Hi all. I live in the U.K. am 62 years of age and have been treated for BPH with Doxozasin and Finesteride, I have have the usual DRE and PSA checks over the years and no alarm bells have been flagged but the DRE confirms I have an enlarged prostate.
I have been on the Finesteride for over a year now and over the last 3 months my sex drive has dropped off dramatically and feel what I can only describe as desensitised down below. My flow is not great and I'm up a couple of times through the night. My doc, on the last visit says I am on the best combination ot drugs but I seem to despair at their lack of expertise and am sure if I go back and mention my decline, he will say it is a pay off to keep the prostate in check, another PSA check DRE.
I know things are advancing with procedures to treat BHP and hope I could delay things until a safe less evasive procedure was available. The word TURP puts the fear of God in me. My friend suffered after one a few years ago.
In anyone's opinion am I on the Finesteride for too long and could the doc give me an option. The Doxozasin was prescribed due to my high blood pressure and is a tablet that they say, if can be tolerated is ideal for my prostate also.
Any info. about good urologists, drugs or the way forward would be much appreciated from you guys, and all the best!
Graham The 2 drugs you are on are going to stop your libido. There are some other med's you can try that do not have the side effects of the 2 your are taking. Talk with your doctor to see if he will change them if not get another doctor that will. And do not be force into any procedure that you are not ready for. Myrbetriq & Cialis are a couple Ken
Cialis (10-mg or 20mg) will revive your erections. But from what you describe, you may want to explore a non-invasive intervention. PAE and REZUM have this year been approved by NICE as cost effective for financing under our NHS. I am 76 and this year had PAE. It is relatively new in the UK and you might need to search a bit for someone who has done it often enough. I went to Poland and paid at a private clinic c £2500 + fares. Two months on, my prostate has shrunk c 10% and vascular surgeon says he expects that to reduce further. Sexual function unchanged. An MRI to detect the size of your prostate seems desirable; a DRE can provide only a rough estimate.
You should stop Finasteride immediately or risk going impotent, just google it you'll see what others say about it. Doxozosin if it is the same as Alfuzosin, Prazosin helps with BPH but there are others that are more specific for BPH, like Flomax (Tamsulosin) and Rapaflo (silodosin) - those are USA names I don't know about UK.
If you need it for blood pressure anyway I suppose Doxozasin should help and you can't take that together with Flomax as far as I know.
So bottom line if the drugs are not enough, I don't know what is available in UK or if you can afford to travel and or pay out of pocket, but there are alternatives to Turp. They are all scary in their own way, you can read about most of them on patient.info but I think the fear of the very idea is worse than the actual pain. If you have surgery to reduce size of prostate there is not guarantee you won't still get up twice a night or more, the bladder gets out shape and many even who don't have BPH get up anyway to pee. If you feel the flow is getting worse to the point where you might get blocked up it's time to act. Learn how to do CIC (self catheter) so you don't have to be rushed to emergency room etc. Then look at options and decide what is for you. Your Urologist may not do that procedure.
Graham If you do need a procedure try Urolift. I know they do them in the UK. That would open you up and it has so side effects. Have a good day Kene
Graham, I believe in the UK and have been put on a waiting list for a Urolift by my urologist... I have both but additionally suffer from a low capacity/overactive bladder... I wake up every hour in the night to pee..
Apparently he is going to do the Urolift in his clinic and said it will take no longer than 10 minute under local anesthetic, and it is also a very quick recovery period..Youll need a cystoscopy to determine whether you are a good candidate for the procedure but I suggest talking to your Urologist about it..
Sorry phone autocorrected.. should have read "I live in the UK"
How much Doxazosin are you taking a day ? You can try to increase it. Some people experience RE with it. About the lower libido, it is probably the finasteride.
Fairly safe procedures are Urolift, PAE, Rezum, and FLA. There are no guarantees they will work for you, however. Hank
I am also on blood pressure medicine (Valsartan - HCTZ) - 69 years old. After about 12 years after my first BPH surgery (TUNA - needle ablation), by BPH returned (mostly increased night visits). I was prescribed tamsulosin (Flomax). Mild reduction in night time visits. But, it reacted badly with my endurance. In combination with the main blood pressure medicine, it was hard doing things. For example, I enjoy jogging. I couldn't do that. Also, there was the retrograde ejaculation issue. Many men have good results with tamsulosin. I wasn't one of those. While I then had success with a surgical procedure (urolift 1.5 years ago), there isn't one answer for everybody. You'll see that if you read these forums. Whatever you decide, good luck.
