How To Relax The Prostate - BPH Pills with Stephen Gange, MD | Off The Cuff with Dr. Mark Moyad

PCRI's resident moderator Mark Moyad, MD, MPH, sits down with urologist Steven Gange, MD, FACS, to discuss "alpha blockers," a class of drugs typically used as a first-line medication for treating lower urinary tract symptoms (LUTS) caused by an enlarged prostate, also known as benign prostatic hyperplasia (BPH).
Dr. Steven Gange graduated from the UCLA School of Medicine in 1986. After his Urology residency training at the University of Kentucky in 1991, he entered the US Army as an academic urologist, teaching, and training residents. He joined Western Urological Clinic (now Summit Urology Group) in Salt Lake City, UT, in 1996. With over 25 years of clinical and research experience, he has developed an expertise in Men’s Health Urology, emphasizing minimally invasive procedures. He continues to be active as a Clinical Researcher and as such was the first Urologist in North America to perform the NeoTract UroLift for BPH, and the first in the world to perform UroLift under local anesthesia.
0:17 Prior to the medicinal solutions developed in the late 1980s, the only treatment available for BPH was the Transurethral Resection of the Prostate (also known as the TURP surgery).
1:16 In the late 1980s to early 1990s two classes of medicines were developed. Alpha-blockers (relaxers) and then 5-alpha reductase inhibitors (shrinkers). This is also the typical order in which they are prescribed-first, alpha-blockers and then 5-alpha reductase inhibitors. This video focuses on alpha blockers.
1:33 "Alpha" refers to a receptor that leads to a muscle contraction, and an "alpha-blocker" is meant to cause a failure of that contraction. Early iterations of relaxers include Prazosin, Hytrin, and Cardura. They have fallen out of use for BPH because of issues with low blood pressure, and are now actually used as blood pressure medications. The current most popular relaxers are Flomax, Uroxatral, and Rapaflo.
2:28 There is muscular and glandular tissue in the prostate. Some prostates are mostly muscular, some are mostly glandular, and some are a mix of the two. The relaxers only work on muscular tissue.
3:05 A lot of men start relaxers with enthusiasm that it will solve their problem, but many are eventually disappointed because of the medication's side effects, their lack of effectiveness, or the cost of the medications.
3:28 One benefit to the relaxers is that if they are going to work, then they will work within a couple of weeks. However, the symptom relief is usually relatively mild (about 3-4 points on a 35 point scale). About 70% of men who try relaxers will eventually stop them and move on to a different treatment.
4:15 Side effects of relaxers include dizziness (which can be extremely dangerous with elderly patients but possibly ameliorated by food), nasal congestion, floppy iris syndrome (which can affect future cataract surgery), and issues with ejaculation (either retrograde ejaculation, in which it goes the wrong direction or anejaculation, in which there is no ejaculation at all).
5:38 Dr. Gange argues that besides the relaxer's mild efficacy and their undesirable side effects, his main issue is that they do nothing to change the long-term course of BPH. They merely delay issues that will eventually have to be dealt with by other means.
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Пікірлер: 92

  • @imtiyazyusuf1374
    @imtiyazyusuf13742 жыл бұрын

    I was started on Flomax and my blood pressure dropped a lot. Had to go to ER.

  • @RobCLynch
    @RobCLynch Жыл бұрын

    I was wondering if Cialis was a suitable swap for Tamsulosin? I realise that they are completely different drugs, but I'm reading that Cialis can have a similar effect in relaxing the bladder. I'm also in Finasteride, so I'm considering a combo of that and Cialis...in place of Tamsulosin

  • @scotniver7180
    @scotniver71802 жыл бұрын

    OMAD I changed to a One Meal A Day... Ket0 diet.. The carbohydrates cause frequent urination. I'm in the process of getting off Tamulsin having great results with the diet. No sugar.. No smoking.. No alcohol..

  • @GWAYGWAY1
    @GWAYGWAY13 жыл бұрын

    A blockers gave me terribly painful GERD because it relaxes the sphincter at the oesophagus junction allowing the contents squeezing up when I lift heavy weights or bend over. I gave tried 5milligrams of cialis or the non named ones and it seems to work quite well without the side effects on the gut sphincter.

  • @richardkremmen7811

    @richardkremmen7811

    3 жыл бұрын

    Great to know, thanks!

  • @samkitty5894

    @samkitty5894

    9 ай бұрын

    I have been on Terazosin for years. It works but with many negative side effects. I tried Viagra few times out of curiosity and I was urinating like an 18 year old. It works far better for BPH.

  • @johnhixson7040
    @johnhixson70403 жыл бұрын

    Cialis alone works great for me.I had that terrible urge to urinate all the time, especially at night. Very tiny stream.

