I have had BHP for the last 10 Years & very slowly it has been getting worse (66 now) I have tried Tamsulosin which didn't help at all only giving me Retrograde Ejaculation so the Doctor asked me to try Finasteride & suggested I see a Urology specialist. I picked the Finasteride up from the Chemist & read the potential side effects with my Wife which were shocking, I haven't used any! This was 4 months ago & last Saturday I went to St James Hospital in Leeds to see a Doctor Prescott. A nurse immediately gave me a cup & a jug of water & told me I would be having a Flow test. An hour later I had the test & then the Nurse scanned my Bladder. 15 minutes later I met Mr Prescott who briefly asked what my Symtoms were. I explained the poor flow, stopping & starting, never quite sure when I have finished, dribbling etc. I get up during the night twice on average I don't have a drink after around 8pm. Going out with the Guys for a few pints on an evening are a thing of the past! I then had an internal inspection which lasted all of 2 seconds! The Doctor said indeed my Prostate was enlarged maybe 50-60? He then informed me I needed a Urolift procedure, a PSA blood test in a couple of weeks & a Flexible Cystoscopy which he said he would organize quickly. There was no explanation of how the Urolift works or any other procedures that might be available. I was sent away with a couple of leaflets for Urolift & information sheet about the Cystoscopy. It all felt very rushed. Can anyone out there tell me if Urolift is the preferred procedure for the NHS & how successful it is?
Don’t. Get PAE.
Does Dr. Prescott do the urolift? If so, that’s one of the reasons he is recommending it. Here in the States, I’ve found that Drs recommend things to me, but I always research stuff and ask questions. Once they see I’m seriously interested in having some say in my care management (whatever, it might be), then they seem to be more open with other options. Sometimes, I find myself having to educate the urologists (example: in my HMO they almost exclusively prescribe tamsulosin, but I insisted on alfuzosin after doing research. My urologist told me later that his department discussed alfuzosin and will now be recommending it more. Also, alfuzosin has been shown to have a significantly less likelihood of contributing to floppy iris syndrome - which can cause problems during cataract surgery).
Short answer is there are quite a number of other options, but I have no knowledge regarding the NHS questions you ask.
I will say that there seems to be more and more posts about unsuccessful Urolifts on this site. HOWEVER, you have to take that somewhat with a grain of salt because it is also true that men who have successful operations are much less likely to post here whereas men who have had problematic procedures do.
Good luck.
No mention of the drug Alfuzosin. I was switched from finasteride years ago (I am 73). Alfuzosin is by no means a cure but it certainly reduced my symptoms to the level of manageable. I still pee every couple of hours but with no side effects of the drug.
Drink less pee less. But at my age, hydration is important and it’s a fair trade – the frequency of need.
A general impression fwiw: invasive procedures like urolift and turp seem high priority for those who administer lifts and turps. I have avoided that road 'till now – 30 years with BPH symptoms but my no means stopped up and unable to void. Maybe ask your doc for alfuzosin – again, no RE and no appreciable impact on sex drive, while knocking frequency symptoms down by maybe half.Good luck.
get a second opinion after the cysto.. i wouldn’t rush it. you’ve had it this long you can afford to check all options.
this board talks about many procedures and their effectiveness. I’d spend a couple weeks reading here while finishing your tests then take all reports for another opinion.
And one more thing:
With my uro’s blessings, I have begun a regimen of daily generic 5 mg cialis (tedalafil) from an on-line supplier via Singapore. Morning erections are back (a nice problem to have…again, I am 73), and urinary urgency/frequency reduced by another 10% along with the alfuzosin therapy. Maybe inquire if that combo might help you as well.
