Improve Symptoms and Avoid Surgery

Allen Barry, Jr. is a stickler for looking after his health. That’s become even more important now that he’s in his eighth decade of life.

Photo by Fred Bellet.

Medications help alleviate Allen’s prostate issues.

“I’m very particular about health care,” he shares. “I make sure I take care of myself.”
Part of his routine is an annual wellness checkup, which includes a PSA (prostate-specific antigen) blood test. High PSA levels – 4.0 or above – may be a sign of cancer or a benign condition such as a larger-than-usual prostate.
“My PSA was not very high to begin with,” Allen recalls. “Let’s say I was bouncing along at a three, and all of a sudden it hit a four and a half or a five. That’s what alarmed my primary care physician.”
Allen didn’t have any other symptoms besides getting up several times a night to use the bathroom. That didn’t seem out of the ordinary to him because he was taking medication that made him urinate frequently, and he also enjoyed alcoholic beverages before bedtime.
“I might have been a three-time-a-nighter,” he says of his bathroom habits, “but I didn’t mind getting up. I’m alone. I wasn’t bothering anybody in bed with me.”
Still, Allen followed his doctor’s advice and made an appointment with Alejandro Miranda-Sousa, MD, of Urology Experts in Fort Myers.
After performing a physical exam, the urologist concluded Allen had benign prostatic hyperplasia, also known as BPH or an enlarged prostate.

A Common Issue for Men

The prostate is a walnut-sized gland located between the bladder and the penis, just in front of the rectum. This gland secretes fluid that nourishes and protects sperm. The prostate surrounds part of the urethra, the tube that carries urine and semen out of a man’s body.
The prostate never stops growing, increasing between one and two percent per year, Dr. Miranda-Sousa educates. For some men, that leads to BPH, which doesn’t increase their risk of prostate cancer.
When the prostate enlarges, it can pinch the urethra, causing the bladder to work harder to push the urine out. Over time, the bladder muscles weaken, making it more difficult for the organ to empty. Patients who don’t eat a healthy diet, are overweight or have other medical issues are at risk of more troubling BPH symptoms, such as incontinence, pain and infections.
Seventy out of 100 men with BPH won’t have major difficulties, Dr. Miranda-Sousa stresses. Most of those who do can find relief through medications and behavior modifications, while only a very small number need surgery. Procedures range from inserting a heated needle into the prostate to destroy extra tissue to removing the enlarged part of the prostate.
Dr. Miranda-Sousa stresses that men shouldn’t assume their symptoms are an untreatable consequence of advancing age.
“A lot of patients have chronic changes in their urination, and they get used to it,” he elaborates. “They may get up from bed often at night, and they cannot drink too much because they’re in the bathroom all the time. Their flow may be weaker. Most of them become comfortable with their symptoms and don’t recognize them because they have adjusted to their condition.”

Medications Make a Difference

For Allen and other patients, Dr. Miranda-Sousa first identifies what other medical issues they may have. Then, he considers any medications his patients are taking and has them keep what he calls a voiding diary.
“It’s a recording of what they drink and when and how they urinate for forty-eight hours,” Dr. Miranda-Sousa explains. “The diary uncovers a lot of abnormal or problematic habits the patient may be doing inadvertently that cause him to go to the bathroom more often. The habits become ingrained and can result in a vicious cycle.
“Before we prescribe any medications, simply asking them to change some of those habits can help patients improve, and thirty to fifty percent of the symptoms will go away,” he adds. “We can improve their quality of life fairly quickly. And then the remaining symptoms can be treated with medication if we need to.”
Allen realized his alcohol consumption was affecting his bathroom routine. While his drinking wasn’t significant, he says, he now limits himself to “an ounce and a half or two a day.”
Another factor was a diuretic prescribed by Allen’s primary care physician. The water pill makes Allen’s kidneys release more sodium into his urine. The sodium then takes water with it from his blood, decreasing the amount of fluid flowing through his blood vessels and lowering his blood pressure.
Certain diuretics help prevent, treat or improve symptoms for conditions including heart and liver failure, tissue swelling (edema) and kidney disorders such as kidney stones.
“The important thing is for patients to use diuretics in the morning,”
Dr. Miranda-Sousa advises. “The next four hours will be more difficult because of the extra fluid they’re trying to get rid of. If they’re taking their diuretic in the evening, they’re going to be up all night. So that is an easy fix. You change the time of the medication, and you can improve the patient immediately without doing any major intervention.”
The urologist also decided to treat Allen by prescribing the alpha blocker tamsulosin to relax the muscles in his prostate and bladder neck, making it easier for him to urinate, and finasteride, which shrinks his prostate.
Men using an alpha blocker, which causes blood vessels to dilate, can see improvement as quickly as a week, Dr. Miranda-Sousa relates, while the other medication usually takes about three months, and sometimes up to a year, to achieve the maximum benefit.
“The finasteride was helpful, and I’ve been on it probably for eighteen to twenty-four months,” Allen reports. “We wanted to make sure we knew what we were starting with before we just jumped in. The doctor said, Why don’t you try this? and I did. Then, maybe six months later, he said, I want you to try that. These two things will work well together for you, and they have.”
Allen, a retired telecommunications manager with a mathematician’s penchant for precision, is supposed to take his pills daily and says he does so “religiously.”
“When I last visited him, the doctor said, Everything is just fine. Come back next March and have another PSA,” Allen relates.
He describes Dr. Miranda-Sousa as “extremely charming” with a “great chairside manner.”
“He’s an enthusiastic individual; easy to talk to,” Allen adds. “He has always answered my questions.”
Achieving a positive outcome can depend heavily on how well the doctor and patient work together, Dr. Miranda-Sousa asserts.
“We take time for the patient to understand what the issue is and why we’re suggesting certain things,” he elaborates. “That will work in our favor and the patient’s favor because we are like a team. Those are the patients who respond the best, when they really participate in their care.”
Allen counts himself as one of those patients.
“Whatever the doctor says should be done, I will follow,” he confirms. “I’m happy with my results.”

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    • Urology Experts

      The team at Urology Experts is dedicated to providing exceptional healthcare and personalized treatment plans. They offer a number of different urological services and specialties that will help any patient restore their quality of life.... Read More

    • Alejandro Miranda-Sousa, MD

      Alejandro Miranda-Sousa, MD, is a board-certified urologist by the American Board of Urology. Dr. Miranda-Sousa graduated from the prestigious Universidad Peruana Cayetano Heredia School of Medicine in Lima, Peru. He also completed his r... Read More