Prostatitis

You have two issues to address.  First and foremost, you indicate that you have a urinary tract infection that has been difficult to resolve.  Unfortunately UTIs, particularly prostate infections, are indeed hard to treat as most antibiotics do not reach the prostate very well.  Cipro is one of the most powerful antibiotics and one of the few that does reach the prostate.  Bactrim, a combination of Sulfamethoxazole and Trimethoprim (the one you are on now) is also effective.  It is not uncommon for two antibiotics to be given at once and Cipro and Bactrim are often used when an infection proves difficult to resolve.  While most people will get relief with a 5 day course of Cipro it may take as much as a month of combination therapy for tough cases.  You may want to ask your doc for a long term combination treatment if you are still having problems.  Hang in there, it will resolve.

The second issue you mentioned is that you have been told (by way of a digital rectal exam) that you have an enlarged prostate which is likely BPH since your PSA is low.  BPH is very common as men age.  This appears to be your first diagnosis of the decease and the first thing to assess is the size of your prostate and how much difficulty you are experiencing.  Google “IPSS” and download the International Prostate Symptom Score questionnaire.  If you score 1-7 you have a mild case and should probably do nothing.  If you score 8-19 you have a moderate case and should consider drugs as your first line of treatment.  Only if you score 20+ should you consider surgery and under no circumstance should you regard HoLep as the first line of treatment.  HoLep is a very difficult surgery to master, it takes a very qualified and experienced Urologist to perform it properly and a procedure by an inexperienced doctor will leave you damaged for life.

The idea that you fly from the UK to the US to get HoLep as a first line treatment for your initial diagnosis of BPH is ludicrous.  For one thing the NHS will not pay for it and secondly at your stage you need to assess your condition first.  HoLep is best reserved for those with very large prostates, 100 ml or above, who are not candidates for other alternatives.  There are other simpler and safer procedures for those with more typical prostates (google BPVP or Button TURP as an example).  As I mentioned you need to assess your condition first as simple drugs may be all you need.

Regarding drugs, Jaylin is also not the first line approach.  Jaylin is a combination of two drugs, Tamsulosin and Dutasteride.  The first line for typically enlarged prostates is Tamsulosin which you are now on.  However you cannot determine the effectiveness of Tamsulosin for your BPH while you have an infection, the symptoms of the infection will prevent an adequate assessment.  As I mentioned you need to resolve the infection first and then give the Tamsulosin time to work.  While Tamsulosin is usually effective within 1-2 weeks, in your case it will take longer (once your infection has cleared) as the infection will leave you swollen and stressed.  Tamsulosin has two primary side effects, headaches as it is an alpha-blocker, and retrograde ejaculation.  For a list of all side effects google “RxList” and then search for the drug in question.  Tamsulosin works fast (for those with no infection) and if you do not like it, its effects go away in a week or so.

In regards to your question about your loose bowel, Tamsulosin is not known for this side effect however since it works by relaxing the muscles around the groin this seems like a possibility.  What dosage are you on?

As I mentioned, Jaylin also contains Dutasteride.  This drug is best reserved for those with large prostates who have not gotten adequate relief from Tamsulosin alone.  Dutasteride takes about 3-6 months to be effective.  It works by preventing the conversion of Testosterone and thus shrinking your prostate to some degree (as much as 30%).  Dutasteride has some strong side effects - it will reduce or kill your libido and at your age you should not take it unless it is absolutely necessary.  If you took it you would have to do so for at least 6 months to evaluate its effects and if you then decide that it is not for you it will take about 2-3 months (or more) to flush the drug out of your system as it is very long acting.  Some people report that its side effects never go away but those men are usually much older than you.

FYI, I am 68, have had BPH for 10-15 years, took drugs for a while, just had a Button TURP, very successful.  I am 2 months post-surgery - my IPSS score prior to surgery was 21 and is now 6, a big improvement.  The Button TURP is supposed to last 10+ years but we'll see, time will tell…  The surgery was no big deal, one night in the hospital with minimal issues afterwards.  I have retrograde ejaculation now (had it on Tamsulosin also) but no incontinence whatsoever and no ED.

