Treatment of Enlarged Prostate and BPH in Patients with Heart Disease (Coronary Artery Disease or CAD)
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Heart Disease and Enlarged Prostate
Men with coronary artery disease (heart disease) and especially those with a history of MI (myocardial infarction or ‘heart attack’) often have symptoms of an enlarged prostate. Men with heart disease and those who have had angioplasty with a drug-eluting stent placed in their coronary arteries of the heart typically have limited options when it comes to treatment for enlarged prostate and BPH.
Blood Thinners, Dizziness, Blood Pressure Medications and Treatment for BPH
Many patients with heart disease take multiple blood pressure medications and may also suffer from occasional dizziness. Many are at high risk for falls because of arthritis, balance problems, and prior falls. Prescribing the most commonly used medications for enlarged prostate such as Flomax (Tamsulosin) can cause what we call “orthostatic hypotension” or dizziness. Dizziness can lead to falls especially in elderly patients who are already at risk for falls.
A complicating issue is that many patients with coronary artery disease also need to take blood-thinning medications such as aspirin, Plavix, and Coumadin. A fall while taking blood thinners can lead to bleeding and other severe complications.
The Challenge of Treating Men with BPH and Heart Disease
The choices for treatment for enlarged prostate in elderly men who take blood thinners or multiple blood pressure medications are complex. As a result, a very challenging situation arises. The situation becomes even more complicated when men who are taking blood thinners have also a history of falls or dizziness caused by orthostatic hypotension.
The most effective medications, called alpha-blockers such as Flomax cannot be given to men who get dizziness and are at risk for falls. The next best option is surgery. Many men who have significant heart disease cannot stop aspirin and/or Plavix as it can lead to a heart attack or stroke. As a result, these men are often not offered surgical treatment for enlarged prostate.
When he comes to treating men with cardiac disease especially those at the highest risk who need to take aspirin and Plavix, a very complex clinical situation is created. Typically due to a concern of side effects from treating enlarged prostate these men are not given the option of either best in class medications or surgical care.
Frequent Urination, Urination at Night and the Risk of Falls.
As urinary symptoms become more severe over time, men develop urinary urgency and frequency. They get urgency and have to run to the bathroom to urinate especially at night. Urinary urgency and frequency can lead to falls when men try to get to the bathroom on ‘short notice’. This creates a vicious circle of one medical problem causing another.
Catheters and the Risk of Falls.
Some men develop urinary retention or inability to urinate spontaneously and require a urethral Foley catheter placement in the urinary bladder. This situation can worsen the problem as sometimes the catheter may cause men to tangle in the tubes at night and fall by interfering with normal movement. Intermittent catheterization is usually a better option in these cases.
Due to the complexity of managing urological issues in high risk patients with coronary artery disease, urinary symptoms are often ignored. Cardiologists are hesitant to treat men with medications for the prostate that may give side effects and stopping blood thinners for surgery puts men at unreasonable risks.
Treatment of Enlarged Prostate in Men who Have Heart Disease at New York Urology Specialists.
Men with Dizziness
For men with a mild-to-moderate enlarged prostate who have dizziness, Rapaflo which has a lower risk of ‘dizziness’ as a side effect may be tried. Cialis daily can also help with urinary problems due to BPH. Medications such as Proscar can also work but they take about 3-6 months to start working.
For men with moderate and severe BPH, minimally invasive surgical treatment often offers the best option. Some of them such as Urolift can be performed while the patient is taking aspirin. Certain surgical options for the treatment of prostate, such as Greenlight laser can be performed while the patient is taking aspirin.
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Dr. Alex Shteynshlyuger is a board-certified urologist in NYC who specializes in treating some of the most complex urology problems including treatment of enlarged prostate and bladder problems in men who take blood thinners