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About Arthur Goldstein, M.D.
Expertise
Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience
I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations
American Medical Association, American Urological Association, American College of Surgeons
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You are here: Experts > Health/Fitness > Urology > Urology > use of flomax
Expert: Arthur Goldstein, M.D.
Date: 5/26/2005
Subject: use of flomax
Question
I am white,68, live in Chicago.
I take Proscar and a bunch of medicines for atrial fibrillation, including coumadin.
I have elevated PSA and an enlarged prostate.
I have strong urges to urinate too frequently.
Several urologists have suggested that I take Flomax (generic name: finasteride).
I hesitate to do so because of the potential for dizziness, and because I already take, every day, 5 pills of various kinds.
Question: the urologists warn me that once I start to take Flomax, I cannot (or should not) abandon use of the Flomax. But I have not received any explanation of why I cannot stop its use.
Can you tell me?
Thnx for your help.
Chris
Answer
Chris, your symptoms suggest that you are suffering from BPH. Benign enlargement of the prostate gland (benign prostatic hyperplasia or BPH) occurs to varying degrees in all men as they age. The prostate surrounds the urinary canal (urethra) just after its connection to the urinary bladder. Inward growth of the prostate either into the bladder neck (opening) or into the urethra itself can cause difficulty with urinating. The prostate is checked by digital examination through the rectum. This gives the doctor an idea as to the size and benignity of the gland. However, it does not always correlate to symptoms as a small gland may have significant inward growth and a large glands enlargement may be entirely peripheral. The ability to urinate involves the urinary bladder muscle actually becoming stronger as it works against increasing resistance from the prostate. This delicate balance can be upset by any factor that decreases
the bladder muscles abiltiy to contract with sufficient force to open the
prostate (such as drugs, anesthesia, too much alcohol, ignoring the desire
to urinate, etc.) or those factors that might cause the prostate to
suddenly swell (ie acute prostatitis, sitting for extended periods of time, biking,
horseback riding, etc.). The typical symptoms that occur include diurnal frequency (daytime), nocturia (night-time frequency), urgency, hesitancy, slow stream and dribbling after voiding. This complex of symptoms is termed “prostatism”. If the obstruction to flow progressively worsens, the bladder eventually may not be able to empty completely. This leads to the accumulation of “residual urine” which may predispose to urinary infections and kidney damage from back pressure. Treatment is indicated to relieve symptoms and prevent complications. In many cases medications can be used. Alphas blockers (ie Hytrin, Cardura, Flomax, Uroxatral etc.) work by relaxing the bladder neck and urethra so the pressure generated by a bladder contraction has less resistance to work against. I am not aware of any contraindication to discontinuing the alpha blockers if they are not helpful. You might ask you doctor for clarig=fication. Saw palmetto, a natural herbal product, often provides symptomatic relief but the exact mechanism of action has not yet been defined. The prescription drugs Proscar (which is finasteride - not Flomax) and Avodart actually shrink the prostate. They work best in the larger glands and improvement may not be noted for up to 6 months. In cases refractory to medication, interventional measures are indicated. The “gold standard” for treatment is the time honored transurethral resection (TUR) of the prostate. For huge glands, open surgery may be necessary. In the past decade a number of other less invasive interventional therapies have been developed to reduce the obstructing prostate tissue utilizing various forms of energy. These include laser, microwave (TUMP or transurethral microwave of the prostate), and radiofrequency (TUNA or transurethral needle ablation of the prostate). Good luck!
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