DEAR DR. ROACH:
I’m a 76-year-old male who has had nighttime urination problems for many years. I must get up from sleeping every 1.5 hours. I can set my clock by the urge! I was prescribed tamsulosin, which I took for many months, but it wasn’t effective. I was then prescribed tadalafil, which I have been taking for a month with no relief. You can imagine how disruptive this situation is to my daily sleep. Is there another alternative? — D.T.
ANSWER:
Many times, men with increased urinary frequency in the nighttime have a problem of an enlarged prostate. Tamsulosin (Flomax) is a frequent choice and effective for most men with urinary symptoms due to an enlarged prostate, which is extremely common for men your age. Tadalafil (Cialis) is more often used as a treatment for erectile dysfunction, but it is also a useful drug for men with prostate issues. Although there are other medications, such as finasteride, it is worthwhile to take a figurative step backward and ask whether an enlarged prostate is really the problem. Very often, the problem isn’t the prostate at all — but the bladder.
Sometimes an overactive bladder can be very difficult to distinguish from an enlarged prostate by its symptoms. Urologists have specialized tools at their disposal that can help distinguish between these possibilities (and some less-common ones). An evaluation of how much urine is left in the bladder after urination is easily obtained by a handheld ultrasound, but most primary care doctors don’t (yet) have that ability. Urine flow can also be measured, and if the problem is thought to be an overactive bladder, an entirely different set of medications is used. Hopefully the correct diagnosis will lead to better treatment.
Of course, it’s possible your problem really is an enlarged prostate, so contemplation of surgery and newer prostate procedures could be in your future. I refer men in your situation to a urologist.
DEAR DR. ROACH:
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