10-15 years I may need a repeat, but my issue is that the specialist seems intent on "curing" me with drugs!! meh! 😃

    I have been taking (most of) the drugs (the ones already mentioned), but even if he wanted to operate, if the symptoms are milder, I wonder if it is possible to do as good a job. Perhaps I will have to wait a few weeks for the symptoms to return. I hate the idea of being on drugs long term (except for a couple of regular supplements I like), not to mention a rubbish libido!!

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  • Posted

    Hi Dave:

    How was the size of your prostate determined? Hopefully, it wasn't from a digital rectal exam (DRE). For years my ex-urologist told me that my prostate was about 40 grams based on a DRE. Last year I had it measured by transabdominal ultrasound (TAUS) and it came in at 145 grams. Three months ago (after being on dutasteride for about 9 months), I had it measured during a 3T mpMRI and it was 100 grams. 3T mpMRI is the most accurate but might not be readily available to you. The next most accurate method is transrectal ultrasound (TRUS) and then transabdominal ultrasound (TAUS).

    Good luck.

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    • Posted

      Hi Derek:

      Not in my case. In fact, my two new urologists told me that they do not provide an estimate of prostate size from a DRE because of the potential high inaccuracy. How big is your prostate?

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    • Posted

      In 1995 it was estimated at 35 grms by both my then GP and Uro and later confirmed by TRUS. Over the years to 2004 I had DRE's with various people as it grew to 75 grs. all of which were confirmed by other means. After my GL I had no need for another DRE until it regrew and again gave me problems in 2013. Several more DRE's, TRUS and cystoscopies saying it was now 135gms and I had another laser procedure. I last had a DRE done by a urology nurse in 2016 when she said it was the expected 55 grms after 80 grms had been removed at my last procedure and I later had a cystoscopy that agreed with her estimate. That DRE stimulated my vagus nerve and put me back into AF after having twice been in it previously once after aortic valve replacement and then with my vagus nerve stimulated during a colonoscopy. So much for the fickle finger of fate 😃

      As most on this Forum are American it may be that Brits do urology better.

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