DEAR DR. ROACH: I am 85 and in good health despite having had open heart surgery 10 years ago. I have been using a catheter three times a day for two years to drain urine, because my enlarged prostate distorts my bladder. It looks like I will use an intermittent catheter for the rest of my life.
I am currently taking Flomax and finasteride, but it does seem to help very much. Can I continue to use the catheter for the remainder of my life without any effect? Do these medications have any side effects on my kidney? Twenty years ago, I had prostate surgery, with my urology doctor using microwaves to burn and open up the prostate canal. I am very hesitant to have another prostate surgery. -- T.L.
ANSWER: The urethra in men goes from the bladder to the end of the penis, and goes right through the prostate. Enlargement of the prostate blocks the flow of urine, leading to symptoms of poor bladder emptying and accompanying frequent trips to the bathroom, including at nighttime.
In addition to the annoying symptoms, severe prostate enlargement leads to elevated pressure inside the bladder, which is transmitted directly to the kidneys. Without successful treatment, either surgical or medical, that increased pressure progressively damages the kidneys. This damage becomes permanent if the pressure is not promptly relieved.
Intermittent catheterization -- a catheter is a plastic or metal tube that is inserted in the urethra and passed upward toward the bladder -- is a way to bypass the blockage at the prostate and, if done as often as it needs to be, protects the kidneys and bladder from damage. However, catheterization technique needs to be meticulous to avoid introducing bacteria.
Tamsulosin (Flomax) and similar medicines work on the small muscles in the prostate and can be very successful in relieving symptoms from mild enlargement of the prostate. Finasteride (Proscar) and similar medicines work by blocking a type of testosterone. Over months it reduces the size of the prostate. These medicines are very safe for the kidney -- it’s the pressure, not the medicine, that most commonly causes damage.
In more severe prostate enlargement, medications may not be enough, and one of many different types of surgical procedures is considered. Although most people have a good outcome, some people have worsening of symptoms after surgery, requiring intermittent or permanent catheterization. Ten percent or so of men require a second surgery within five years of the most common type of prostate surgery. Microwave treatment has a much higher risk of needing reoperation than traditional surgeries or some newer options.
DEAR DR. ROACH: For some years I have been experiencing pain and numbness in the first two fingers and thumb of both hands. I have mentioned it to my doctors and have gotten no answers. Lately the same thing is starting on the last two fingers of my right hand. I have been diabetic for more than 20 years. -- J.K.
ANSWER: The location in the hands is highly suggestive of carpal tunnel syndrome. Many people also notice that part of the ring finger may also have pain or numbness. Diabetes is a known risk factor for development of carpal tunnel syndrome.
A physical exam can often make the diagnosis with reasonable accuracy. A test of the nerves (EMG and nerve conduction test) may be necessary if the diagnosis is uncertain or if surgery is considered. For mild cases, conservative treatment with anti-inflammatories, a wrist splint or an injection can be effective. If hand strength is affected or if nonsurgical treatment is ineffective, then surgery can be considered.