I am 65 years old (married 34 years) and had the BPH condition, was completely blocked and was retaining 4 liters. I had the green light laser procedure with Dr. Ricardo Gonzalez at Houston Metro Urology on July 19. I highly recommend him and this procedure. I am peeing normally now and feel completely healed. I have the dry ejaculation (sperm goes to the bladder) but I don't believe that is avoidable based on how the prostate tissue has to be removed from the urethra. I do have a relatively normal orgasm and there is some sperm that makes its way out - but not much. The catheter after the operation for up to 3 or 4 days is uncomfortable for sure. I slept in a recliner for those days and took some sleeping pills so I could stay in one position all night which worked ( I normally sleep like a live fish on a dock - which makes it tough). Anyway, I'm better now and recommend the procedure. I'm not on any drugs and I like it that way. Good luck!
I don'y know if the doctor you are going to see is Neil Barber but he said it was a very good procedure if you have sexual concerns 100 % Ken
Also, after finding I was retaining 4 liters, I began self-catheterizing to empty my bladder. While this was uncomfortable as well, it did give me complete peace-of-mind that my bladder was empty which was worth the discomfort of doing it. Plus, I did not have to urinate between self-caths which was a also a relief - especially at night. I did that 2 or 3 times a day for 4 weeks until my operation and measured and logged my "output" each time to completely understand how much urine I was producing and retaining after I peed all I could pee. It was surprising but I also came to understand how my kidneys and bladder were working which also gave me great comfort and peace of mind. An interesting stat my Uro Doc provided was that your bladder can comfortable retain up to a quarter of its "capacity" without causing a problem for your kidney's. For me that up to a liter - which seemed like a lot when I self cathed. That eventually went down to 500-600ml and I stopped self cathing about 3 weeks after the procedure. Self cathing after the procedure when the urethra channel has been freshly opened up was a little more uncomfortable also but was tolerable and - again - knowing that my bladder was emptying gave a peace of mind and a careful understanding of was really going on biologically. I just prefer that over depending on drugs and dealing with side effects. I'm no masochist and don't have a high pain tolerance but I preferred this real, physical solution over drugs and side effects. And it has worked for me.
I have had the same issue.
Have your testosterone checked!
If it is low this may be your problem. I was low and now back to normal and my sex life has been Fantastic!!
Graham,
Finisteride is the drug that is lowering your libido. It will continue for at least a year after you stop taking it and possibly be permanent. My Urologist did not tell me that when he prescribed it for me. I think many Urologists do not tell their patients about the long lasting effects of it, in fact they may not be aware.
Doxozasin is and Alpha Blocker so lowers blood pressure. It relaxes the prostate and bladder neck, so can cause retrograde ejacualation (dry ejeculation). It will also cause lackluster ejaculations since it relaxes the prostate. Fortunately the effects are temporary and will go away within a day of stopping the drug.
A drug you can try in place of Doxozasin is Cialis, which is a drug similar to Viagra, so could improve your sex life.
If you want to get off all those drugs you could try CIC (Self Catheterization). There are some good discussions about it, on this web site. A good way to start is to get your Urologist's office to show you how and order supplies for you.
Thomas
No, not Neil Barber... But yes, it is the least invasive surgical intervention... I also have a high bladder neck apparently, so of the Urolift is not successful, he has suggested that he does surgery to correct that too.. but I am very hopeful the Urolift will produce positive results... I have a very poor flow rate but at least I manage to empty my bladder currently.
As already mentioned NICE has passed PAE as a safe procedure so it is now up to local health authorities to fund it. Ask your GP if it is available in your area. If not ask for a referral to where it is. PAE is the least invasive of all the procedures and maybe exactly what you're looking for, a cystoscopy examination and excluding cancer as the cause needs to be established first, this should ensure the right procedure is offered.
Hi Graham, i am 62 and had bph and are much better now and definitely did not want turp! get off finasteride asap! dont believe what they tell you, my suggestion is start with a simple and cheap ultra sound of your prostate to help identify the exact cause of your issues, its wise despite your fears to realize prolonged use of drugs is not ony bad in so many ways but as mentioned by others your bladder and kidneys will be getting damaged while you postpone what maybe the inevitable, I left acting too late and now its taking a long time to hopefully retrain my bladder, in my case I had an enlarged median lobe as seen from the ultra sound and 9 months ago chose FLA with outstanding results, no issues, no pain, no damage,no regrets,now life is a million times better, you will need to ascertain your exact reason for bph before doing anything else and get off finasteride asap all the best Brian.
Hi Graham I forgot to mention try not to push urine out as that will increase bladder and kidney damage.
Please what ever you do do not let them do both at the same time. Have the Urolift first. It will take the pressure of the bladder. If they touch your bladder neck it will not close right and you will end up with retro ejaculation. Make sure that is the only thing you sign and give permission for. Ken.
Thanks Ken... We are only doing the urolift first.. and then evaluating the results after 8 weeks...
If it is not as successful as I hope, then we will discuss further options... he did say, that if he does do the bladder neck, he would only do half, so whilst I would have reduced ejaculation, it would not be full retrograde ejaculation... however, Urolift first ... hoping for positive results