I Can Answer This One

Prostate problems. The curse of older men, I’m afraid.

I am awaiting an operation to treat an enlarged prostate, after various tablets failed to work. My consultant has told me there are a few types of procedures they cannot offer me – such as less invasive ones. Should I seek a second opinion?

Prostate problems are very common in older men. And one that we see very often is an enlarged prostate, which happens when the gland gets too large and pushes on the bladder.

This causes a range of distressing symptoms, such as going to the toilet often at night and feeling you haven’t emptied your bladder properly.

Often, men find their symptoms resolve easily with medication. But if not, surgery is offered.

When it comes to operations, the NHS has a few options. The one patients get will depend on factors like other health concerns and the specifics of their prostate problems.

In the early stages, Tamsulosin will help. Indeed, when I started on this medication, it was almost a miracle cure. Tamsulosin as an alpha blocker and relaxes the prostate, reducing the pressure on the urethra. Even in the later stages, it made a difference between being able to urinate or not.

There are a number of problems that arise from this condition. As the prostate enlarges, it squeezes the urethra and the base of the bladder. This means that it is difficult to void the bladder fully, leading to a constant feeling of urgency – even if you have just urinated. The outcome is an over active bladder. At its worst, this can lead to spasms where you need to urinate every fifteen minutes or so. As you may imagine, this can be somewhat limiting when it comes to quality of life. You spend your whole time when out and about sussing out where the nearest toilet is and when you do need to go, you spend ages trying to empty the bladder only to need to go a gain a few minutes later. I was travelling about the country for my work at the height of the problem, so journeys would be carefully planned and I avoided the back roads, keeping to the motorways and stopping at every service station.

Nightmare doesn’t even begin to describe it.

There came a point where the tamsulosin wasn’t really doing the business. I was also on Mirabegron and solifenacin to calm down the bladder spasms. I was even on finasteride for a while, to reduce the size of the prostate, but this failed.

Eventually, we got to the point where some sort of intervention became necessary. The least invasive was embolisation, which is a relatively new procedure, pioneered primarily in the USA and Portugal. This involves keyhole surgery to block the arteries feeding the prostate, thereby causing it to shrink. It also has minimal side effects, reducing the risks of erectile dysfunction as none of the nerves are affected.

Did this work? Well, yes and no. At first, there was a burning sensation and reduced flow due to the prostate tissue dying off. Then I went into full retention, leading to an A&E visit and catheterisation. It was assumed at this point that things would settle down. When the catheter came out, it did seem as if everything was working as normal, but over the next few days, I went back into full retention. Eventually I was put on a regime of self catheterisation. This lasted nearly eighteen months. The urology department contacted me from time to time, but things didn’t seem to be going anywhere. I mean, how helpful is a brief conversation asking if everything is okay, when what you really need is an appointment to fix the problem? Finally, frustrated, I paid for a private consultation. TURP I was told was the best option. I’d been dreading this as it is probably the most invasive. But I was now desperate. I paid £6.5k to have the procedure carried out privately. As it turned out, the previous embolisation, having shrunk the prostate, made the procedure go better and with less bleeding. End result? Everything works fine. There are minimal side effects and those that there are are so minimal, it’s not an issue. In short, dry orgasms, which is the usual side effect.

I can now go about life without medication, as one by one, I’ve not needed the bladder calming pills, and I can ride the back roads without worrying about where the nearest toilet is. I still have a slightly over active bladder and sometimes I’ll have a bad hour or so until it settles down, but mostly, everything is working normally. I do not get the urgency that used to characterise this condition. I just have to be careful about what I drink. Acids and too much water will trigger it as would coffee if I still drank it.