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An Option to Medications for BPH

By Lance Patrick Walsh, MD, Ph.D.

Having to go all the time? You are not alone. Over 70% of men in their 60s have symptoms of BPH (benign prostatic hyperplasia),1 a condition in which the prostate enlarges as men get older. While BPH is a benign (non-cancerous) condition, it can certainly decrease one’s quality of life.

The most common treatment for BPH is drug therapy which requires that patients take a pill each day for the rest of their lives. Until recently, the only other option was invasive surgery which left many with undesired side effects including sexual dysfunction. In 2013, the FDA cleared the UroLift® System, a minimally invasive procedure that does not require any cutting, heating or removal of prostate tissue.

Medications to treat BPH include alpha blockers and alpha reductase inhibitors. However, over 17% of men on BPH drug therapy discontinue treatment early due to undesirable side effects or not getting adequate symptom relief and it is easy to see why.

Alpha blockers (Flomax, Rapaflo, Hytrin, Uroxatral, Cardura) are most widely used to treat BPH and work by relieving the amount of tension in the smooth muscle of the prostate and bladder neck, which allows easier urination.  These drugs require a pill a day for the rest of your life in order to keep symptoms from worsening. While they provide rapid improvement of urinary symptoms and some improvement in urinary flow, associated side effects include impotence, retrograde ejaculation (dry orgasm) and decreased sex drive, as well as other physical effects such as wheezing, fatigue, dizziness or hypotension (low blood pressure).

5-Alpha reductase inhibitors, or 5-ARIs, include Proscar (finasteride) and Avodart (dutasteride). These medications work by blocking the conversion of testosterone to DHT. 5-ARIs shrink the overall prostate gland size and reduce the obstruction that causes problems with urination. They also require ongoing daily dosage and can take 3 to 6 months to be effective. Side effects of 5-ARIs may include impotence, decreased sex drive, reduction in semen during ejaculation, swelling of the breasts, and artificially low readings of PSA levels. 

When alpha blockers are not enough and the prostate grows to a certain size, a combination of an alpha blocker and 5-ARI may be prescribed.  This is called combination therapy and has been shown to be more effective than just one drug, but also associated with added side effects. It can require two pills a day, or there is Jalyn which has both drugs in one pill.

As an urologist, I have treated BPH for decades and welcome the UroLift system as a safe and effective option for patients, which do not require a lifetime of medications. The minimally invasive procedure can be done in an office setting and most importantly, preserves sexual function. Numerous clinical studies have demonstrated that the UroLift provides a similar level of symptom relief compared with other BPH procedures with fewer side effects.2 Reported side effects include blood in the urine, painful or difficult urination, the urge to urinate, pelvic pain, and urge incontinence. Most events were mild to moderate in severity and resolved within two to four weeks after the procedure.

If you are experiencing symptoms of BPH or would like to consider options to medication, speak with your urologist to see if you are a candidate for this innovative technology.

Dr. Walsh is a specialist in urology, treating a variety of conditions ranging from cancer of the genitourinary tract (kidney, prostate, bladder) to benign conditions including kidney stone, BPH, incontinence, bladder prolapse, and hematuria. He specializes in minimally invasive and robotic assisted laparoscopic surgery using the latest techniques to help his patients. For more information call (760) 346.7191 or visit walshurology.com

References: 1) NeoTract US market model estimates for 2013 based on IMS Health and Drug Procedure Data; 2) Publications http://urolift.com/physicians/results/publications/

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