There is nothing wrong about these medications, but it is important to know that even minor anticholinergic side-effects of various medications that the patient may take, can add up. This effect is amplified in the elderly and in particular in elderly men where there is already a high percentage with a partial blockage of the urethra from prostate enlargement . As the urethra squeezes itself through the enlarged prostate, there can then be suddenly a complete closure of the urethra leading to hospitalizing this patient with an acute urinary retention. Here is an example of such a patient.
Here is the explanation regarding this patient: This is an example where several negative factors mounted on top of each other. Because of the age related BPH the flow rate had slowly been reduced below the 600 ml/minute rate. He also had a variety of conditions that he could not necessarily control. The ranitidine, the trazodone and the antihistamine all have anticholinergic side-effects, which were superadditive and led to an intolerance of the diuretic push induced by a few beer. In this patient there was a situation where the physicians decided to improve the urethral flow with a TURP as the patient could not be completely kept off all of the medications. He is presently still taking the ranitidine and the trazodone, but has no problems with the urine flow and his kidneys are protected from hydronephrosis and eventual pyelonephritis. Unfortunately many patients wait until it is too late and the kidney damage is irreversible. Symptoms: The symptoms of an enlarged prostate are more frequent urination, which over time is getting worse with smaller amounts on each trip to the bathroom being delivered, but leaving the patient with a feeling of urgency all the time. The patient also has to get up several times during the night (=nocturia). The urinary stream is smaller in diameter and has less force. When the volume per second or per minute is measured, it is clearly deteriorating over time. This is directly due to the clamping down of the rubbery enlarged prostate gland around the upper portion of the urethra located directly under the bladder. This leads to retention of urine in the bladder, which can balloon considerably and this is felt as suprapubic pain (central lower abdominal pain). As the patient is more prone to urinary tract infections, this too can be a signal for the physician to check this patient for BPH. On rectal examination the physician finds a rubbery, enlarged prostate gland. However, it is not hard as would be the case in prostate cancer. Blood test are done to look for kidney function and a PSA level. In 30% to 50% of BPH the PSA is elevated, which makes it difficult to delineate from prostate cancer where the PSA is positive in 30% to 95%, depending on the tumor size. The urologist will have to do some prostate biopsies to differentiate between these two conditions. BPH Treatment: Milder cases of BPH can be treated with medication such as finasteride (brand name: Proscar), terazosin (brand name: Hytrin), doxacosin (brand name: Cardura) or tamsulosin (brand name: Flomax). Unfortunately all these medications would have to be taken life long, which makes this approach less attractive. Surgery is the other approach. However, many men are afraid of losing their potency (=ability to have a penile erection). With the conventional TURP method (transurethral resection of the prostate) the rate of impotence is about 5% to 10%. However, with the laser beam methods there is only a rate of impotence of about 3 to 4 %. With the radio frequency thermal therapy of the prostate by transurethral needle ablation (="TUNA") the impotence complication rate is less than 2%. Essentially heat is used here to destroy the prostatic tissue immediately adjacent to the urethra without damaging the urethra. Whoever is the patient affected with BPH should discuss all these options with the treating urologist. The gold standard is still the original TURP, but there are now significant improvements that have been achieved since then. Hormones and BPH: As men
age, there is a gradual loss of testosterone and progesterone production from
the testicles and the adrenal glands. On the other hand as the man ages, there
is more sex hormone binging globulins, which keeps these hormones bound and reduces
the free hormone portion even more. In addition many men have a sagging, bulgy
stomach (from overeating, too much beer and lack of exercise). The extra fatty
tissue contains an enzyme, called "aromatase", which produces estrogens
out of circulating male hormones. The end result is a lack of male hormones, too
much circulating estrogen and a lack of progesterone that could have kept the
excess estrogen at bay. Dr. John Lee called this hormone constellation "estrogen
dominance" (Ref. 10). He explains that this is the real reason for the enlargement
of the prostate in the aging man as depicted in the table above. He further explains
in Ref. 10 that eventually this leads to the development of prostate cancer. For
decades physicians believed that a surplus of testosterone would be responsible
for the development of prostate hypertrophy and prostate cancer. This was based
on the observation of Dr. Charles Huggins that castration reduced testosterone
levels. At that time it was not known that castration also removes a man's estrogen
production, as nobody thought about testing a man's blood for female hormones.
When saliva hormone tests and blood insulin tests are done, it is clear that with
metabolic syndrome (=insulin resistance) often testosterone and progesterone levels
are low, but estrogen levels are high. These men are at a high risk of developing
BPH and prostate cancer. Hormone treatment with bio-identical hormones:
Pain relief: There is an FDA approved non-drug method available, IceWave patches from Lifewave, which will control pain. This is mentioned in the book "Breakthrough" by Suzanne Somers (Ref. 9) where newer insights of antiaging medicine are also reviewed. Although the patches are placed over acupuncture points, there are no needles involved. Nanotechnology, a newer technology, was used in the manufacturing of these patches and infrared (heat) waves from body heat are utilized to stimulate an acupuncture point, which modifies pain perception and reduces pain to half or less. Medically this would be considered an excellent pain reliever. For more info on the patches see the IceWave patches from Lifewave link above (click "products"). In the US a 5 pack of the IceWave spray is available that can be directly sprayed onto the skin in the area where the pain is located.
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