  • @samkitty5894

    @samkitty5894

    3 ай бұрын

    How long did it take to work for you?

  • @charlesrobert6211
    @charlesrobert62112 жыл бұрын

    Lets talk about weight gain. I'm 71 and within 5-6 weeks of taking Tamsulosin I went from getting up three times a night to one and sometimes none. After three months my weight went from 210 to 230 without a change in eating habits. I'm still gaining weight so I would like to know if there is a good alternative to this drug?

  • @Dulcimerist

    @Dulcimerist

    2 жыл бұрын

    There are other alpha blockers, like Doxazosin, which tend to have fewer side effects than Tamsulosin. A different class of BPH medication like Tadalafil could be another option. Definitely discuss the other options with your doctor, to see what might be right for you.

  • @MM12331

    @MM12331

    2 жыл бұрын

    Its actually alfuzosin that is the safest one. Virtually no side effects. I was fortunate enough to be put on it. Takes at least a week to work though and is extended release which is a plus. Im taking it with potassium magnesium aspartates, rhodiola and Loratadine. Spasm relief, enhanced micro-circulation and mast cell stabilization.

  • @richardkremmen7811
    @richardkremmen78113 жыл бұрын

    Would be very nice if the doc would offer surgical alternatives to the TURP he mentioned. Such as Rezum especially.

  • @ThePCRI

    @ThePCRI

    3 жыл бұрын

    Richard, Here is one we have on Rezūm: kzread.info/dash/bejne/gZtky6SwqaTZhtY.html

  • @richardkremmen7811

    @richardkremmen7811

    3 жыл бұрын

    @@ThePCRI Yes I wound up seeing that and it was great. Thanks!

  • @GWAYGWAY1

    @GWAYGWAY1

    3 жыл бұрын

    I have just had it done, but privately as the NHS is closed for routine ops. It was very quick but the recovery is drawn out and troublesome . Catheter for a week then out but there was difficulty getting a good stream as the dead cells put pressure on the urethra two weeks later I went into retention and had to catheterise myself again as nothing was coming , a week later took it out then the same , so another catheter in. This one blocked with a clot so needed flushing out. All out now and stream is better, but the nocturnal peeing is still frequent at four times just easier to do. I also feel very tender in the perianal area when sitting on a hard surface. I understand that things are better after 3 months and I am only 6 weeks in. Be prepared for problems and rectal trouble when tender.

  • @richardkremmen7811

    @richardkremmen7811

    3 жыл бұрын

    @@GWAYGWAY1 "NHS" you referred to is England's National Health Service I presume. Thanks very much for sharing your experience. Best wishes to you for a speedy recovery. Btw I'm wondering if doing intermittent catheterization would help you, especially before bed time. It's possible to use them for irrigation also- possibly unnecessary to do an indwelling Foley I suspect. I hope you'll follow up with more comments here on your progress or write me: karlremmen@yahoo.com. Thanks again.

  • @agaragar21

    @agaragar21

    3 жыл бұрын

    @@GWAYGWAY1 Thank you for your information...it all helps !

  • @johnstanton8499
    @johnstanton84992 жыл бұрын

    Does anyone know if Tamsulosin crosses the blood brain barrier and possibly cause Tinnitus?

  • @richardkremmen7811
    @richardkremmen78113 жыл бұрын

    The alpha blockers are a temporary pap at best and they allow the prostate to continue growing. Avodart and Finasteride mess up your hormone balance and have bad sexual side effects in a lot of guys. If BPH is causing any degree of urinary retention look for a prostate procedure you could live with. You really don't need a stretched out bladder with diverticulum which straining while trying to void will cause. Research all of the alternatives and don't advance to any significant urinary retention. Have your doc order you some hydrophilic catheters to keep on hand in case of need and learn how to use them with sterile technique.

  • @HJC1950

    @HJC1950

    3 жыл бұрын

    Good points. I am 71 with BPH for a long time. I had Greenlight Laser procedure done. I got to hate Finasteride: minimal ejaculation became zero ejaculation, no orgasm at all. I am now on Tamsulosin. My problem now is that I have become very sensitive to bladder irritants. Besides having episodes of extreme urgency, I have something worse. If I accumulate too many bladder irritants over the course of a day or two, I wind up at 4:00 a.m. in retention or near retention. It can literally take me an hour and a half to empty my bladder. I doubled up on Tamsulosin but that made the dizziness worse and I was still having problems emptying my bladder. I did get some training on the use of catheters but I need a refresher course. I agree that I need a supply of catheters on hand and the knowledge to avoid giving myself a UTI. I agree the fancier catheters make sense: less likelihood of giving myself a UTI.

