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Dear Dr. Roach: I'm 79, and for several years, I have been taking finasteride and tamsulosin for benign prostatic hyperplasia. (In the past, I underwent a TURP procedure, which I will never go through again.) As we know, within time, these medications will affect your sexual drive and erectile function.
My urologist wants to perform a new treatment on me called UroLift, which would increase my sexual drive and improve my erectile dysfunction. I would no longer need to take the above medications. I would like to know your pros and cons with this procedure. -- B.M.R.
Answer: I am concerned that your understanding of the benefits of the UroLift procedure might be overly optimistic. UroLift uses mechanical implants to pull the prostate tissue away from the urethra (the tube that carries urine from the bladder to the outside of the body). This relieves the obstruction that can be caused by an enlarged prostate.
Most men have about a 90% improvement in prostate symptoms immediately after the procedure, which was then reduced to about 50% improvement over their baseline after five years. UroLift is very effective at preserving sexual function, but it does not guarantee improved sexual function.
Of the two medicines that you take, tamsulosin (Flomax) very infrequently affects erectile function, about as often as a placebo drug. Less than 2% of men will notice a loss of desire with tamsulosin -- again, about the same as a placebo tablet (which doesn't have an active ingredient).
Finasteride (Proscar) is more likely to cause problems with sexual function, but it is still uncommon. During the first year of treatment, erectile dysfunction was noted in 8.1% of finasteride-treated patients, compared to 3.7% of men who were on a placebo. Loss of interest was noted in 6% of men on finasteride, compared to 3% of men on a placebo.
If UroLift is successful, many men can stop their medications. If the medicine is the cause of their sexual troubles, then there is a good chance that it will improve.