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Online clinic on prostate & testicular health - Nov 2018

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General Prostate Health Questions

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Benign prostatic hyperplasia

Postby Twittering on Wed Nov 07, 2018 11:55 am

Hi

I have suffered from BPH for about 15 years. I am now on what I have been advised is the maximum pharmaceutical treatment, ie Tamsulosin (400 micrograms), Finaseride (5mg) and Mirabegron (50mg) - one of each every day. Have tried solifenacin, tropsium chloride and fesoterodine fumerate with no benefit. I have been told that I might also have an unstable bladder though a cystoscopy in 2014, when my prostate was 60-80 grams, showed a normal bladder. I think that the medication is stopping things getting worse though I still suffer from nocturnia, daytime frequency and sometimes urgency. Regular PSA tests are within the normal scale.

I have consulted about surgery, including TURPS, Eurolift and Rezum but have been put off by possible after effects including need for catheterisation and incontinence. If I could be confident that these would only be short term I might go ahead but I have heard about too many adverse experiences, and Rezum seems too new to have a reliable track record.

What is the likely prognosis if I continue as I am.? Am I worrying too much about side effects of surgery? Any other comments? Any advice would be much appreciated.

Phil T
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Re: Benign prostatic hyperplasia

Postby Twittering on Wed Nov 07, 2018 1:05 pm

"Urolift". I must have had Brexit on the brain!
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Re: Benign prostatic hyperplasia

Postby Jonathan Makanjuola on Thu Nov 08, 2018 1:06 am

hi Phil

I am sorry you are having all of these issues

Have you had urodynamics ? its a specialised bladder test. if not, I would get that done before proceeding with any surgery to understand the nature of you bladder, given you have has this for a long time and tried many medications for the bladder, some of the symptoms like urgent may not fully go away after surgery but may improve over time

Regarding surgical options - take your pick, there are a few available to make a bigger hole in the prostate ( which is the end game with surgery)

They all have slightly different side effect profiles

TURP and HOLEP (for bigger prostates) is the main operation offered in the uk and are very effective but do have the side effects although incontinance is only about 1-5% risk and both are durable so last up to 10 years if done properly ( the prostate does grow back)

Newer treatments are NICE approved such as Urolift , Rezum- but long term data is still lacking and have less side effects but may not last as long (need re treatment sooner)

talk to your local urologist to see what they offer , good luck
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