  • @johanbadenhorst8907
    @johanbadenhorst89074 жыл бұрын

    I have a enlarged prostate and have started with a daily intake of curcumin and black pepper and honey 2 weeks ago and are already feeling a differens with my condition and don't want to go to toilet at nights at all tky Johan

  • @williamosorio1849

    @williamosorio1849

    3 жыл бұрын

    Quercetin Bromelain pills check goglee...really work

  • @wethepeople3124

    @wethepeople3124

    2 жыл бұрын

    Do you mix all of these together and then drink them?

  • @thasultan
    @thasultan2 жыл бұрын

    Fanistrade 5mg and tadalafil are the only best medications for BPH.

  • @samkitty5894

    @samkitty5894

    5 ай бұрын

    Finasteride kills the sex drive, dries up testicles, causes ED, turns men into women, and tadalafil is used for ED. What is the result? Status quo?

  • @samkitty5894

    @samkitty5894

    3 ай бұрын

    Finasteride turns men into women. Dries up testicles, grow hair where hair should not grow, kills sex drive, etc. Cialis helps ED. Taking these two drugs together sounds silly.

  • @princegrannum1724
    @princegrannum17243 жыл бұрын

    Could Flomax be taken with a supplement like Prosta-Genix

  • @ThePCRI

    @ThePCRI

    3 жыл бұрын

    Hello, our helpline might be able to help you with that question. You can find the contact information here: pcri.org/helpline

  • @richardkremmen7811

    @richardkremmen7811

    3 жыл бұрын

    I suspect that all of the prostate supplements are useless. Dietary modifications such as limiting fat (especially sat fat) and limiting animal protein (especially high leucine foods like dairy) will help somewhat with BPH and prostate health in general. Fill the vacated stomach space with lots of veggies, cooked and raw- whatever veggies you like, but especially brassicas.

  • @allangreenley9901

    @allangreenley9901

    Жыл бұрын

    I was on tamulosin and spent extra money on prosta genix .. My advice is don't buy them. No improvement at all . It's all lies what they say about how good they are, my improvement on prosta genix was hardly noticeable.. Rip off.

  • @mohammadalshammary2039
    @mohammadalshammary20393 жыл бұрын

    Any solution for retrograde ejaculation.

  • @scarface548
    @scarface5482 жыл бұрын

    Do these drugs work for someone with prostate cancer.

  • @ThePCRI

    @ThePCRI

    2 жыл бұрын

    They are not known to have any anti-cancer benefit, but if a person has BPH symptoms concurrently with prostate cancer, they may help relieve those symptoms. Some BPH drugs can artificially lower the PSA and potentially mask prostate cancer issues, so it is important to discuss with your doctor.

  • @samkitty5894

    @samkitty5894

    5 ай бұрын

    No. Some have potential to cause cancer, like Finasteride.

  • @jerrysegal4181
    @jerrysegal41813 жыл бұрын

    after 3 years on flomax which heloed my frequent urination issue, it is now not helping much. have i developed a tolerance to the drug or does flomax lose its effectiveness over time? i have been experiencing dizziness lately (a known side effect in EARLY use) and want to stop the meds but what sacares me the most is that my doc says i may wind up not being able to urinate. can this be true? using a catheter is my worst nightmare.

  • @ThePCRI

    @ThePCRI

    3 жыл бұрын

    Jerry, our prostate cancer helpline may be able to ​help with your question. Please feel free to contact us here: pcri.org/helpline

  • @williamosorio1849

    @williamosorio1849

    3 жыл бұрын

    tried Quercetin Bromelain pills you gone to see...$20 dls amazon

  • @williamosorio1849

    @williamosorio1849

    3 жыл бұрын

    quercetin bromelain pills natural really work

  • @rhondapagan5759

    @rhondapagan5759

    3 жыл бұрын

    Hello sis, use Dr omo herbal medicine very active with no side effects it will help you get rid of them fast

  • @williamosorio1849

    @williamosorio1849

    3 жыл бұрын

    quecertin bromelian

  • @rajsharma1639
    @rajsharma16392 жыл бұрын

    Bottomline is that BPH has no any permanent treatment in medical science. Either take these costly and dangerous medicines or just suffer the disease whole of your life. So sad 😭😭😭😭

  • @balaramkundu4683

    @balaramkundu4683

    2 жыл бұрын

    Urivoid 25mg twice, and Silodal D/4, Daily. Urine retention 300cc. prostate at. 35gm. Taking for 4/5 years. Psa below 3 . I am 75 years. Should I continue medicine or which surgery is suitable as I have haemophiliacs pl advice.

  • @travissimon2036

    @travissimon2036

    Жыл бұрын

    What about surgery

  • @Sunspot1225.
    @Sunspot1225. Жыл бұрын

    What does mean " not compelling "

  • @azmike1

    @azmike1

    Жыл бұрын

    It means: Not convincing. Not impactful. Not pushing forward to happiness.

