How to treat and manage benign prostatic hyperplasia?

Question

Hello doctor,

I have attached a PDF containing the details of my recent visit with my urologist. I am trying to understand everything that he said for me to do. I think I understand all of it except this: What is he saying about one to nine? They seem to be related to what I am supposed to do.

1. Taking Tadalafil 5 mg daily for one month and seeing the effect.

2. Low testosterone.

3. Risk of hormone therapy.

4. Bone density scan.

5. I have BPH.

6. I have retrograde ejaculation.

7. In section III on page 5 of the PDF, the doctor recommended a trial of Sudafed and emphasized that it should not be used as a chronic medication due to potential heart problems. He mentioned that I should notify him if I experience antegrade ejaculation, at which point we would consider a repeat semen analysis.

8. Reference to a semen analysis in section IV on page 5 of the PDF. However, I was not instructed to have a semen analysis during the meeting.

9. If regular usage of Tadalafil does not address my symptoms, I should notify the doctor, and we will consider prescribing Vibegron.

Next, I took the bone density scan he talked about. Then he said in a message that I have osteopenia. Because of this and testosterone deficiency, I should see an endocrinologist for the management of both conditions. I understand this much and am currently working on it. However, I am seeking clarification on how all these aspects are related and what further actions are required. During the meeting, it seemed like there were two or three courses of action to try, followed by reporting back to the doctor on the outcomes or deciding on the next steps. Could you please provide some guidance on this matter?

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I went through the PDF (attachments removed to protect the patient's identity), your questions, and the urologist's notes. For BPH (benign prostatic hyperplasia) with an overactive bladder, medications are offered and if they fail, endoscopic surgery is next. If surgery is decided, Urolift causes minimal retrograde ejaculation while TURP/HoLEP (surgical procedures) causes retrograde ejaculation in 70 % of cases. For you, currently, Alfuzosin 10mg once a day will be more beneficial than Tadalafil. It has less chance of orthostatic hypotension and retrograde ejaculation than other medications. Your doctor should add Mirabegron 50mg once daily, with care that it may cause an increase in BP (blood pressure) in some cases (15%). Tadalafil is more of an add-on drug if Alfuzosin is less effective. Now regarding retrograde ejaculation, it needs to be proven first that it is there. If there is dry ejaculation, a post-coitus urine sample will prove it. If it is already proven, you need to decide whether you want sperm from semen or you are ok with using the frozen sperm. If there is low testosterone, replacing testosterone can alter sperm production, so that has to be kept in mind. Bone density scan is for bone thickness. If bones are brittle, 6-monthly injections of bisphosphonates help. Another side effect of testosterone is an increase in prostate size. So better to take hormone therapy after the sperm issue is sorted and the prostate has been operated upon. So this order of events seems logical -

1. Decide if frozen sperms will do or if they need fresh sperms.

2. If fresh sperms are needed, diagnose if there is retrograde ejaculation.

3. Treat the retrograde ejaculation by Sudafed or obtain sperm from urine after coitus.

4. Get endoscopic treatment for the prostate and then start hormonal therapy.

I hope you find this helpful.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Yes, I would suggest above one to five points would cover all the procedures needed.

Thank you.