I hope the above information will help you make a decision.  You can easily check my recommendations by googling the drugs and surgical alternatives in question.  The Mayo Clinic has a good website about BPH.  Just google “BPH Mayo” and the first link will lead you to good information.  For whatever it is worth I have cut and pasted some of their recommendations below:

“Prostate gland enlargement is a common condition as men get older. Also called benign prostatic hyperplasia (BPH) and prostatic hypertrophy, prostate gland enlargement can cause bothersome urinary symptoms. Untreated prostate gland enlargement can block the flow of urine out of the bladder and can cause bladder, urinary tract or kidney problems.

A wide variety of treatments are available for enlarged prostate. They include medications, surgery and minimally invasive surgery. The best treatment choice for you depends on several factors, including how much your symptoms bother you, the size of your prostate, other health conditions you may have, your age and your preference. If your symptoms aren't too bad, you may decide not to have treatment and wait to see whether your symptoms become more bothersome over time.

Medications are the most common treatment for moderate symptoms of prostate enlargement.  Your doctor may recommend surgery if medication isn't effective or if you have severe symptoms. There are several types of surgery for an enlarged prostate. They all reduce the size of the prostate gland and open the urethra by treating the enlarged prostate tissue that blocks the flow of urine. The decision about which type of surgery may be an option is based on a number of factors, including the size of your prostate, the severity of your symptoms, and what treatments are available in your area.

Any type of prostate surgery can cause side effects, such as semen flowing backward into the bladder instead of out through the penis during ejaculation (retrograde ejaculation), loss of bladder control (incontinence) and impotence (erectile dysfunction). Ask your doctor about the specific risks of each treatment you're considering.”

Firstly thanks for your concern and comprehensive reply which has given me much food for thought. My condition has improved slightly especially over the last 2 days, the flow is better although still stop start but better, stinging still especially at the beginning but iam not straining now just letting it flow so to speak as best as it can. No passing stools as well because obviously not straining as much. Yesterday during the night i noticed i was passing more as well, not neccesarily emptying my bladder fully but much better, ie: as much as 150 ml in one visit as opposed to 30-75ml previously although still up every 90-120 mins or so. Now iam not sure if its the antibiotics (trimethoprim) or the Alpha blocker Tamsulosin i have been on the Tam for 5 days now so maybe its kicking in now as the GP did tell me it wouldnt be instant relief. My antibiotics finish on Sunday and i have heard that a low daily dose of say 100ML at night might ward off future infections, have you heard of this. 

My ISS score is 27 which is high isnt it, but as i say my symptoms have improved now also the urgency has subsided slightly, my own scoring system would say if 4 days ago i was a 2 on a scale of 1-10 then now iam probably hitting a 5.5

Iam aware of the ejaculation issue but frankly will accept that if i can get good relief from the meds.

The Urology department at my local hospital did contact me yesterday and they said i should hear regarding my appointment by the beginning of next week, fingers crossed!!

Anyway thanks again but will keep you updated.

Phil

A prostate infection will give you a high IPSS just like BPH because many of the symptoms are the same.  I would do the test again after your infection has passed and see where you stand.  The hospital should evaluate your prostate (size, flow rate, retention, etc.) and this should give you a better picture.  If your retention issues continue and your IPSS stays high I would try the meds first and then surgery if the meds don’t work for you.  A Button TURP would be a rather easy surgery if your prostate is not too large.  If it is then a HoLep might be your best choice.  Since this is the first time you have been diagnosed with enlargement it would seem likely that your prostate is moderate, not super large.   If it was large you would have noticed BPH symptoms earlier on as the prostate does not grow overnight.

Good luck next week…

C.S.

Google long term antibiotics prostatitis

Emis Moderator comment: I have replaced the links with a suggested Google search term rather than specific websites as some of the articles were very general and to sites not suitable for inclusion in the forums.

Safety of long-term therapy with ciprofloxacin NIH

Repeated antibiotic use alters gut's composition of beneficial microbes Stanford