Procedures for prostate troubles
DEAR DOCTOR: Is there any treatment besides surgery that can reliably help an older man urinate when he is experiencing difficulty due to prostate enlargement?
DEAR READER: This common problem becomes more common as men get older. In fact, 40 percent to 50 percent of men ages 51-60 — and up to 80 percent of those over 80 — have prostate enlargement. Slightly more than half suffer symptoms, including poor urine flow, frequent urination, incomplete emptying of the bladder and waking up multiple times at night to urinate. Some symptoms can be improved by decreasing alcohol and caffeine and by decreasing evening fluid intake.
Drug treatment is the first line of therapy. Alpha-1 receptor blockers work to relax the smooth muscles in the prostate and the lower portion of the bladder. This relaxation allows the urine to flow more easily from the bladder. The biggest side effect is lightheadedness, because the drug also lowers blood pressure. This lightheadedness has not been reported as much with newer formulations — tamsulosin, alfuzosin and silodosin — that
improve urine flow and reduce frequency because they’re more selective to the urinary tract.
Another option is to decrease prostate size with a medication — finasteride or dutasteride — that reduces the formation of the hormone dihydrotestosterone, or DHT. This hormone stimulates the prostate to grow; the medications work by inhibiting the enzyme that produces it. These drugs can take six months to one year to reduce symptoms; the biggest side effects are a lowered libido and, less commonly, erectile dysfunction.
A daily 5-milligram dose of the erectile dysfunction drug Cialis can reduce symptoms of an enlarged prostate. For those who don’t retain urine in the bladder, anticholinergic medications such as tolterodine and oxybutynin help relax the bladder and decrease the urge to urinate. These medications have side effects — dry mouth, blurred vision, drowsiness, constipation and mental impairment.
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