Medication
Neil Barber was involved in the production of the video above, funded by the NHS and produced by Health Innovation Oxford and Thames Valley (formerly Oxford AHSN), working with clinicians from the Frimley Health and Oxford University Hospitals NHS Foundation Trusts.
The choices of medication include:
Alpha-blockers, such as tamsulosin – give rapid relief of symptoms within a few days, but do not stop the process of prostate enlargement.
Side effects - the most important side effects of alpha blockers are dizziness and low blood pressure after sitting or standing up, headache, blocked nose and, in some men, dry or reduced ejaculation. The side effects all resolve if the medication is stopped.
5-alpha reductase inhibitors, such as dutasteride or finasteride, may reduce the size of an enlarged prostate but may take up to 6 months to show any effect on symptoms and are associated with side effects including loss of libido, erectile dysfunction, breast swelling and tenderness.
Using a combination of an alpha-blocker with a 5-alpha reductase inhibitor long-term does help your symptoms more than either medicine alone and is associated with a substantially lower risk of suddenly being unable to pass urine or needing surgery.
Side effects - ejaculation problems in about a third of all patients and erectile dysfunction. A loss of libido may not resolve when the medication is stopped
Anti-cholinergic drugs such as oxybutynin, detrusitol (tolteradine), or vesicare (solifenacin) may be prescribed alone or in combination with other medication if urgency or frequency are a problem.
Side effects - this family of drugs is strongly associated with side effects, particularly in terms of dry mouth and constipation, however this is a large class of drugs and it may be possible to find the most beneficial medication for each patient.
Beta 3 agoinist – Betmiga (mirabegron) this relatively new drug is used as an alternative to the anti-cholinergic drug but seems to be both equally effective and better tolerated in terms of side effects.
Phosphodiesterase-5 (PDE-5) inhibitors, such as tadalafil (Cialis) are also effective in reducing prostate related urinary symptoms in combination with erection problems. This is a major step forward in the medical treatment of patients with both complaints. It is given as a daily 5mg dose.
When the symptoms from BPH are relatively severe or unresponsive to medication, then the next step is to consider procedures that aim to create as wide a passage as possible though the prostate gland.
Options include: the Urolift device, TURP (transurethal resection of the prostate) or procedures employing laser energy. At Urology Partners we offer the full range of treatment options, so we can tailor your care according to your symptoms and preferences.