Dear Dr. Roach: I am a 66-year-old man, who is healthy with a very active life, both physical and sexual. Like many men my age, I have an enlarged prostate that my doctor monitors during annual visits. It doesn’t impair my life, with the small exception of being annoying (waking up nightly to a weak or slow urinating stream), and it doesn’t bother me too much during the day, except once in a while when I have to urinate a little more than usual. Every now and then I’ll try an over-the-counter prostate supplement, but they never work. I will not go for surgery because it’s not really necessary.
I just read about a new revolutionary treatment option called a prostatic lift device, which is supposed to “lift and remove the prostate tissue out of the way so it no longer blocks the urethra (the passageway that the urine flows through).” It says: “Tiny implants are placed to hold the tissue in place, like tiebacks on a window curtain, leaving an unobstructed pathway for urine to flow normally again.” They go on to say that treatment typically takes under an hour, preserves sexual function, doesn’t require cutting, heating or removal of tissue. Compared with other benign prostatic hyperplasia surgeries, this system is supposed to have a strong safety profile with minimal side-effects. I am curious if you’ve ever heard of this. Do you think it’s safe? It sounds great. However, the thought of tiny implants being placed inside of me and staying there scares me.
V.A.
The prostatic urethral lift procedure is yet another option for men with symptoms of an enlarged prostate. The procedure does involve the placement of small implants. The procedure is said to be easy to perform (easy for a urologist, that is), and improves quality of life and measures of urinary flow.
In a study of 206 men, none developed sexual troubles after the procedure. It has significant benefits over traditional surgery: Recovery is faster and has less risk of sexual side-effects, but traditional surgery improved urinary flow and complete bladder drainage more than the urethral lift procedure. Also, 14 per cent of men who had the lift procedure needed the traditional surgery within five years. The implants seem to be safe and do not affect the ability to do surgery if necessary.
I wouldn’t recommend this procedure nor a surgical procedure — or even an alternative procedure such as laser, microwave, plasma vapourization or water vapour ablation — without a trial of prescription medication first. Most men do very well with an alpha blocker such as tamsulosin (Flomax), a dihydrotestosterone blocker like dutasteride (Avodart), or a combination of the two. I’m not sure you have tried that.
Dear Dr. Roach: Should a person be concerned about serious side- effects from long-term use of Claritin-D? My son has been using the medication continuously for about nine years. He has had allergy shots, which were minimally helpful. He cannot use nasal rinses or sprays because they cause nosebleeds. He does have some sleeping problems, but since he’s been taking Claritin-D for so long, it’s hard to tell if that medication is the cause.
M.S.
Claritin-D is a combination of the antihistamine loratadine and the decongestant pseudo-ephedrine.
Loratadine is considered safe in most people. Pseudoephedrine is safe for younger people, but it can raise blood pressure and pulse, and in older men, can cause urinary symptoms.
He might try plain Claritin, which is just the loratadine, and save the Claritin-D for his worst days. Less pseudoephedrine is probably better.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu
