Benign Prostatic Hyperplasia (BPH)

As men age, the likelihood of developing prostate-related diseases significantly increases. Nearly half of men over the age of fifty may experience benign prostatic hyperplasia (BPH), which adversely affects urinary function.

Symptoms

• Frequent urination
• Nocturia
• Difficult urination
• Blood in urine
• Painful urination
• Weak urinary stream
• Incomplete bladder emptying
• Urinary incontinence
• Discomfort in the lower abdomen or pelvis

 Diagnostic Methods

Doctors will first review the patient's medical history, conduct a physical examination, and perform an "International Prostate Symptom Score" (IPSS) for initial clinical assessment. Depending on the situation, additional tests may include:

• Digital Rectal Examination (DRE): The doctor will wear a lubricated glove and insert a finger into the patient's rectum to assess the size, shape, and texture of the prostate.
• Urinalysis: Testing for any infections or bleeding in the urinary tract.
• Prostate-Specific Antigen (PSA) Blood Test: The doctor may recommend this test to check for elevated PSA levels, which can indicate benign prostatic hyperplasia or prostate cancer. A more than-normal PSA level may necessitate further investigation to rule out prostate cancer. Blood tests may also include kidney function and blood glucose evaluations.
• Ultrasound Scan: Using ultrasound to assess prostate size, check for tumors, evaluate residual urine in the bladder, detect bladder stones, and determine kidney function related to abnormal urination.
• Urine Flow Test: The patient will urinate into a device that measures the flow rate. Slow urination may be caused by benign prostatic hyperplasia.
• Cystoscopy: The doctor inspects the internal condition of the urethra and bladder. It is employed when there is suspicion that symptoms may result from other urethra, prostate and bladder conditions.

Treatment Methods

Medication

After evaluation by a doctor, if the condition is mild, medication may be a treatment option. This can include alpha-blockers, 5-alpha reductase inhibitors, and other combination drugs. Possible side effects include fatigue, dizziness, low blood pressure, reduced libido, erectile dysfunction and decreased semen volume due to retrograde ejaculation. Recent medications tend to have fewer side effects compared to older options. For more severe conditions or if a patient cannot tolerate medication side effects, surgical treatment may be considered.

Minimally Invasive Surgical Options	Principle	Trauma Level	Recovery Time	Impact on Sexual Function	Suitable for
Prostatic Urethral Lift (UroLift)	Uses permanent implants to pull enlarged prostate tissue outward, widening the urethra	Low	<30mins	Very minimal	Patients with mild to moderate BPH and younger patients with a need to preserve sexual function
Prostate Steam Thermal Therapy (Rezum)	Uses heat generated from water vapor to destroy excess prostate tissue	Low	<30mins	Minimal
Transurethral Resection of the Prostate (TURP)	Uses a semicircular metal wire to remove enlarged prostate tissue through the urethra via a resectoscope	Moderate	1-2hrs	Moderate to severe	Patients with significant urinary obstruction due to BPH particularly of size >100mL
Thulium Laser Vaporization or Holmium Laser Enucleation of the Prostate (HoLEP)	Utilizes high energy to vaporize excess prostate tissue or resect prostate tissue	Low to moderate	1-2hrs	Moderate to severe
Aquablation Therapy	Employs high-pressure water jets, guided by imaging, to precisely remove overgrown prostate tissue	Moderate	<1hr	Minimal	Patients with mild to moderate BPH and younger patients with a need to preserve sexual function.
Open Surgery	Involves a surgical incision to remove prostate tissue in severe cases	High	Long	Severe	Patients with a significantly enlarged prostate who are not suitable for other surgical treatments
Prostatic Artery Embolization (PAE)	Reduces blood supply to the prostate by embolizing its supplying arteries, causing shrinkage and relieving pressure	Low	<1hr	Almost None	High-risk patients or those unsuitable for anaesthesia

The choice of surgery should be based on the individual patient's needs and conditions. Please consult your urologist.