Medical, surgical or no treatment. Please help me decide.

Hi, My only experience with Tamsulosin has been reasonably positive, and unless you are very unlucky, I would not fear experimenting with it if I were in your place with the recommendations you have had. I don't take it now, but while I did I din't notice anything amiss day-to-day except postural low blood pressure, which was fine as I learned to lift up from my Yoga Down Dog posture slowly and held on to the wall while the slight dizziness subsided. Driving was never a concern. Also, although intercourse felt the same, ejaculation was dry when masturbating, which made it less pleasurable. Now I'm off the Tamsulosin everything is back to my normal. I haven't heard any risks of any permanent changes from taking this drug.

I took Tamsulosin for many months at a time, over the years, and apart from occasional slight dizziness on getting up from heads-down Yoga postures, and dry ejaculation, only noticeable if masturbating rather than penetrative sex, there were no problems. Everything has returned to normal quickly on cessation of the medication.

I too use running as my primary cardio. I have tried 3 different alpha-blockers and had the same side effects with them all. Dizziness, severe nasal congestion when trying to sleep, retrograde ejaculation and lower energy levels. Running at first was very difficult, but can be managed by the time of day you take the pill (after running). While I could not run as well while taking this drug, it was possible. However, long hikes and runs >10km were not possible - I simply did not have the energy. The nasal congestion was the primary reason I stopped taking them as it impacted my sleep, running was a close second.

Over the course of several months, I modified the time and dosage and the net result for me was the benefits were marginal and did not offset the side effects, so I stopped taking them, though everyone is different. Within 72 hours of stopping the drug, all side effects were gone. 

You may want to look at your diet for possible aggravating factors. For some, caffeine and alcohol can be irritants that cause urinary issues, in addtion to being diuretics. When I cut those two items from my diet, my symptoms improved, but I still have the issue of slow start after sleep. Still working on that one.

Good luck!

I'm shaking my head, after reading of your experience, and what the doctors you're seeing are saying!  And I applaud your decision to refuse the TURP!

Please read up on alternatives to TURP; that procedure is NO LONGER "the Gold Standard" that so many urologists claim it is, and it is SO fraught with potential side effects and quality-of-life issues.  If you check the topics on this site, you should find plenty of reasons to hold TURP as your LAST resort!

Urolift and "green light surgery" and other treatments have been discussed here at length; others will recommend their favorite solutions that don't involve TURP.  

Retention IS a potential issue, and you will want to have that test done, to see if your BLADDER is functioning correctly and is able to empty itself fully.

Prostate size and configuration is important to know! For example, Urolift can be done on prostates between 40 and 80 grams, and only if there is no medial lobe.

I favor Urolift, partly because it is the ONLY treatment that is reversible.  That said, others have argued convincingly for other options, and I trust they will in response to your situation.

I too took Tamsulosin, when first diagnosed.  It did nothing much for my situation, affected, yes, my sex drive, and also caused dizziness.  My yoga practice was not affected as much as Pepesan's was  :-)  but I was working on ladders doing construction work for my wife's church, and was simply careful and aware that I was compromised.  Driving was never a problem for me, either.

READ! READ! READ!  Learn as much as you can before you face another doctor, and know what your options are!

 

have you considered PAE...Prostate Artery Embolization. I notice on this forum a lot of discussion about its non invasive benefits compared with TURP. see

 https://patient.info/forums/discuss/personal-pae-at-unc-experience-529461

I was ~42yo when put on Tamsulosin. My daily run was 9 miles at 9mph, so running is very doable. I did not have RE while on Tamsulosin. Keep in mind, side effects may vary.

Usual workflow for diagnosis would include cystoscopy, just to see what the heck is happening at your bladder neck. You might have constricture of urethra messing with your flow.

Treatments - TURP has stopped being Gold Standard in countries were HoLEP is available. HoLEP will very likely result in RE.

PAE seems to be minimally invasive treatment, someone posted a link to it.

Urolift, ITIND will not stop your prostate from growing, you will need some other treatments down the line.

Rezum, injecting steam into prostate, is likely to reduce growth for some time.

Green Laser ( PVP), burns off parts of prostate, some folks need repeat treatments.

You should not consider TURP. Its a last resort only - and maybe not even that. There are three, non invasive procedures with few if any side effects and very quick recoveries. They are PAE, REzum and Urolift. PAE and Rezum kill prostate tissue - PAE by cutting off the blood supply done thru the veins by an Interventional radioligist (for that reason no urologist will suggest it), Rezum does it by spraying steam directly on the prostate. Urolift essentially holds down the prostate bulges with small bands. None carry much in the way of long term problems - the most you risk is the cost and inconvenience.

If you can, find a urologist who is familiar with and performs these procedures. Not everyone is a urolift candidate but if your prostate is "medium sized" you are almost surely one for REzum and PAE. 

Your situation isn't dire and I recommend these non surgical procedure before even something like Holep which is a srugery and will leave you with rE premanently. You can always do that if one of the less invasive things doesn't do the trick - but from your description, they probably will.

Yes, to what Old Buzzard just posted!  As for quick recovery times, yes indeed!  I had the Urolift in December, in Utah.  One hard day of recovery, on pain meds, but peeing immediately, no catheter.  Next day I flew home to Pennsylvania, and on the third day, I stacked half a cord of firewood, with no problems!  Your mileage may vary, of course!  :-)             

I will add that the prostate, even when held back by implants, will continue to grow.  I will be having a second session for more implants next month.  But again, little pain and the procedure is REVERSIBLE, e.g., if other surgery is needed...