Paul,
Firs of all find the size of your prostate. 5-60 g by DRE is bullshit. Based on my experience before you will get a decent CT or better 3T MRI scan, or TRUS (transrectal ultrasound imaging ) you don’t really know the size of your prostate. Given 10 years of BPH history and dribbling, I will bet it’s greater than that. If it’s really 50-60 g, PAE will do nothing or mostly noting to your condition. Start with alfuzosin. I’m 10 years on alfuzosin and 5 mg of Cialis and they do a great job. Especially after my PAE 22 month ago. PSA and flexible cystoscopy is a must. NHS will cover both PAE and Urolift. Keep in mind, Urolift is also a temporary solution, works not for everybody and is not reversible. Start with alfuzosin and measuring your prostate volume. If it’s greater than 60 g,try PAE first. Anything else can wait…
That’s what I did an will recommend to everybody with similar symptoms. My volume was 110-120 g., which is best treated with PAE. Complete the study first. All possible tests were discussed in detail on this forum, as well as all possible remedies. Good luck
Owen: You probably know this but I’ll repeat it for the benefit of the OP. Alfuzosin and finasteride are different classes of drugs. Alfuzosin like tamsulosin relaxes the prostate and bladder neck making it easier for the bladder to push liquid out. However, finasteride and dutasteride reduce the size of the prostate typically by 20 to 25% after around a year or so.
Owen:
Been meaning to ask you how the compression socks have been working? My apologies if I’m asking the wrong Owen.
Hi Paul
I am one of the ones who has had pretty good results. Had Urolift almost 3 years ago . My prostate was about 65 grams. I had bladder stones, a little bleeding and moderate symptoms from BPH. Never was on meds for it. Had it done in US at an outpatient surgical center using sedation. Procedure was easy with minimal side effects. A little sore for a few weeks but not bad. Catheter for 2 days was annoying but not really painful. Flow at first was great. Not as good now but still decent. Get up about once a night. No RE. Who knows how long it will last. I’m almost 74. My URO
was only doing Urolift or full turp at that time. He didnt really push me to go with Urolift but thought it was better for certain people. He hadnt done a lot. 25 or so but he did a lot of robotic surgery so I thought he was probably good using scopes. Cystoscopy was not too bad either. mine was quick and done in under a minute. About like getting an IV started. Not much worse than that for me ive had 2 cystoscopies and they were both about the same.
Good Luck
Tom C
His prostate isn’t that large. PAE, I was told, wouldn’t work for me because my prostate was only 49 cc.
From the OP’s post it sounds like the prostate size was “estimated” from a DRE, which is notoriously inaccurate (in my case 40 grams measured by DRE was more like 100 to 140 grams measured by ultrasound).
Would recommend that the OP get a transrectal ultrasound. What you say about PAE is also true for finasteride or dutasteride.
I think you’re doctor is getting it all back assward: starting with the procedure and looking for a diagnosis that fits. I hope you’re just explaining it wrong or in a jumble. You don’t know if you need a Urolift until AFTER the cytoscopy NOT before. That makes no sense. The Cyto is diagnostic. It will show the blockage.
First, you need to know what’ s going on. What is the the problem to solve? Where is the blockage?
For that you need the cytoscopy. Then and only then after the Cyto, will the doctor and you know what the problem is and then know how to best fix it.
So I would tell the doctor you want the cyto but say no to any other procedure until after the Cyto. I had to do that to one of my Uros: I said no to the needle biopsy. Later, my now Uro said my cancer risk was too low to need a biopsy.
Also, are you retaining? How much? If you’re retaining a lot of urine you should learn how to self-cath. It can be a life saver and can buy you time and help empty and thus rehabilitate your bladder while you figure out a more permanent fix.
Also, it will help avoid or lesson the time you need a Foley after whatever procedure you do have. And, if you ever stop entirely, it will save you a trip to the ER.
Ah yes. I remember our chat. I believe summer came and I was disinclined to use them. You remind me now – with temp at 20 here today – that I was in the middle of a test of sorts. I must resume it.
Regarding the finasteride, my bad. I had been prescribed tamsulosin (flomax), not finasteride. So I was switched from flomax/tamsulosin to alfuzosin with decent results. It was maybe ten years ago. Sorry for any confusion, but bottom line is I have decided against more invasive procedure thus far while having grown to accept the inconvenience of now more moderate frequency bathroom visits.
