Dr. Roach: For prostate enlargement treatment, it’s meds first, surgery last

Keith Roach
To Your Health

Dear Dr. Roach: In a prior column, you discussed an enlarged prostate, or BPH. How does one know if they have BPH or overactive bladder? I wake up three times a night to urinate. I tried Flomax for three weeks, but it did not work. Tamsulosin plus finasteride seems risky, having two drugs in one’s system. Why not just get surgery to reduce the prostate and be done with it, rather than relying on two drugs for a lifetime with risks of side effects?

— E.M.

Dear E.M.: The symptoms of an enlarged prostate and overactive bladder can look the same in men. Many doctors will give a trial of tamsulosin (Flomax) or similar drug, but if it fails, some simple testing can help to make an accurate diagnosis. Urologists measure urine flow and bladder pressure in order to make the diagnosis for certain.

Surgery is not appropriate for overactive bladder symptoms, but if it’s proven that your prostate is the source of the problem, then surgery is one of the many options available. A patient’s personal preference is very important in deciding the best therapy, but surgery is usually reserved for people who do not respond to medication treatments. Surgery itself has the potential for side effects. Some patients’ symptoms worsen after surgery, and many continue to require medications even after surgical treatment.

There are a range of alternatives to traditional surgery, a good number of these have a lower risk for side effects. Only a urologist, after a thorough evaluation, can make personalized recommendations, but I advise against rushing to surgery.

Dear Dr. Roach: Will donating blood decrease my immunity during the coronavirus pandemic? I am a healthy 58-year-old female.

-- P.A.

Dear P.A.: No, the effect on your immune system from donating blood is minuscule. There is still a need for blood donation, and blood donation drives -- a big source for blood banks to acquire donors -- have been largely canceled. Check with your local blood bank, such as the American Red Cross, about donating. If you are healthy, please consider doing so.

Dear Dr. Roach: A recent column featured a reader’s 75-year-old uncle who experiences burning sensations shortly before and during urination. If a urinary tract infection has, indeed, been ruled out, I would like to suggest an effective one-week test that the uncle could easily self-administer. Simply eliminate caffeine, alcohol and hot spices for one week to see if the burning sensations subside. I learned this from my urologist years ago, and it’s amazing how often this simple adjustment to diet works for people.

-- B.P.

Dear B.P.: I thank B.P. for writing. I would also add that sometimes drinking more water can relieve the symptoms, as very concentrated urine can cause burning, and people may consciously or unconsciously drink less to avoid the uncomfortable feeling during urinating. These are easy solutions to try before a more thorough workup should be undertaken.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.