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Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH), or enlarged prostate, is a common urological condition among men over 50, caused by the non-cancerous enlargement of the prostate gland.

The main function of the prostate is related to the production of fluids that accompany semen during ejaculation. The prostate lies between the bladder and the penis. As men get older, the number of prostate cells increases, causing the prostate gland to enlarge, squeezing down on the urethra. This can result in:

Benign Prostatic Hyperplasia (BPH) Symptoms

BPH usually leads to symptoms that affect urination, such as:

  • Difficulty urinating or a weak urinary stream
  • Stopping and starting during urination or significant dribbling after urination
  • Incomplete emptying of the bladder or blockage or urinary flow
  • Having to urinate again shortly after urination
  • Frequent urination, especially at night
  • Urgent need to urinate
  • Blood in the urine

Consult your urologist if you are experiencing any of these symptoms. Your doctor will perform tests to rule out prostate cancer and confirm a benign diagnosis. If the BPH condition is left ignored for a long period of time, patients are likely to develop the inability to pass urine (acute urinary retention), bladder stones, recurrent urinary infections, and eventually obstructive kidney damage.

Causes of Benign Prostatic Hyperplasia (BPH)

An enlarged prostate can be caused by:

  • Obesity
  • Lack of physical activity
  • Erectile dysfunction
  • Increasing age
  • Family history of BPH

Benign Prostatic Hyperplasia (BPH) Diagnosis

Prostate enlargement is diagnosed by:

  • Bedside ultrasonography of the prostate, bladder, and kidneys
  • Uroflowmetry and residual urine measurement (CTA: pg. 3 Residual Urine Bladder Scan)
  • Digital rectal examination of the prostate
  • Blood tests to assess kidney function and the likelihood of prostate cancer
  • Cystoscopy, where a flexible endoscope is passed up the male urethra to assess the lower urinary tract for urethral strictures or bladder tumours

Benign Prostatic Hyperplasia (BPH) Treatment Options

During the early phases of the condition, urologists keep a watchful eye on an enlarged prostate with periodic examinations and screenings. Once symptoms have progressed and become bothersome to the patient, treatments include drug therapy, minimally invasive procedures, and surgery.

Early BPH symptoms can be well controlled with medications known as alpha-blockers, which act on receptors in the bladder neck to relax the bladder outlet during urination. When symptoms are not improving with medications, the following treatment options are recommended:

  • Transurethral Resection of the Prostate (TURP): This surgical procedure involves scraping the prostate to create a channel for the flow of urine. It is the mainstay of treatment for BPH and is effective in relieving prostatic obstruction. Patients will be under anaesthesia, and an apparatus known as a resectoscope with an electrical loop at the end will be passed through the urethra. The loop is then used to cut the prostate tissue causing the obstruction, whilst sealing the blood vessels at the same time. The cut tissue is flushed out of the body. The patient recovers comfortably after surgery with a one- to two-night hospital stay, passing clear urine smoothly within two weeks.
  • Greenlight™ and Thulium Laser Vaporisation: A special green light laser is used to vaporise the prostate tissue, creating an open channel allowing for better urinary flow. Under anaesthesia, a scope along with the greenlight laser device is passed through the urethra to the prostate gland. Once there, the surgeon activates the laser, and the released energy is absorbed by blood, causing the surrounding prostate tissue to vaporise, clearing the obstruction. As the tissue vaporises, heat from the laser seals the blood vessels and minimises bleeding. Greenlight laser is a recommended option for patients on anticoagulation blood thinners. It reduces complication rates, in particular bleeding, and shortens hospital stay compared to TURP.

Minimally invasive methods are usually performed as day procedures and do not require full general anaesthesia. They aim to provide relief of symptoms while minimising the risk of urinary incontinence and sexual dysfunction. These include treatments like Urolift, BPH Water Vapour Therapy, and Prolieve.

  • Urolift®: A prostatic lift procedure, often performed in the office, utilises implants to open an obstructed prostate channel, not reducing the size of the prostate. It is usually done under local anaesthesia in a clinic setting or day surgery centre. There is a rapid relief of symptoms, and patients can return to normal activities after a few days.
  • Rezum™: A minimally invasive procedure, which involves injecting sterile water vapour (steam) into the prostate gland. The procedure can be done under local anaesthesia, and the whole process takes 15 minutes with patients typically discharged on the same day. This is a very targeted therapy as the procedure is done under direct vision, and the steam is injected into a defined and confined area. The result is a targeted reduction of excess prostate tissue, which helps resolve symptoms caused by an enlarged prostate. There is no risk of incontinence, and patients can preserve sexual function. Patients can return to regular activities within a few days.
  • Prolieve Thermodilatation System: Prolieve is a minimally invasive day procedure that utilises heat to treat the enlarged prostate gland. It is a combination treatment using microwave heating together with pressurised balloon dilatation.

Why should you choose Dr Colin Teo to perform your BPH treatment?

Dr Colin Teo is the Founding Head of Khoo Teck Puat Hospital’s Urology Department, with years of experience in minimally invasive keyhole surgery*, operating with precision surgical techniques. Many fellows have trained under his mentorship. He did a Fellowship in EndoLaparoscopy and Andrology at St James’ Hospital in Leeds, UK, and was sponsored for a Senior Healthcare Medical Development Program (HMDP) in Advanced Laparoscopic and Robotic Surgery at University of Southern California (USC) Keck Hospital in Los Angeles, USA.

Dr Teo was a co-author in the Urological Association of Asia BPH Consensus Committee and was involved in the Singapore Urological Association BPH Guidelines and the Society for Men’s Health Better Prostate Health Guidelines committee. He piloted and published the ePOD (early post-operative discharge) Prostate Bipolar Surgery Study that translated bipolar prostate surgery technology to shorter hospitalisation and catheter dependence in peer-reviewed journals that have since changed the clinical practice in his department and was invited for presentations for his BPH work in regional and international conferences.

*Robotic surgery refers to the use of a robotic surgical platform known as the da Vinci® Surgical System to perform minimally invasive surgery through small incisions. This innovative technology comprises a surgical cart that is docked next to the operating table to small ports placed through incisions <1cm in the patient’s abdomen. Robotic wristed instruments are then passed through these small ports into the abdomen, which are controlled by the surgeon sitting at the operating console some distance away from the operating table. A binocular camera lens affords the surgeon a 3-dimensional view of the operating field, which can be magnified up to 12 times. The surgeon then manipulates the camera lens and the various robotic instruments at the console using the hand controls and pedals. These specially designed instruments afford the surgeon excellent precision and dexterity of surgical movement because of their patented robotic wrist technology.

Seek recommendations on suitable treatment options for Benign Prostatic Hyperplasia (BPH) with Colin Teo Urology. Contact us to book an appointment today.