As you may be aware, BPH, also known as benign prostatic hyperplasia or enlargement, is a non-cancerous enlargement of the prostate gland that occurs as men age. This affects an increasing number of men over each decade of their life, beginning in the mid-to-late-40s and 50s. If left untreated and the condition worsens, this can result in progressive damage to the bladder. As such, much of our focus now is not only on evaluating and managing men’s benign prostatic enlargement, but also focusing on maintaining the functional health of the bladder.

As a consequence, we can now commonly refer to the acronym of BPH not only as Benign Prostatic Hyperplasia, but also as Bladder Preservation Health. This is especially important now, as, over the last number of years, there have been increasing studies suggesting risks of side effects to the commonly-prescribed medications for BPH. These medications include the following class of drugs: the first being an alpha blocker. The most common of those is termed Tamsulosin. The second class are 5-alpha-reductase inhibitors, including medications such as Finasteride and Dutasteride. In addition, anticholinergic medications or antimuscarinic medications like oxybutynin may commonly be prescribed for overactive bladder, which may coexist or be caused by the enlarging prostate.

With the antimuscarinic medications for overactive bladder, many studies have reported not only the common side effects of dry mouth and dry eyes, blurred vision, constipation, but also associated a possible increased risk of cognitive decline in older adults. These antimuscarinic bladder medications also can have added side effects with other medicines commonly prescribed in the older patient populations, including things such as tricyclic antidepressants, which may be used in the treatment of Parkinson’s and Alzheimer’s diseases as well. There are numerous other medications which could have an added side effect profile with these prescribed bladder medicines. Alpha blockers, including Tamsulosin and Alfuzosin, are commonly prescribed for BPH patients. Some of the common side effects of these medicines are asthenia or generalized loss of strength, dizziness, headaches, nasal congestion, sexual dysfunction, a floppy iris, as well as some reports suggesting an increased risk of cognitive decline.

The 5-alpha-reductase inhibitors, including finasteride and Dutasteride, have been reported to have similar potential side effects on sexual function, also erectile dysfunction, loss of libido or sex drive. There has also been a recent report associating what is termed post-finasteride syndrome with similar side effects, but also other symptoms such as depression, anxiety, and cognitive complaints persisting, despite withdrawal of the medication. Additional reports have recently described patients taking 5-ARI medications a greater risk in the delay or diagnosis delay in prostate cancer, with more advanced disease at diagnosis.

All of this information may sound rather ominous and is not intended to suggest that your doctor and you should not be continuing you on these medications, but it could be, at a minimum, a good reminder to discuss with your doctor about your symptoms that you may be experiencing. Personally, for me, it is also is a good reminder that we need to review with our patients their BPH treatment history and medication indications and evaluate the risks and potential benefits of their previous BPH medical management concurrently with other ongoing treatment alternatives for their BPH. So, all that being said, in the past, many patients may have been continued on medication for their bladders and prostates because of fear of side effects of other surgical treatments for their BPH, even though these medications may not really have been providing them a full benefit.

So, here’s the update. We have new indications for minimally invasive treatment of BPH using the Urolift system that is now approved by the FDA to include patients whose prostates are up to 100ccs or 100 grams in size. That’s a pretty big prostate. Historically, these patients would typically require much more invasive treatment as their condition worsened. In addition, follow-up real-world studies in communities across the country have been completed and reported, which include a broad patient population, have been reporting similar outcomes data results to the original randomized studies, thus underscoring the overall safety and efficacy of the Urolift system for the treatment of men’s BPH.

So, with this expanded indication for BPH treatment, we can consider and evaluate many more men to treat their enlarged prostates, avoiding more invasive surgeries and enabling these men the opportunity to get off of their BPH medications. There are numerous treatments for BPH and now with effective, low-side-effect, minimally invasive office treatments, this has allowed us the opportunity to address many men’s BPH condition earlier in their disease course and provide the best chance for also preserving their bladder health. As the first Center of Excellence Urologist in Houston for BPH care using the Urolift system, and on behalf of Northwoods Urology of Texas physicians, we remain committed to your urologic care. Be sure to follow our social media for more tips like this.