Benign prostatic hyperplasia (BPH) Surgery Options

Bill what botanicals do you use? Were the recommended by a doctor?

@rfherald if you would like to direct your question at a specific member, it is helpful to reply to their comment or use the "@" + their handle so they can get a notification of your interest for them to respond. For example, I believe you are interested in hearing back from @bill5letsfixthis. I hope this helps!

Thanks. I'm used to my email that assumes the "to:"

@bill5letsfixthis
Bill, can you tell me what botanicals you use? I am starting the "try this" then, "try that" to see what works.

@rfherald I knew it was a matter of time before someone would ask. After searching out the few studies that were done and after Googling “What botanicals mimic Finasteride” I have come up with the following. All from high quality US manufacturers with independent ratings. 500 mg Saw Palmetto, Stinging Nettle Root (not the leaf) and Pygeum Bark Extract if you can get it, if not the Pygeum Extract will do.

The Pygeum is what came up as mimicking Finasteride, only it does not shrink the prostate.

I must tell you, between my BPH symptoms and most recently Chronic Pelvic Pain Syndrome I became a new man after about 2 weeks. CPPS is totally gone. BPH symptoms much reduced where I am now close to normal except for the occasional urgency. I am a former athlete/firefighter and avid cyclist doing 100 miles a week so my prostate does get a bit of a hammering but split seat helps. I don’t sit a lot which I think is helpful, I use a standing desk for my part time job.

I am doing my best to avoid any lasering , steaming, slicing, clipping, or tearing procedures which sound too medieval to me, that’s why I think if I need to do something I may do the PAE.

As a side note, I did the same with my damaged rotator cuffs and avoided operations. I’m a believer in botanicals and therapy, almost 70 and not giving up.

Also, when I asked my Uro about the botanicals he said he knows nothing about them. But he knows all about all the other medieval procedures.

Good luck, let me know how you do.

Bill

bill5letsfixthis: Thank you. I have never been into botanicals at all and you have given me plenty to research both online and through our local Vitamin Cottage. I, too, would prefer to handle my BPH with something that enters the body through the mouth than other orifices. My doctor has put me on Avodart but it takes 2-6 months for noticeable effects. Still preferable to surgery.

Thanks for that reply about PAE, Bill.
July 7 I had an initial visit with SC at Mayo Rochester to discuss treatments for my BPH. I noticed he both followed the AUA guidelines for selecting treatment but also went beyond them, based on Mayo experience. The guidelines group treatments by prostate size. Given my size (110 cc as of 2017) I should not be a candidate for Rezum. But SC was enthusiastic about Rezum and said I could choose it if I wanted to, based on Mayo experience. His enthusiasm did not go beyond what is said about it elsewhere. The other surgical treatment he offered, given my prostate size, was HoLEP. His description of it followed what is said of it elsewhere.

I asked him to quantify sexual side effects for medical treatments and he offered numbers, which were not so bad. But, what I've seen about them and my own experience suggests the reality is not good. So I am presently evaluating which surgical treatment, Rezum or HoLEP to seek.

I'll say he also counseled that I could drop two of the four daily self-catherizations I'm doing, which gives me greater mobility during the day. He confirmed that increasing tamsulosin from one to two/day is appropriate. My most disturbing symptom of BPH was several episodes of acute urinary retention. I have not had any more acute retentions since I've begun self-catherizations and increasing tamsulosin from one to two/daily.

If I do choose Rezum, which I would do in early November, after a European trip Sept-Oct, I should add Dutasteride now but could drop it (and tamsulosin) after Rezum.

There are a number of talks at Grand Rounds comparing Rezum, HoLEP and other treatments.

I'd be grateful for comments of individuals who have undergone Rezum or HoLEP.

Bill,

I forget to say in my previous reply that SC at Mayo Rochester said he had no confidence in PAE, that Mayo does not do it. So I'm no longer considering it. Although I have seen glowing comments on it from the Yale Medical School and docs at UCSan Francisco and UCLA. There is disgreement about almost everything.

Bruce

@bruce1sparkle. I agree with you that there is disagreement about almost everything. I believe this condition is different for each of us and we need a multi faceted approach to get relief. My first realization that I had a problem was a urinary retention episode about 6 years ago. Tamsulosin made it the last episode. My prostate size is a little larger than yours at about 150cc that my Doc seems to think the Urolift with extra clips may work. Where he gets that idea I don’t know. Also one or two of the other procedures may not be appropriate either. In one of the videos the urologist mentions PAE may be appropriate for those of us who are hesitant to do any of the other procedures. I thought when the time comes I would do the PAE and if it didn’t work my next choice would be the HoLEP as I think it may have a better track record. As far as the multi faceted approach I am using now is making sure I stay regular as the rectum and prostate are next to each other and one can affect the other. I know a lot of guys with this problem and everyone seems to be different. We think about this everyday and sometimes I can’t do enough research to find the holy grail of relief. I wish my grandfather was still alive (he was a drinker and lived to 90) so I could pick his brain about how his generation handled this. I wish you all the best Bruce in your decisions. Let us know how you do because your information will do a world of good for us. Mayo giving us this forum is the best way for us to find solutions.

Bill

AUA is offering a class, Surgery Management of BPH (2021) that is virtual and free. 7/14/2021, 7pm EDT.
https://auau.auanet.org/content/surgical-management-bph-2021#group-tabs-node-course-default5