Long Term BPH Symptoms - unsure of next steps would love some help / suggestions

I'm 51 with ongoing i would say moderate to severe symptoms of BPH.

Summary of my symptoms - sleep through sometimes but normally wake once.

This is except when i get what i can only refer to as a 'flare up', in this case i'm up 4-5 times. A flare up is probably every few months and lasts 1-3 days.

Always had a weak /intermittent stream even when i was younger but just got used to it and accepted as normal.

Saw a doctor when i was 38 who did the DRE and said it felt normal, had a PSA which was low.

Symptoms got worse around 2 years ago when one morning woke up to wee and it was dribbling, no stream at all.

Saw a private doctor who did a DRE and said it felt 'small and normal' but recommended a cystoscope.

It showed my prostate was 'occlusive' and he put me on tamsulosin and finasteride.

I decided against the finasteride as i was worried about the side effects, I'm still taking tamsulosin (reduced ejaculate at first but no zero side effects - in fact ejaculate seems increased??)

I also sometimes take tadalafil as i found it helps the symptoms.

Fast forward to last week, i went to see a doctor on Harley Street in the UK, he was a specialist in the Minimally invasive procedures including I-Tind which i liked the sound of.

After the cystoscope he said my prostate was 'bulky and occlusive' and about 35cc in size with no median lobe. He commented that my bladder was heavily trabaculated and large.

I also did a void test afterwards which i failed totally - my PVR was 440ml.

I was in quite alot of pain and managed to wee when i got on the train on the journey home.

Based on all of this information he recommended a Uro-lift as a first option. Given the size and shape of my prostate and my relatively young age and desire to maintain sexual.

The thing that worried me was he said that its possible even if he opens up my prostate it may not work based on my PVR results.

I had a phone call with him yesterday and he said there is a chance it could work once the pressure is relieved but if i wasn't young he would be recommending a bigger procedure.

I can wee on my own and have never self cathed.

I never have pain and I have never leaked in any circumstances.

I just have a stream that varies from a dribble to a relatively normal stream (god knows why the difference!)

Sexual function is good.

Based on this information I am assuming (and hoping) that my bladded although battered is not beyond repair.

I'm going to get a second opinion from a doctor in Nottingham nearer where I live but wanted the opinion of this forum please!

Sorry for the long message.

Thanks,

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