Some years ago I was prescribed the drugs tamsulosin and finasteride for an enlarged prostate. But I was never warned that they might make me impotent, which they have. Should I have been told?

N. Palmer, Broadwell, Glos.

The condition you describe, benign prostatic hyperplasia – or an enlarged prostate – affects nearly all men to some extent once they hit their 60s and beyond.

As the prostate ‘grows’ (driven by testosterone), it distorts the bladder and causes symptoms such as poor stream, hesitancy when trying to empty the bladder and waking frequently at night to do so.

At worst it can lead to complete urinary retention – which is a medical emergency – though fortunately we see this less commonly than earlier in my GP life, thanks to drugs called alpha blockers. These include tamsulosin, the drug you’ve been prescribed and which is the most commonly used.

Alpha blockers relax the smooth muscle, which the prostate is largely made up of. As the gland relaxes, flow improves.

However, impotence is not a common side effect of tamsulosin (rather it may cause dry ejaculation, when semen is ejected back into the bladder). While it works for most patients, some still experience nocturia – needing to visit the bathroom at least once or twice at night.

The other drug you were prescribed, finasteride, can help with nocturia and other symptoms by effectively blocking the effect of testosterone, so shrinking the prostate.

Unfortunately, this does also almost inevitably cause impotence. In some patients it can lead to enlarged breasts.

In your longer letter, you mention you’ve now stopped taking the drugs and that your GP has also prescribed tadalafil (a drug that improves erections), yet this hasn’t helped.

Most men suffer from an enlarged prostate as they age, with this distorting the bladder and causing symptoms such as a poor stream (picture posed by model)

So rather than the drug, your erectile problems could be primarily due to underlying, possibly undiagnosed, type 2 diabetes, or a side effect of something else – such as medication for high blood pressure.

Cholesterol build-up in the arteries is another potential cause (as it can limit blood flow in the arteries to the penis).

I’d talk to your doctor about continuing the tadalafil (at least 5mg daily) as well as tamsulosin (400mcg) each morning.

The tadalafil dose can be increased to 10mg or more. While it’s primarily a drug to treat erectile problems, it can help some patients with an enlarged prostate, too.

There is every reason to hope that your situation will improve, provided there aren’t also other factors responsible for your erectile issues.

My wife is 82, in a care home, bedbound and in constant pain from the lower back down and suffering from dreadful contortion of her legs. Her left leg is twisted outwards at right angles and her right is permanently bent. Both heels permanently touch her buttocks and she is confined to one position, in bed 24/7. Her GP just prescribes more painkillers.

Declan Trant, West Sussex.

It is heartbreaking to hear of your wife’s predicament. The onus is on the care home to ensure her condition is managed as well as possible.

The first step is for the head of the care home’s nursing team to assemble a multidisciplinary team – comprised of her GP, a physiotherapist, an occupational therapist and preferably an orthopaedic consultant who specialises in the lower limbs. Ideally you would also be there.

You explain in your longer letter that your wife’s left leg sticks out so much that she is unable to get through a doorway. 

A relatively minor operation to release a tendon could allow her to relax this leg to a degree and, along with the prescription of appropriate painkillers, may at least allow her to be lifted out of bed and into a wheelchair so she can leave her room.

If the nursing home fails to help, write to the Care Quality Commission to complain.

Better treatment for blocked noses

Nasal polyps – painless, benign growths – are something we see a lot of in general practice.

They’re caused by chronic inflammation, typically as a result of allergy, often leading to chronic discharge and the loss of the sense of smell – making life miserable for those affected.

While corticosteroids can suppress the polyps, there is no cure and even after surgery to remove them they can recur.

But new biologic drugs such as depemokimab, which target a factor driving inflammation, can help, reducing the need for steroids and repeat sinus surgery.

Depemokimab is given by injection twice yearly, helping patients with this aggravating chronic disorder breathe more easily. The drug is currently being reviewed by the National Institute for Health and Care Excellence – so a new option for these patients may be just around the corner.