Dear Dr. Roach: I’m a 76-year-old male who has had nighttime urination problems for many years. I must get up from sleeping every 1.5 hours. I can set my clock by the urge. I was prescribed tamsulosin, which I took for many months, but it wasn’t effective. I was then prescribed tadalafil, which I have been taking for a month with no relief. You can imagine how disruptive this situation is to my daily sleep. Is there another alternative?
D.T.
Many times, men with increased urinary frequency in the nighttime have a problem of an enlarged prostate. Tamsulosin (Flomax) is a frequent choice and effective for most men with urinary symptoms due to an enlarged prostate, which is extremely common for men your age. Tadalafil (Cialis) is more often used as a treatment for erectile dysfunction, but it is also a useful drug for men with prostate issues. Although there are other medications, such as finasteride, it is worthwhile to take a figurative step backward and ask whether an enlarged prostate is really the problem. Very often, the problem isn’t the prostate at all, but the bladder.
Sometimes an overactive bladder can be very difficult to distinguish from an enlarged prostate by its symptoms. Urologists have specialized tools at their disposal that can help distinguish between these possibilities (and some less-common ones). An evaluation of how much urine is left in the bladder after urination is easily obtained by a handheld ultrasound, but most primary care doctors don’t (yet) have that ability. Urine flow can also be measured, and if the problem is thought to be an overactive bladder, an entirely different set of medications is used. Hopefully the correct diagnosis will lead to better treatment.
Of course, it’s possible your problem really is an enlarged prostate, so contemplation of surgery and newer prostate procedures could be in your future. I refer men in your situation to a urologist.
Dear Dr. Roach: How effective is hyperbaric oxygen therapy in treating a radiation wound on one’s foot? I’m a 67-year-old male with high blood pressure that is currently under control. I had radiation treatment for plantar warts last summer. Nine out of 10 have been eradicated. One turned into a wound that never healed until I started to see a podiatrist at a wound care centre. It seems to be helping, but it’s taking a long time to heal.
K.L.
Radiation can sometimes lead to chronic, non-healing wounds. I am very surprised about the use of radiation treatment for plantar warts. There are many treatments that are safer than radiation, which was at a dose where you have developed this serious complication. However, since you have this complication, the treatment for it definitely requires special expertise. Wound care experts typically include plastic surgeons and wound care nurses.
Standard treatment for wounds can be augmented with the use of hyperbaric oxygen (“hyperbaric” means at a high pressure). In practice, this involves a pressure chamber with pure oxygen, allowing the oxygen to come into direct contact with the wound at very high concentrations. This has many effects both systemically and at the site of the wound. While the exact mechanism for its effectiveness isn’t known, real-world data have shown its effectiveness, even if high-quality trials have not had consistent results.
Uncontrolled studies have shown that 75% of radiation-induced wounds can be healed by hyperbaric oxygen, but it may take months to do so. A longstanding wound tends to be harder to heal and requires more time. I do want to emphasize that hyperbaric oxygen is used in addition to the best practices of wound care.
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