Oh – and more on the socks: In the interim, my doc had me screened for peripheral artery disease/ PAD. Finding: very slight (for my age) narrowing of one leg and not cause for concern. With that result, the socks were further de-prioritized – even as I was forgetting their original purpose. As I age I find myself more and more forgetful of yesterday’s strategies and commitments. A problem.
Very well and wisely formulated by Motto. My experience is exactly the same. Now I’m 20 years back anatomically after successful PAE but would I have a pack of disposable catheters back then, 5-6 years ago it would save me three trips to ER and annoying Foley installed for . a week with ensuing infection of LUTS. Having a spare disposable catheter around will save you money and time. Foley is needed only after Urological surgery. Most ER and Uros abuse Foley practices (it brings money to the ER or Doc and very sizable amount).
Listen to Motto’s reasons.
Thanks for all your replies, I described it exactly how it happened. I agree I want to know the outcome of the Cystoscopy before going any further.I will be taking things very slowly. I dont regard my BPH problems as urgent, just a bloody nuisance. I want to be sure any procedure is the right one for me.
Tests like Rectal Ultrasound and cystoscopy are routine before any procedure to alleviate BPH.
I had a Urolift by choice(Turp alternative) because I wanted to preserve "normal"sexual function(see effects of Turp and retrograde ejaculation).
My prostate was measured(by Rectal Ultrasound) to be around 85cc. Which is “on the upper limit” for Urolift, but I chose to go ahead with it.
After 3 years of reasonably normal bladder function( but with some PVR = post voiding residual) I experienced AUR(again) and had a TURP(no realistic alternative). I am fortunate, and have a very good Urologist(private ) I do not have RE(retrograde ejaculation)lucky me!
I am in a (small) minority (approx 85% of post Turp men have RE?)
We are all individuals. I researched the symptoms and prognosis of BPH thoroughly so that I was able to make informed decisions about my treatment after consultation with my urologist.
Medication for BPH has its place, but it was never going to be for me, my personal decision.
Paul,
Had a problem with Tamsulosin myself. Told the doc and he recommended Alfulosin. Much improved and worked quite well. On it for at least 4 years. 71 here. Also on Dutasteride. Seems to be helping quite a bit. Some side effects but livable. Don’t read the small print on the bottle. We would all be on no drugs at all if we did that. Worst case scenario which effects a very, very few. And if you are one you don’t like you can drop it. 2 times up a night is not excessive for folks our age. The start, stop, dribbling is annoying but can be dealt with. A little extra time. Start, wait 15 seconds and go for a second round. Dribbling, just spend a little more time at the end and then accept the results, not bad. Go from bitters to a cocktail. Less volume and less trips to the head. Urologists aren’t the most expressive and warm physicians (direct from my GP doc, I had to laugh at that one and he did too) on the planet. Funny generalization but that is what he said. I have found it to be totally accurate. So do extensive, extensive homework and research on the Urolift. Had one and it was a bust. Caused some minor permanent issues but nothing too serious. Good luck sir.
D.
Not a great advice Lester. Actually, a bad one.Finesteride and especially dutasteride kill libido in most ageing men and in many causes impotence. Well documented. In most results are permanent even after terminating the drug. Research the publications yourself. It took me 6 months to return to normal after two weeks on dutasteride.
Putting up with PVR,dribbling is even worse than impotence. It either leads to an enlarged bladder that is not able to contract and requires Self-cath for life + ensuing infection of LUT or contraction of the bladder and super-sensitivity due to the thickening of the bladder walls. As a result, the number of night and day trips to the loo will multiply to unbearable. The earlier you do something to decrease the obstruction created by the BPH the better for your bladder, kidneys and quality of life. Sexual life as well… Period.
Good luck to everybody. Everybody is different but not when it comes to obstruction of the bladder neck. Pretty much the same for all men suffering from long time BPH. It won’t dissolve itself… Don’t bet on it. It will grow and grow.