So, if a man is having urinary issues due to BPH, what are treatments that are available?
Boy, it's a huge industry. There's herbal products like saw palmetto, Crilla, other
things that are anti-inflammatories like curcumin. These things may improve urinary symptoms.
Then you're on to the pharmaceutical agents like Flomax, Myrbetriq, there's a myriad of
different products, and often they're pretty helpful in making sure that men aren't waking
up so frequently at night or rushing to the bathroom with a strong sense of urgency or
urinating too frequently. These are the main complaints that we see. And then, of course,
if those reversible treatments aren't working—usually we start with pills or something that you
can stop and start, you're going to dig yourself a hole you can't get out of, but men that
don't respond to those, they can go onto other treatments like Rezum or Urolift, embolization,
some sort of laser TURP. These things are done by urologists and are effective in improving
symptoms, but they do come sometimes with some risks and side effects that in rare occasions
don't go away. So, it's a huge field honestly.
So, is the average urologist trained to handle all these different types of BPH treatments?
Absolutely, the bread and butter of the urology world is to take care of men with large prostates,
prostate cancer, and basically anything directly related to the genitourinary tract.
Are there certain types of BPH treatments that you have seen maybe have some lasting
long-term side effects that you would prefer men not have?
Well, anytime you have a procedure where they go and cut part of your prostate out or something
like that. There are small risks of incontinence. It's quite common for men to get something
called retrograde ejaculation where they have dry orgasms, and other things can happen.
For the most part, the net benefits are positive. These treatments don't work in everybody,
so you can't go into, say, a transurethral resection or a laser TURP, it's called, with
100% certainty it's going to help the urinary symptoms, but it often does. It's often effective,
and it does have some risks.
You mentioned embolization for the prostate in regard to BPH. Can you explain how that
works?
So, when the prostate is super enlarged sometimes it's pressing on the urethra and creating
difficulty for urinary flow, and there are specialists, interventional radiologists,
that can thread tiny little tubes, catheters or straws, through the bloodstream into the
prostate and then inject substances that block off the blood flow, and when you deny the
blood flow to the prostate—or any organ for that matter—that tissue dies, and when
it dies then the gland will shrink down in size. And, embolization appears to be effective
in some men. Like many of the treatments, it doesn't work in everybody, but sometimes
these gentlemen are desperate. You know, their bladders aren't emptying properly or they're
just, you know, totally in a bad way with urinating really frequently and such measures
are appropriate.
So Dr. Scholz, you mentioned Mybetriq, Flomax, I know there's many others. Are there any
benefits to one over another?
Well, they work by different mechanisms. So, if one is not working, you might be able to
switch over to another, and also, if one of these medicines is giving a partial effect,
you can add a second or a third medicine. There's another category we call the 5-Alpha
Reductase Inhibitors, Proscar and dutasteride which shrink the prostate by blocking dihydrotestosterone.
So, you can even be on all three types: The alpha-blockers (like Flomax, Rapaflo, uroxatral)
these medicines, Myrbetriq which reduces the irritability of the bladder, and the 5-Alpha
Reductase Inhibitors to shrink the overall size. So, some men don't respond to just one
might do better with 2 or 3.
We always have to mention with the dutasteride and the Proscar that there is a risk of reduced
libido from these medicines, and so people need to be warned if they start to run into
those side effects they have to stop the medicine. But they're good. I mean, usually, we'll start
off with an alpha-blocker and then if you don't get a satisfactory result, add some
Myrbetriq, and the goal, of course, is for men to go to the bathroom less frequently,
be able to sleep through the night, and to be able to empty their bladders completely.
Men are dealing with this on a daily basis and it can really improve their quality of life
You also mentioned supplements very early on in the list of treatments. So, what type
of results have you seen with those supplements? Are they as effective as the pills?
In my experience, they aren't. It'd probably be like taking a third of a Flomax if you
think of something like saw palmetto. So, if people have very mild symptoms, they can
buy these things at the pharmacy without a prescription; they can try it. The results
should occur within a few days if it's effective, and if that works, that's great, but oftentimes
the people I'm seeing have already done that and it hasn't helped them.
Are there any side effects to those supplements?
None that I've seen, no, they're very well-tolerated.
So really, I think the major takeaway is that less is more in the beginning. That you should
start, maybe, with supplements, and then go to pills, and then look at the procedures,
and not go straight to the procedures considering the side effects. And these second, I would
imagine, is that it really is important who the doctor is if you're going to get to that
procedure level and research, you know, are they experienced and do they know all the
different types of treatments, and do they have your quality of life in mind...
I agree.
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