As men get older, many will experience urination issues due to an enlarged prostate. This is a common condition known as Benign Prostatic Hyperplasia (BPH). At age 40, 8 per cent of men have BPH. By the time men hit 60 years of age, one out of two have BPH, according to the Singapore Urology Association clinical guidelines for BPH 2017.
A prostate that is larger than usual puts pressure on the urethra, which can cause uncomfortable symptoms, such as an urgent or frequent need to urinate, increased frequency of urination at night, and difficulty starting urination. Other symptoms include a weak urine stream or a stream that stops and starts, dribbling at the end of urination, or the inability to completely empty the bladder. This can affect quality of life, especially in cases where you have to get up several times at night to pee.
Dr Tan Yung Khan, a senior consultant urologist and medical director of Urohealth Medical Clinic, says genetics accounts for the majority of BPH cases, but it can also be associated with diabetes, obesity and a diet high in fat.
Advancements in treatment options
Drugs and surgery are two ways to treat BPH. Drugs are often the first line of treatment. They relax the bladder neck muscles and muscle fibres in the prostate, making urination easier. Known as alpha blockers, they are effective in patients who suffer from severe enlarged prostate conditions, but they often need to be taken for life. Side effects include headache, constipation, hypotension, and retrograde ejaculation. According to Dr Tan, another type of medication, known as 5 alpha reductase inhibitors, can partially reduce the size of the prostate by reducing testosterone activity, but this may also result in erectile dysfunction, fatigue and enlargement of the breast.
Surgery is another way used to treat BPH. Traditional surgery, known as a transurethral resection of the prostate (TURP), removes excess prostatic tissue through the penis. Its potential side effects include sexual dysfunction, urinary tract infection, heavy bleeding, incontinence, and retrograde ejaculation, where semen goes backward into the bladder during orgasm, leading to little or no semen being ejaculated.
Some men who have problems with an enlarged prostate avoid seeing a doctor as they worry about side effects from traditional surgery or being on long-term medication. Others may dismiss BPH symptoms as signs of ageing.
However, left on its own, BPH could get harder to treat. Dr Tan says: “The bladder could be further damaged. And the more serious the condition, the longer and harder the recovery is likely to be.
“Severe cases may even end up on long-term catheterisation,” he adds. Catheterisation involves inserting a tube known as a catheter in the bladder to drain urine.
The good news is that advances in the field in recent years have meant that minimally invasive procedures are now available to treat the condition effectively without any troubling side effects.
“Some men still do not know that there are newer minimally invasive therapies that do not affect sexual function,” says Dr Tan.
“There is thus a need for more education on the many minimally invasive treatment options now available,” he adds.
UroLift and Rezum – two safe and effective procedures
Over the past three to five years, doctors have been able to treat BPH using two minimally invasive procedures, UroLift and Rezum. These two are the most established minimally invasive procedures for the condition, and most men with BPH can undergo them. Doctors would need to assess whether their patients are suitable for either of the two procedures based on the size of their prostate, their medical history and the severity of their symptoms.
Both procedures have proven their safety and effectiveness through extensive clinical trials. They are performed under sedation in a day-surgery setting. Each procedure takes about 20 minutes.
The UroLift procedure involves lifting the enlarged prostate and holding the tissues in place with small implants. There is no need for incisions or to cut off tissues.
For Rezum, a water vapour therapy, steam is injected in a controlled and targeted manner directly into the prostate gland to reduce excess prostatic tissues.
The side effects of both procedures are some initial urgency to urinate and frequent urination after the procedures, as well as minimal bleeding. But the major advantages are that sexual function is preserved and patients can return to regular activities within a few days. Moreover, patients who have been on long-term medications can go off them.
Dr Tan says a patient can enjoy almost immediate relief following a UroLift procedure, while with Rezum, relief occurs within a few weeks as the tissues need time to shrink. Both procedures have about 90 per cent success rates. The retreatment rates for UroLift and Rezum are about 13 per cent and 4 per cent respectively at five years following the procedures.
“Witnessing how a patient's quality of life improves after treatment is very satisfying. Most of my patients are amazed to get relief for most of their urinary symptoms and that recovery is very quick,” Dr Tan says.
Urohealth Medical Clinic, whose doctors include senior urologists Dr Tricia Kuo and Dr Tan Teck Wei, performs both procedures regularly.
Dr Tan advises men to consult a doctor once BPH starts to affect quality of life. If you are troubled by symptoms of an enlarged prostate, do consult a urologist to learn more about your treatment options and assess if you are suitable for UroLift or Rezum.
For more information, visit www.urohealth.sg.