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Overheated irrigant can cause thermal injury to any tissue that is subsequently exposed to the fluid and thermal injuries to the bladder have been reported after endoscopic prostate surgery. This is further detailed in the section on medically complicated patients. While this study did not report on reoperation rates, it did report a significantly higher of post-operative morbidity at 9 months in the TUVP group (29% vs 2% Clavien I), significantly higher rates of hematuria with clots at 4 weeks (9% vs 0%) and significantly higher rate of urethral strictures in TUVP groups at 6 months (11% vs 0%). At 9 months follow-up, there was no difference in change of IPSS (6.9 vs 5.2), max flow rate (18.3 vs 19.1 ml/sec), or prostate volume (31.8 vs 30.6 g).
In a trial involving 450 men, 81% of those using finasteride alone showed hair improvement, compared to 59% of those using minoxidil alone. One study found 94% had low libido and 92% experienced ED months after stopping treatment. Large clinical trials show that less than 2% of men report new sexual side effects, which typically resolve over time. A randomized, double-blind study found that men using finasteride 1 mg/day with TRT experienced greater hair growth than those on finasteride alone, without lowering testosterone. If you’re using testosterone replacement therapy (TRT) and also taking finasteride for hair loss, you’re probably wondering how they interact. Finasteride and testosterone replacement therapy offer a powerful combination for men’s health. The combination may also affect prostate health differently than either treatment alone.
In the 24-month study, improvements in Qmax and prostate volume reduction were more prominent in the combination therapy group. Qmax improvement was seen in combination therapy compared to placebo, but not dutasteride monotherapy. Both studies concluded that combination therapy was not superior to alpha blocker monotherapy.
In 2002 Sairam first suggested that PDE5s could improve urinary symptom scores in men attending the andrology outpatient clinic for ED.153 In 2006, Mulhall confirmed this pilot evidence in a population of men with comorbid ED and mild to moderate LUTS.154 These studies were small, non-controlled cohorts. For patients with LUTS/BPH irrespective of comorbid erectile dysfunction (ED), 5mg daily tadalafil should be discussed as a treatment option. Clinicians may consider 5-ARIs as a treatment option to reduce intraoperative bleeding and peri- or postoperative need for blood transfusion after transurethral resection of the prostate (TURP) or other surgical intervention for BPH. These controlled studies used more rigorous methods compared to the anecdotal reports of persistence. There is neither a strong nor consistent association based upon well-designed, controlled epidemiological studies reported in the literature. However, the robustness of the data justifying this change, which is based on anecdotal patient-reported outcomes rather than prospective trials, remains unclear.
Two observation studies have examined the risk of diabetes to men on 5-ARI; however, these trials have yielded contradictory results.131, 132 There was no significant difference in changes in any of the ejaculatory domains among men assigned to doxazosin as compared to placebo. Amongst men randomized to 5-ARI instead of alpha blocker alone or placebo groups, there is a lower risk of AUR and BPH related surgery.96

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