Go With The Flow Part I

In the age of internet technology, web apps, email, YouTube, and now AI, personal information isn’t really all that personal any longer. 

As our collective mindset about protecting personal information begins to accept that disturbing reality, we just accept the fact that if someone out there in the web world really wants to know something about us, it probably isn’t too difficult to get there.

That said, and in the interest of information sharing, I decided to use this month’s column to cater to our older male population (sorry, ladies, but you may still find the subject matter interesting!) and share a personal experience with what is one of the most common medical conditions affecting aging men. Benign Prostatic Hyperplasia, or in simple speak, enlargement of the prostate gland, which serves men well in their reproductive years, but loses its favored status as we age and the gland begins to “hypertrophy” or enlarge to the point that it begins to present with symptoms that urologists refer to as Lower Urinary Tract Symptoms, LUTS. These symptoms include frequent urge to urinate, incomplete emptying of the bladder, painful urination, having a weak urine stream, and difficulty starting and stopping urination. When things finally progress to the point where a patient experiences urinary retention, not being able to empty the bladder, it warrants immediate attention, including catheterization.

As I am in the prime age group of men and have personal and intimate experience with the condition, I shall regale you with a first-person point of view from start to finish.  I first began noticing symptoms of early BPH in my mid-50s, including a slow but modest increase in the PSA (prostate-specific antigen), a protein made by the prostate that, if substantially increased over time, could indicate possible prostate cancer. After doing some online research I found that a group of blood pressure medications known as alpha-blockers were favorable adjunct therapy for BPH.

Alpha-blockers do their thing by blocking certain pathways involving the nervous system’s processes of transmitting chemical and electrical signals that affect many of our organ systems, in this case, the bladder muscles. Alpha-blockers relax the smooth muscle of the bladder neck, also called the vesicle sphincter, the most distant part of the bladder that forms the anatomical juncture connecting the bladder to the urethra, the tube that carries urine from the bladder to the outside world. By relaxing this muscle, urination is “normal” and slows down the progression of symptoms as the prostate continues to enlarge over time, and in so doing, compresses the urethra, making urination more frequent, less complete, and much less fun to live with. Because of the symptoms and PSA leveI, I asked my primary care doc if Terazosin, one of the several selective A1 blockers, was an appropriate choice. He agreed, and I began my long love affair with the drug.

For many men, as was my case, medication therapy was a particularly good option that provided satisfactory results for almost twenty years. However, once I got into my late 60s the efficacy of the drug therapy began to wane, until one Saturday night a few years ago, after a full day of not being able to empty my bladder (“void” in medical-speak), I ended up in the emergency room with urinary retention and left with a Foley catheter in my bladder. (Frederic Foley invented the indwelling urinary catheter in 1929, and millions of patients can owe him a posthumous debt of gratitude for the wonderful invention. It’s the best and the worst of worlds depending on why you have it and how long you have it!)

That was the shot across the bow that my BPH history might be changing; however, I continued to do well with Terazosin for a couple more years, but with less and less optimal results. My PSA fluctuated, but not dramatically, during the next few years, and I underwent a prostate biopsy that was negative, and several years later, with a new urologist, a fusion MRI that provided much better visualization of the prostate anatomy.

In the next column, I’ll continue with how the story ends, as there are numerous options for treating this common male problem!

Portrait of Gary Crump, AOPA's director of medical certification with a Cessna 182 Skylane at the National Aviation Community Center.
Frederick, MD USA
Gary Crump
Gary is the Director of AOPA’s Pilot Information Center Medical Certification Section and has spent the last 32 years assisting AOPA members. He is also a former Operating Room Technician, Professional Firefighter/Emergency Medical Technician, and has been a pilot since 1973.

Related Articles