Prostate problems and erections in Valladolid: a guide for English speakers

After fifty, two problems often turn up together: getting up at night to pee, and erections that are not what they were. Both become more common with age, the treatments overlap, and prostate surgery can affect sex life for months or longer.

If you have moved to Valladolid with a prostate history, perhaps on tamsulosin from your GP back home or after an operation in the UK or Ireland, this page explains what the Spanish product information (the ficha técnica) and European urology guidelines (EAU) say, what your medicines are called here, and how to reach a urologist through Sacyl, the regional health service.

Your prostate medicines under Spanish names

Ask for the active ingredient, not the brand, and the pharmacist will find it. These are the names you are most likely to meet:

One more thing to tell any doctor here: finasteride roughly halves your PSA reading, and dutasteride works in a similar way. If your PSA history comes from abroad, bring the numbers and note when you started the drug.

Daily tadalafil for an enlarged prostate

In Spain, Cialis and its generics are licensed both for erectile dysfunction and for the signs and symptoms of benign prostatic hyperplasia (BPH). For the prostate the dose is 5 mg once a day, at about the same time, with or without food, and the same dose covers men who have both problems.

The numbers in the ficha come from four 12-week trials with more than 1,500 men. Prostate symptom scores (IPSS) improved by 4.8 to 6.3 points on tadalafil against 2.2 to 4.2 on placebo, sometimes within the first week. In the one trial that also used tamsulosin, the improvements were 6.3, 5.7 and 4.2 points for tadalafil, tamsulosin and placebo. In men with both conditions, the erectile function score rose by 6.5 points against 1.8. The benefit held for up to a further year in an extension study. The 2.5 mg dose has not been shown to work for BPH, and daily use is not recommended with severe kidney impairment.

It is not funded by the Spanish public system for either indication, so you will pay the full price.

Mixing prostate tablets and erection tablets

Alpha-blockers and ED tablets can both lower blood pressure. Tadalafil with doxazosin is not recommended, and the ficha asks for caution with any alpha-blocker, especially in older men, and a start on the lowest dose, raised gradually; a small study in healthy volunteers found no such effect with tamsulosin or alfuzosin. With sildenafil, you should be stable on the alpha-blocker before starting. Tadalafil 5 mg was tested alongside finasteride 5 mg without new side effects, although no formal interaction study exists. Nitrates and riociguat rule out every ED tablet.

What we sell, and how it relates to the prostate

• Cialis Generic: includes 5 mg tadalafil in large packs, the daily dose in the ficha, though BPH needs a diagnosis first. The 40 mg tablet also listed is above the licensed maximum.
• Cialis Original: sold here only as 20 mg, which is not the BPH dose.
• Propecia Generic: finasteride 1 mg, the hair-loss dose, and 5 mg, the BPH dose. It can affect desire and erections and it lowers PSA.

After a radical prostatectomy

The EAU guideline is frank. Erection problems are common after radical prostatectomy whatever the technique, and recovery depends mostly on age, how good erections were beforehand and whether the surgeon could spare the nerves. Without any treatment, only about 20 to 25% of men regain erectile function in most studies.

When the nerves were spared, ED tablets are the first-line treatment. The Cialis ficha adds that it is not known whether it works after surgery that did not spare them. As for penile rehabilitation, early treatment seems to affect how long recovery takes, but no regimen has been shown to be the best, and a Cochrane review found that taking these tablets on a fixed schedule made little or no difference to short-term potency.

If tablets are not enough, Spain has the same second-line options you may have heard about at home: alprostadil injections into the penis (Caverject), alprostadil cream (Virirec), vacuum pumps and, eventually, a penile implant. After a radical prostatectomy there is no ejaculate any more, although orgasm is still possible.

Operations for BPH, such as TURP or laser, leave part of the prostate in place. Retrograde ejaculation is the usual after-effect, and the EAU also lists BPH surgery among the situations associated with erectile dysfunction, so raise any change at your check-up.

Seeing a urologist in Valladolid

If the INSS (Spanish Social Security) recognises your entitlement, as a worker, pensioner or EU citizen registered with an S1, Sacyl gives you a tarjeta sanitaria and a GP at your centro de salud (health centre). The GP checks your symptoms, orders a PSA test if needed and refers you on. Valladolid is split into two health areas, each with its own hospital:

• Hospital Clínico Universitario de Valladolid (Valladolid Este), whose published urology service portfolio includes andrology and penile implants.
• Hospital Universitario Río Hortega (Valladolid Oeste), with urology clinics at the hospital and at the Arturo Eyries specialist centre.

Bring your discharge letter, histology and PSA results from home, translated if you can. On a temporary stay, an EHIC (TSE) covers care that turns out to be necessary; with private insurance, prescriptions from private doctors in Spain are valid in any pharmacy, and those from other EU countries are accepted too. For a duty pharmacy (farmacia de guardia), the Valladolid pharmacists' college publishes today's rota.

Prostate questions we hear

Other cities: side effects in Jerez de la Frontera, ED after 60 in Alicante, comparing the four ED tablets in Madrid.

Sources: Spanish product information (fichas técnicas) for Cialis, Viagra, Proscar, Avidart, Urorec and Omnic Ocas, CIMA register (AEMPS); EAU Guidelines on Sexual and Reproductive Health; BIFIMED funding database, Spanish Ministry of Health; service pages of Hospital Clínico Universitario de Valladolid and Hospital Universitario Río Hortega (Sacyl); Colegio Oficial de Farmacéuticos de Valladolid. For information; your own doctor makes the call. In Spain, prescription-only medicines may not be sold online, and customs can hold a parcel that contains them. We do not check prescriptions: talk to your doctor before you order.