Prostate Enlargement / BPH

Prostate Enlargement BPH

Prostate Enlargement/ BPH

Benign prostate hypertrophy (BPH) or prostate enlargement is a normal part of the ageing process in men. This can cause bothersome urinary symptoms and may lead to complications with time. Fortunately there are many ways this can be treated.
 

What is a prostate?

A prostate is a walnut sized gland that lies above bladder and surrounds the urethra, the tube you pass urine from. The prostate makes ejaculatory fluid, the milky white fluid that makes up most of the ejaculate, and provides nourishment for the sperm.

Why do prostates enlarge with age?

The prostate tissue is very responsive to testosterone, the male hormone made in the testes. Testosterone stimulates the prostate glands to grow – as men usually don’t stop making testosterone as they get older, their prostates may continue to grow in size.

Why does an enlarged prostate affect urination?

The prostate is located under the bladder and surrounds the urethra. As it enlarges, it may compress the urethra leading to obstruction. The overall size of the prostate does not correlate to the degree of obstruction. More importantly, it is the degree of obstruction that is more likely to cause symptoms. This explains why a man with a smaller prostate may have worse symptoms than a man with a much larger prostate.
Urolift Procedure on Prostate

What symptoms does BPH cause?

BPH may cause a variety of urinary symptoms:

  • Weak urine stream
  • Intermittent urine stream
  • Feeling of incomplete emptying
  • Frequent voiding
  • A sudden urge to void
  • Waking at night to void repeatedly

What complications may occur if BPH is left untreated?

Most men with BPH have minor symptoms and do not have complications. In some men with severe obstruction, the following complications may occur:


  • Urinary retention (a painful condition where you can’t void at all)
  • Repeated urinary infection (UTI)
  • Pressure related damage to the bladder
  • Bladder stones
  • Haematuria (blood in the urine)
  • Kidney failure from chronic backpressure


How is BPH diagnosed?

We perform a few different tests to confirm BPH is responsible for your urinary symptoms rather than another cause such as infection or bladder/prostate cancer. These tests also allow us to assess the severity of the problem to help direct the most appropriate treatment. This may include:

  • A questionnaire about your symptoms (IPSS score) – you can use here this to check if your urine symptoms are significant
  • A voiding diary to record your fluid intake and urine output
  • A urine test to exclude infection
  • PSA blood test to check for prostate cancer
  • Blood test for kidney function
  • A urine flow test and check for postvoid residual - to check the speed of your urine flow and how well your bladder empties
  • An ultrasound of your prostate, bladder and kidneys
In some circumstances, we may recommend a look inside your prostate and bladder with a cystoscopy to make sure there is no other explanation for your symptoms.


What treatments are available for BPH?

If symptoms are mild and there are no complications, BPH can be managed with lifestyle advice. Otherwise, BPH may be treated with medications or surgery:

  • Alpha blocker medication
  • 5-alpha reductase inhibitors (5-ARI’s)
  • Combination medical therapy
  • Transurethral Resection of the Prostate (TURP)
  • Greenlight Laser Prostatectomy

Lifestyle changes

For men with mild symptoms, your doctor may recommend the following lifestyle changes:

  • Do exercises to strengthen your pelvic floor muscles for better urinary control
  • Reduce the amount of fluids you drink, especially before you go out or go to bed
  • Drink less coffee, tea and alcohol


Medications

For men with more significant symptoms, doctors may prescribe medication. There are two main types of medication.

  • Alpha blockers - These have a quick acting effect on relaxing the smooth muscles around the prostate and bladder neck, easing the obstruction.
  • These medications may cause dizziness as a side effect by lowering your blood pressure.
  • Other side effects include retrograde ejaculation, which results in reduced or dry ejaculation at orgasm; and blocked nose.
  • 5-alpha reductase inhibitors (5-ARIs) - These drugs stop the prostate from growing and causes it to shrink. However, these medications take a longer time to work, so you have to wait for as long as six months to a year until symptoms improve, so do be patient. They work best when combined with alpha blockers, which can give more immediate relief.
  • There are few side effects with 5-ARI’s, but they may reduce your libido and weaken your erections. Unfortunately, these sides effects may not always be reversible when you stop taking the medication. So sexually active men should discuss the pros and cons of taking 5ARIs with their doctors.
  • 5-ARIs are also used to treat baldness, so you may notice a few more hairs on your head.
  • While both classes of drugs are effective, they do need to be taken on a long term basis to treat BPH.

Surgery for BPH

There are several methods for creating a larger channel out the prostate to relieve obstruction. They are performed under anaesthetic with a telescope through the urethra.

