Like many relationships, the win-win situation may just be a Utopia that is simply unattainable in medicine. Every intervention offers benefits and drawbacks. The assessment of the pros and cons is crucial prior to deciding medical choices. Many patients are faced with limited options when accepting therapy, despite the risks outweighing the benefits.

With that in mind, lets look into the dilemma faced by one of the readers who is affected by the side effects of medical therapy, but increasingly cornered to face the inevitability.

Dear Dr G,

I am 52 years old and have a young wife who is 36. We have been married for two years. This is my second marriage. My wife and I enjoy our intimacy tremendously, and this is a very important bond in our relationship.

In the last 12 months, I have been facing problems due to enlarged prostate and this is putting a dent in our sexual relationship.

Since I turned 50 years old, my prostate had become enlarged and I started to have problems such as nighttime urination and urgency.

The urination is also getting difficult to start and the ending is dribbling. I have also faced the problems with erectile dysfunction, but this is resolved with the blue pills.

I have been to the urologists, who said the condition is due to the enlarged prostate, which is non-cancerous. He initially prescribed a medicine that improved the flow, however, this resulted in the drying up of semen with endless frustrations.

The doctor then changed my medications to another one that is supposed to shrink the prostate. This side-effect of decreasing my libido and worsening erectile dysfunction is making it worse than before.

According to the specialist, my prostate symptoms are quite serious and I have to consider the eventuality of an operation. I gather this will also have a permanent irreversible damage to my sex life.

I really hope you can tell me what he said is not true. Surely, in the 21st century of advance medicine, there will be a middle ground when the prostate can be treated and yet the sex life of a man be preserved.

I want my prostate symptoms treated and yet I am not ready to compromise on my sex life. Can you help?

Regards

Husni

Prostate enlargement is a fact of life in most men with advancing age. Recent studies highlighted the correlations between enlarged prostate and worsening sexual functions in men in their 50s and 60s.

It is noted that 30% of men facing Benign Prostatic Hyperplasia (BPH) will encounter compromised sexual function, and around one third of men suffering erectile dysfunction (ED) have concomitant troubling symptoms related to prostate.

Sadly, this is a “chicken and egg” situation, which the causality dilemma will never be resolved. For men facing lower urinary tract symptoms of frequency, urgency, slow flow and dribbling, the first line treatment is a group of medicine called alpha-blockers.

The function of this medicine is to relax the prostate in order to ease the flow of urine.

Most men will experience the relief of the urinary symptoms. Some may even experience improvement in blood pressure. One of the complaints encountered by sufferers is retrograde ejaculation. This is caused by the easing of the prostatic sphincter resulting in the semen going backwards. Yes, going backwards!

Retrograde ejaculation is completely harmless. (Well, the backward drainage of the sperms into the bladder is definitely not going to self-impregnate the men!).  Although such inconvenience may sound trivial to some, the “dry orgasm” may be a grievance to sufferers to quit the medicine.

Another class of drugs for the treatment of BPH is 5 Alpha Reductase Inhibitor. The mechanism of such therapy is the reduction of the active component of testosterone which plays a role to shrink the prostate.

Needless to say, the active component of the prostate also plays a crucial role in generating libido and sustaining erectile rigidity. Therefore, it is not uncommon for men to experience flagging sexual desire and compromised erectile after the initiation of treatment.

Recent scientific research had pointed out that medicines such as the blue pills (PDE5-I) will also have a relaxing effect on the prostate.

Therefore, the long acting subgroup of this medicine is licensed to the treatment of BPH. Many of the medical intervention have temporary effects on men, and with advancing age, the looming surgery may be inevitable!

The operation to correct the obstructive prostate can either be carried out with electric loop (TURP) or laser. The technique is simply coring out a cavity to allow better flow of urine with minimal resistance.

The adverse effect of the operation such as retrograde ejaculation is both undeniable and unavoidable. But the degree of compromise on erectile rigidity is still unclear and hotly debated.

“You can’t have your cake and eat it too” is a popular English figure of speech. I guess once the cake is eaten, it is gone. Sometimes, in life’s choices, we really cannot “have it both ways” or  the “best of both worlds”.