  • @westfield90
    @westfield902 жыл бұрын

    Why does Tamsulosin cause nasal congestion and how long does this side effect last?

  • @sergiovillarreal1516

    @sergiovillarreal1516

    2 жыл бұрын

    I had to get taken off tamsulosin it doesn't go away nose completely clogged prazosin helps

  • @westfield90

    @westfield90

    2 жыл бұрын

    @@sergiovillarreal1516 thank you Sergio. I will ask my doctor to switch

  • @Dulcimerist

    @Dulcimerist

    2 жыл бұрын

    I was switched to Doxazosin, and that works well. Tamsulosin works on both the alpha1 and alpha 2 adrenergic receptors, while Doxazosin and Prazosin focus mainly on the alpha1. That might be why Tamsulosin tends to have more side effects, plus Tamsulosin crosses the blood brain barrier while the other two don't.

  • @westfield90

    @westfield90

    2 жыл бұрын

    @@Dulcimerist thank you this is very helpful

  • @sergiovillarreal1516

    @sergiovillarreal1516

    2 жыл бұрын

    @@Dulcimerist glad they switched your meds please give us an update on how well it works

  • @garymagruder7154
    @garymagruder71544 жыл бұрын

    I have been on daily Cialis for several years .....my nightly trips at night for urination has dropped from three to four times a night to once or not at all .....for me miraculous ...no side effects ...now generic

  • @stevebarrera7018

    @stevebarrera7018

    4 жыл бұрын

    HI. What dosage are you taking?

  • @glenbearh9109

    @glenbearh9109

    4 жыл бұрын

    @@stevebarrera7018 sorry just saw this. 5mg a day

  • @vegimiteboy

    @vegimiteboy

    3 жыл бұрын

    How long did it take to work

  • @farisazmiarifin1549

    @farisazmiarifin1549

    3 жыл бұрын

    Can estrogen and Finasteride be used together help BPH (Benign prostatic hyperplasia)? *How Prostate Cured Total* 👉 *For more information My Profile In About* Or Bio

  • @peacefulruler1

    @peacefulruler1

    3 жыл бұрын

    Eating a raw green salad a day helped me, for whatever reason.

  • @tomhora4381
    @tomhora43812 жыл бұрын

    The title is "How To Relax The Prostate" , Well???

  • @erichart9166
    @erichart91662 жыл бұрын

    Flomax can make using catheters, difficult.

  • @samkitty5894

    @samkitty5894

    5 ай бұрын

    Don't I know it. Even with catheter in place I would get a very very strong urge to pee. Urine would shoot out around the catheter. Impossible to control.

  • @johnnyschmidt6945
    @johnnyschmidt69452 жыл бұрын

    Tamsulosin

  • @williamosorio1849
    @williamosorio18493 жыл бұрын

    guys tried quecertin bromelian 100mg a day you gone to see

  • @denieledwards6893

    @denieledwards6893

    3 жыл бұрын

    DO YOU HAVE PROOF THIS WORKS ???????? THANKS.

  • @samkitty5894

    @samkitty5894

    5 ай бұрын

    I drink 4 oz of Castor oil before bed time.

  • @isaacali3067
    @isaacali30674 жыл бұрын

    Well nothing much has changed the surgical procedures seem to be the only real treatment according to the doctor

  • @ThePCRI

    @ThePCRI

    3 жыл бұрын

    Hello, our prostate cancer helpline may be able to ​help with your question. Please feel free to contact us here: pcri.org/helpline

  • @sergiomanhatan3133

    @sergiomanhatan3133

    3 жыл бұрын

    What are the most experienced and top-rated robotic surgeons, for prostate cancer, in Bangalore? Do you have any real-life experiences to share about the da Vinci Surgical System? *How Prostate Cured Total* 👉 *For more information My Profile In About* Or Bio

  • @GWAYGWAY1

    @GWAYGWAY1

    2 жыл бұрын

    I went ahead and had a rezum procedure and although still slowish I have no trouble getting started and stopped, but still need twice a night but not like before, 12pm and 6 am does me now

  • @samkitty5894

    @samkitty5894

    5 ай бұрын

    Even these procedures have to be repeated every couple of years. Sometime they fail right off the bat.

  • @normanreed572
    @normanreed5722 жыл бұрын

    This may be considered non constructive but I must agree with one other poster. Your title says “how to relax the prostate” and your text does not address this to any great extent. Most of the questions are refereed to another site and this doesn’t help here.

  • @ThePCRI

    @ThePCRI

    2 жыл бұрын

    The title is referring to the mechanism by which alpha blockers improve urinary symptoms caused by BPH in some men. The muscle tissue in the prostate is smooth muscle, without voluntarily control, and can only be relaxed by medicinal means.

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