Large Median Lobe of the Prostate Acting as Ball-Valve is Often the Reason Why Pills for Enlarged Prostate Such as Flomax and Finasteride (Proscar), Tamsulosin, Silodosin (Rapaflo) and Uroxatral (Alfuzosin) Do Not Work Well.
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Symptoms of BPH but Medications Do Not Help
A commonly encountered situation is that men improve a little bit on medical therapy (Flomax, Uroxatral, Avodart, Proscar, Rapaflo) but not as much as an experienced urologist would expect. Usually, further evaluation is initiated.
Quite commonly in this situation, the patient may have a very large prostate which is beyond the effectiveness of medical therapy. Another common situation is a prominent, large median lobe of the prostate protruding into the bladder and blocking the urine flow in a ball-valve fashion.
Timely Decision that Medications Cannot Help is Important
Medical therapy is usually not effective for men with large obstructive median lobes. In this initiation, minimally invasive surgical therapy with Greenlight laser of the prostate or bipolar TURP is usually necessary to provide adequate relief of symptoms and long-term effectiveness. While many patients initially are hesitant to commit to surgical treatment, sooner or later it becomes necessary in a situation where a large median lobe obstructs urine flow. The most common regret that patients experience in this situation is that they did not have the procedure done sooner.
While medications are a good treatment option when they are effective, surgical therapy should be offered promptly to men who do not benefit from medical therapy after a thorough evaluation to exclude other causes of poor response to medications for BPH such as a coexistent overactive bladder, nocturia caused by low DDAVP, bladder cancer and other causes.
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