I’ve been following this blog for about 7 months and have heard a lot about cathing, drugs, and the various BPH procedures including PAE, Rezum, Urolift, TURP, Green Light Laser and HoLEP.  The following summarizes what I’ve read as best I can.

 

Bottom line:  drugs may work for a while (for me it was about 3 years), but they are not a long term solution and can also result in damage the bladder from constantly being over extended/full.  Some procedures seem to work for some but not all.  Worse yet, some have reported total incontinence after their surgical procedures.  It’s hard to tell if it was a botched job or not.

 

The real answer imho is surgery, specifically HoLEP.  I did the research on all the procedures (except PAE….had not heard of it), and chose HoLEP.  It is the best surgical procedure because; 1) less time in the hospital and a on catheter (less than 24 hours), 2) less bleeding, 3) very small chance of needing a repeat procedure, and 4) they remove prostate tissue (instead of burning or otherwise destroying it), so they can biopsy it for cancer.  I have heard no reports of anyone having HoLEP and needing a second procedure or experiencing incontinence or needing to continue cathing.  I’ve heard way too many horror stories on this blog about TURP & GL.  My uro explained that they both burn the tissue out, and therefore leave scar tissue.  That tends to shrink over time, and hence the need for a repeat procedure. With HoLEP, they cut the tissue away, grind it up with a ‘morcellator’, push it into the bladder, and then wash it out.

 

Yes, you the have retro ejac, but sex drive returns, and since I don’t plan to have any more children (age 68), it’s not a problem for me.  I was retaining close to 800ml, and my prostate was 85 grams, PSA 3.8.  After it was 46 grams, PSA 0.2.  I had my surgery in January, and after two to three months had no problems at all.  I did have leakage for 3 or 4 weeks.  Some in the UK report they were told to do Kegel exercises for a few months before surgery to avoid this.

 

I have heard some good reports on PAE which is done by interventional radiologists.  It is an outpatient procedure and far less invasive.  If I had it to do over again, I might do that first.

 

Lastly, the experience & ability of the doc is critical, and often difficult to determine.  Hospital ratings for various specialties can be found in the US News & World Report evaluations.  Bios for docs may or may not be available.  For example, the Mayo Clinic was rated best in the nation, and they have the education and publications of their docs listed…… very helpful. Best of luck!

I’ve been following this blog for about 7 months and have heard a lot about cathing, drugs, and the various BPH procedures including PAE, Rezum, Urolift, TURP, Green Light Laser and HoLEP.  The following summarizes what I’ve read as best I can.

 

Bottom line:  drugs may work for a while (for me it was about 3 years), but they are not a long term solution and can also result in damage the bladder from constantly being over extended/full.  Some procedures seem to work for some but not all.  Worse yet, some have reported total incontinence after their surgical procedures.  It’s hard to tell if it was a botched job or not.

 

The real answer imho is surgery, specifically HoLEP.  I did the research on all the procedures (except PAE….had not heard of it), and chose HoLEP.  It is the best surgical procedure because; 1) less time in the hospital and a on catheter (less than 24 hours), 2) less bleeding, 3) very small chance of needing a repeat procedure, and 4) they remove prostate tissue (instead of burning or otherwise destroying it), so they can biopsy it for cancer.  I have heard no reports of anyone having HoLEP and needing a second procedure or experiencing incontinence or needing to continue cathing.  I’ve heard way too many horror stories on this blog about TURP & GL.  My uro explained that they both burn the tissue out, and therefore leave scar tissue.  That tends to shrink over time, and hence the need for a repeat procedure. With HoLEP, they cut the tissue away, grind it up with a ‘morcellator’, push it into the bladder, and then wash it out.

 

Yes, you the have retro ejac, but sex drive returns, and since I don’t plan to have any more children (age 68), it’s not a problem for me.  I was retaining close to 800ml, and my prostate was 85 grams, PSA 3.8.  After it was 46 grams, PSA 0.2.  I had my surgery in January, and after two to three months had no problems at all.  I did have leakage for 3 or 4 weeks.  Some in the UK report they were told to do Kegel exercises for a few months before surgery to avoid this.

 

I have heard some good reports on PAE which is done by interventional radiologists.  It is an outpatient procedure and far less invasive.  If I had it to do over again, I might do that first.

 

Lastly, the experience & ability of the doc is critical, and often difficult to determine.  Hospital ratings for various specialties can be found in the US News & World Report evaluations.  Bios for docs may or may not be available.  For example, the Mayo Clinic was rated best in the nation, and they have the education and publications of their docs listed…… very helpful. Best of luck!

Richard, If you can I would suggest doing the Holep, if not do the turp. I have been having prostate problems for around 12 years.  At first, I didn't want to do surgery, so I did all the alternative methods, herbs, diet etc. Finally, I did take medication doxasosin and avodart. It helps a little but not as dramatically as the turp.  I thought to myself, I should have done the turp, the first time around and not bother with the medication etc.  I believe I would have been better off. Right now I am wearing a catheter, because I can't urinate on my own.  I see my uro on Aug. 25, and hopefully I'll  be able to void, after the catheter is removed.  I know you must feel a little scared about doing surgery, but if the uro does a decent job, you should be fine.  Good luck!