Reasons for surgery include:

  • Severe symptoms
  • Medication fails to control bothersome symptoms
  • Obstruction from the prostate is damaging the bladder
  • Complications of BPH occur
  • Not wanting to rely on long term medications

Recently , three new minimally invasive surgical treatments (MIST) for BPH have become available in Singapore.

These MIST have the following advantages over the previous standard surgery of TURP (Transurethral resection of Prostate) : 

  1. preservation of sexual function 
  2. not requiring hospital admission or general anaesthesia/ spinal anaesthesia 
  3. lower complication rates and earlier return to normal activity

MIST (Minimally Invasive Surgical Treatments)

Urolift

This procedure involves passing a small camera into the urethra (cystoscope) and putting small permanent implants into the prostate. These implants will lift, and hold, the obstructing prostate tissue apart, increasing the width of the urethral passage. This reduces obstruction to the urinary flow, improving the speed of the flow and reducing BPH symptoms.

This procedure is performed under local anaesthetic and sedation as a day surgery procedure, and typically takes 5-10 minutes. Symptoms resolve soon after the surgery, and patients typically return to normal activities by the next day.

Normal Prostate vs Enlarged Prostate

Urolift Procedure

Rezum Water Vapour Therapy 

Rezum works by inserting sterile water vapor (steam) through a cystoscope, into the prostate gland during a series of nine-second treatments. The therapy is targeted to a defined area because steam will travel only between cells until it encounters natural barriers within the prostate.

When the steam contacts the prostate tissue, all the stored energy is released into the tissue. Over time, the body absorbs the treated tissue, shrinking the prostate. With the extra tissue removed, the urethra opens up, reducing BPH symptoms.

This procedure is performed under local anaesthetic and sedation as a day surgery procedure, and typically takes 5-10 minutes. After the procedure, a urethral catheter is inserted for 5-14 days. Learn more about Rezum Treatment in Singapore.

Rezum Steam Therapy for Prostate

Prolieve

Prolieve is a catheter that is passed into the prostate part of the urethra, and combines using focused Microwave Heating to destroy prostate tissue, together with a Pressurized Balloon to push apart the prostate tissue. This creates a wider passage in the prostate for urine to flow through.

The treatment takes 45-minutes, and is can be performed under local anesthesia.

Prolieve ® Treatment

All 3 MISTs can effectively relieve BPH symptoms while preserving sexual function. Most men see improvement in their symptoms within a few weeks and can return to regular activities within a few days after the treatment.

However, there are selection criteria for these treatments. The choice of MIST needs to be individualised, and carefully selected by the treating urologist, based on the size and configuration of the patient’s prostate.


Surgical options requiring hospital admission and general/spinal anaesthesia

Not all prostates can be treated by MIST. Very large prostates or men who have complications from BPH such as urinary retention (complete inability to pass urine), bladder stones, or blocked kidneys, need surgery that can treat larger volumes of prostate tissue.

Transurethral Resection of the Prostate (TURP)

TURP is the standard operation for BPH and has been in use for over 40 years. It uses an electrical wire loop to cut away the inside of the prostate into strips.

Transurethral resection of the prostate (TURP) is the most common surgical treatment for BPH, and remains the gold standard upon which other surgical treatments are compared to. In a TURP, the urologist inserts an instrument called a resectoscope through the tip of your penis and into the urethra. The resectoscope helps your doctor see and trim away excess prostate tissue that's blocking urine flow. After which a urinary catheter is inserted for 1-2 days. TURP is performed under general or spinal anesthesia, and patient need to stay in hospital for 1-3 days.

Greenlight Laser Therapy / Prostatectomy

This technique uses a green coloured laser to vaporise the inside of the prostate, creating a channel to improve urine flow. It is best suited for small to medium sized prostates, or in patients who are on blood thinners.

Greenlight laser therapy involves using a laser fibre through a cystoscope to heat up and vapourise obstructing prostate tissue. This unblocks the urethra and restores normal urine flow from the bladder. This procedure is performed under general or spinal anaesthesia, and can be done as a day surgery or an overnight stay, and recovery is generally quick.

The advantage of Greenlight Laser over the TURP is better control of bleeding, and is especially useful for men who are on blood thinners for heart attack/stroke prevention.

Do note that Greenlight Laser Therapy, and TURP may have side effects that include retrograde ejaculation and erectile dysfunction.

What should you do?

If you find yourself displaying any of these symptoms, consult a urologist and get yourself checked out. It is important to understand that while these urinary symptoms are more common with aging, they should not be regarded as a normal part of life. Men should be evaluated to rule out more sinister causes of urinary symptoms.

Men do not need to suffer from urinary symptoms of BPH. There are many treatment options available, and a urologist can help men find the best treatment for their individual needs, and improve their quality of life.

Early detection can save your life.

Most conditions can be treated effectively if detected early.

Make an appointment with us to get an accurate diagnosis and a treatment plan.