In the treatment for enlarged prostate, it is rarely possible to achieve maximum efficacy of treatment without compromised libido, erectile function or backward shoot of the semen.

Aung San Suu Kyi once said: “If you want to bring an end to long standing conflict, you have to be prepared to compromise.” So Husni, which of the sexual dysfunction are you ready to give up for the treatment of your prostate?

The post Prostate Enlargement and Sex appeared first on George Lee.my.

What was thought to be an earthquake with the magnitude of 8.8 was subsequently revised to be as high as 9.1, and recognised to be the third largest earthquake ever recorded by the seismograph.

The earthquake had triggered a series of deadly 30m tsunamis, killing 230,000 people in 14 countries. The tremor triggered other earthquakes as far as Alaska.

I don’t want to end 2014 by writing about a depressing history that affected mankind. Ten years though, it is unsettling for me to learn that my hometown and a large part of the east coast are affected by one of the worse flooding ever recorded in Kelantan on Christmas and Boxing Day.

Naturally, having moved to Kuala Lumpur a long time ago, I worry about the safety of my friends and family at home. As the water rises by the hour, the more isolated they are from the outside world.

The last I heard from my mother was that the electricity was cut off for safety reasons. This reminds us how vulnerable we all are against the forces of nature, even in the 21st century.

On that note, I would like to answer a reader’s email about his journey of adversity is life.

Dear Dr G,

I am a 64-year-old man who had an operation for the removal of prostate cancer several years ago.

In 2008, I was diagnosed having stage I prostate cancer. The doctor told me the disease was diagnosed early as my PSA was 11, and all the scans showed the disease had not spread.

As I was 58-year-old then, I agreed to have the removal of the cancer by keyhole operation. The doctor told me the cure rate was high and the complications of erectile dysfunction and urinary incontinence were low.

After the operation, I was rather sad to learn the cancer was actually more extensive than initially anticipated.

The surgeon needed to remove more tissues to eradicate the tumour. As a result, I am now experiencing erectile dysfunction and urine leakages that required regular pads.

I have seen several specialists, who prescribed me pills for the ED, but they seem to have no effect at all.

I wonder if you can help me? Can you explain to me why did everything go wrong?

Why are the pills not working for me? What other options do I have?

Can anything be done about the urinary incontinence?

Could I have avoided all these complications if I had opted for robotic operations?

Hope to hear from you soon.

MK

Like the forces of nature, prostate cancer is poorly understood and can be unpredictable.

Although, clinicians try their best to work out the prognostic factor that determine the outcome and success of operations, these are purely predictions, and the probabilities are all based on statistics obtained from other patients.

It is normal to doubt decisions when scrutinising the matter retrospectively. Many men consider surgery as the only option, especially when facing the disease at a younger age.

Radical Prostatectomy, or the operation to remove the prostate gland, should eradicate cancer completely, especially during stage I/II.

However, due to the proximity of the organ to the nerve and vessels supplying the pelvis, the complications such as erectile dysfunction and urinary incontinence are sometimes unavoidable.

Although many advancements have been made for the treatment of cancers in the last two decades, namely the keyhole and robotic surgery, most of the techniques result in faster patient recovery, but not necessary in the protection of sexual function and continence.

It is not uncommon for men not responding to the pills for ED after Radical Prostatectomy.

This may be caused by the irreversible damage of the neurovascular bundles of the sexual organs during the operation. When facing such detrimental complications, other none medical treatments should be considered.

The treatments for severe urinary incontinence and erectile dysfunction may include injectable and prosthesis.

The injections of the agents to expand the blood vessels of pelvis has high efficacy, otherwise, the surgical options of prosthesis also carry a high success rates.

Prosthesis such as artificial sphincters is also available for patients with incontinence after operations.

My late father used to tell me: “In the time of crisis and adversity, the true strength and resilience of a man will prevail.” With that, I wish all a Happy New Year and hope 2015 will bring a brighter year will less threats from the forces of nature.

The post The Aftermath of Prostate Cancer appeared first on George Lee.my.