Understanding medication options for male urinary symptoms
Mr Gidon Ellis is a Consultant Urological Surgeon in London specialising in the assessment and treatment of male lower urinary tract symptoms (LUTS), including urinary symptoms caused by an enlarged prostate and overactive bladder. Medication can be an effective treatment for many men with urinary symptoms. However, the most appropriate medication depends on understanding the underlying cause of the problem.
Some men have difficulty emptying the bladder because of prostate enlargement, while others have bladder storage problems causing urgency, frequency and waking at night. Many men have a combination of both. A careful assessment helps ensure that treatment is targeted towards the symptoms that are most troublesome.
When is medication used?
Medication is often the first treatment considered for men with bothersome urinary symptoms, particularly when:
- Symptoms are mild or moderate
- There are no complications such as recurrent urinary retention or kidney problems
- A patient prefers to avoid or delay a procedure
- Symptoms are expected to respond well to medication
For some men, medication provides excellent long-term symptom control. For others, symptoms persist despite treatment, side effects become troublesome, or a more definitive treatment is preferred.
Medications for enlarged prostate (benign prostatic hyperplasia)
An enlarged prostate can narrow the urethra and make it harder for urine to leave the bladder. This can cause symptoms such as:
- Weak urinary stream
- Difficulty starting urination
- Straining
- A feeling of incomplete bladder emptying
- Frequent urination
Different medications work in different ways.
Alpha blockers
Alpha blockers are commonly prescribed medications for men with urinary symptoms caused by an enlarged prostate.
Examples include:
- Tamsulosin
- Alfuzosin
- Doxazosin
These medications relax the smooth muscle within the prostate and bladder neck, allowing urine to pass more easily.
Benefits
- Often work relatively quickly
- Can improve urinary flow
- Can reduce symptoms caused by bladder outlet obstruction
Possible side effects
- Dizziness or light-headedness
- Changes in ejaculation
- Tiredness
- Low blood pressure in some patients
5-alpha reductase inhibitors
5-alpha reductase inhibitors reduce the effect of hormones that contribute to prostate growth.
Examples include:
- Finasteride
- Dutasteride
These medications can gradually reduce prostate size and are particularly useful in men with larger prostates.
Benefits
- May reduce the risk of urinary retention in appropriately selected men
- May reduce the likelihood of needing future prostate surgery
- Can improve urinary symptoms over time
They usually take several months to achieve their full effect.
Possible side effects
- Reduced libido
- Erectile or ejaculation changes in some men
Important considerations with 5-alpha reductase inhibitors
Like all medications, 5-alpha reductase inhibitors have potential side effects. In recent years, concerns have been raised about a possible association between these medications and mood changes, including depression and suicidal thoughts.
The available evidence is not conclusive, and it remains uncertain whether these effects are directly caused by the medication itself or influenced by other factors. However, it is important that patients are aware of this potential risk. If you notice new or worsening low mood, depression, anxiety or thoughts of self-harm while taking finasteride or dutasteride, you should seek medical advice promptly.
Combination treatment
Some men benefit from a combination of an alpha blocker and a 5-alpha reductase inhibitor, particularly when they have:
- Significant urinary symptoms
- A larger prostate
- Increased risk of progression
The choice of treatment depends on individual factors, including prostate size, symptoms and overall health.
Medications for overactive bladder symptoms
An overactive bladder causes symptoms related to bladder storage, including:
- Urinary urgency
- Frequent urination
- Waking at night to pass urine (nocturia)
- Urgency-related leakage (urgency incontinence)
Medication aims to reduce unwanted bladder contractions and allow the bladder to store urine more comfortably.
Antimuscarinic medications
Antimuscarinic medications reduce involuntary bladder contractions.
Examples include:
- Solifenacin
- Tolterodine
- Oxybutynin
They may improve:
- Urgency
- Frequency
- Urgency incontinence
Possible side effects
- Dry mouth
- Constipation
- Blurred vision in some patients
They are used with caution in some men who already have difficulty emptying their bladder.
Beta-3 agonists
Beta-3 agonists work by relaxing the bladder muscle during filling.
Examples include:
- Mirabegron
- Vibegron
Benefits include:
- Reduction in urgency and frequency
- Improvement in overactive bladder symptoms
Blood pressure monitoring may be recommended in some patients taking mirabegron.
How do we decide which medication is right for you?
The correct medication depends on understanding whether symptoms are mainly due to:
- Bladder outlet obstruction from an enlarged prostate
- Overactive bladder
- A combination of both
- Another cause such as urethral stricture or underactive bladder
Assessment may include:
- Detailed discussion of urinary symptoms
- Urine testing
- Uroflowmetry (urine flow test)
- Bladder scan to assess how much urine remains after passing urine
- Prostate assessment where appropriate
This ensures that treatment is directed at the underlying problem rather than simply treating symptoms.
When is medication not enough?
Medication is not always the best long-term solution. Some men continue to experience troublesome symptoms despite taking medication. Others experience side effects or prefer a treatment option that provides more definitive relief. Where symptoms are caused by significant bladder outlet obstruction from an enlarged prostate, minimally invasive procedures may provide longer-lasting improvement.
Mr Ellis offers:
- HoLEP (Holmium Laser Enucleation of the Prostate)
- Aquablation Therapy
- TURP (Transurethral Resection of the Prostate)
These procedures aim to remove or reduce the blockage and improve urine flow.
Why choose Mr Ellis?
Male urinary symptoms are often caused by a combination of prostate and bladder problems. Mr Ellis takes a comprehensive approach to assessing lower urinary tract symptoms, ensuring that medication is recommended when appropriate and that alternative treatments are discussed when medication is unlikely to provide the best outcome.
Treatment decisions are personalised, balancing symptom improvement, quality of life, potential side effects and long-term goals.
Frequently asked questions
Do prostate medications shrink the prostate?
Some medications, such as finasteride and dutasteride, can gradually reduce prostate size. Alpha blockers improve urine flow by relaxing the prostate and bladder neck but do not shrink the prostate.
How long do prostate medications take to work?
Alpha blockers often improve symptoms relatively quickly. Medications that reduce prostate size usually take several months to achieve their maximum benefit.
Can medication prevent me needing prostate surgery?
In some men, yes. However, if there is significant obstruction, recurrent retention, complications or persistent symptoms despite medication, surgery may provide a more definitive solution.
Can I take medication for an enlarged prostate and an overactive bladder at the same time?
Yes. Many men have both obstructive and storage symptoms and may benefit from a combination approach.
Arrange a consultation
If you are experiencing urinary symptoms related to an enlarged prostate or overactive bladder, Mr Gidon Ellis offers specialist assessment and treatment in London. A consultation can help identify the cause of your symptoms and determine whether medication, lifestyle measures or a minimally invasive procedure is the most appropriate option.
