Benign Prostate Hyperplasia (BPH)/Prostate Enlargement
WHAT IS BENIGN PROSTATE HYPERPLASIA (BPH)/PROSTATE ENLARGEMENT?
Benign prostate hyperplasia is the benign enlargement of the prostate gland. This is a common condition among older men. As many as 50% of men at 50 years of age will have it and up to 80% at 80 years of age. 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 such, when it grows bigger it can lead to obstruction of the flow of urine during urination. Long term obstruction can lead to urinary tract infection, retention of urine and even kidney failure.
SYMPTOMS OF BENIGN PROSTATE HYPERPLASIA (BPH)/PROSTATE ENLARGEMENT
Symptoms of prostate enlargement include slow urination, starting and stopping of urine flow, frequency of urination and waking at night to urinate.
DIAGNOSING BENIGN PROSTATE HYPERPLASIA (BPH)/PROSTATE ENLARGEMENT
Prostate enlargement is diagnosed by a rectal examination, a urine test, uroflow test, and PSA (Prostate Specific Antigen) test.
TREATMENTS FOR BENIGN PROSTATE HYPERPLASIA (BPH)/PROSTATE ENLARGEMENT
Treatments for prostate enlargement include Medication, minimally invasive procedures and Surgery. Some drugs known as alpha blockers can help relax the prostate to improve flow. Drugs like 5 Alpha reductase inhibitors can go some way in shrinking the prostate. Both kinds of drugs can reduce symptoms by about 30% but have some side effects and need to be taken in the long term otherwise symptoms will return. Medications can cause side effects like giddiness, visual disturbance and sexual dysfunction.
Surgical methods can also be employed to manage an enlarged prostate. These methods include methods like TURP and greenlight laser of the prostate. Minimally invasive methods are usually performed as day procedures and do not require a 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 Vapor Therapy and Prolieve.
- TRANSURETHRAL RESECTION OF THE PROSTATE (TURP)
This 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. However, this procedure may be associated with urinary incontinence, bleeding and retrograde ejaculation.
- GREENLIGHT LASER VAPORISATION OF THE PROSTATE
This special green light laser vaporises prostate tissue. It reduces complication rates, in particular bleeding, and shortens hospital stay compared to TURP. This is especially beneficial for patients on blood thinner drugs.
Surgical methods have shown to have long-lasting improvement to urinary symptoms and flow. Furthermore, the improvements in symptoms offered by these surgeries are in the range of 80% compared to the 30% of drugs.
- UROLIFT SYSTEM
Not all patients are comfortable with long-term medications or surgery. Fortunately today, we have Urolift. This 15 minute treatment for enlarged prostates is FDA approved, minimally invasive and bridges the space between medications and more invasive surgeries. This procedure lifts the enlarged prostate and holds the tissues in place using small Urolift implants thereby unblocking the urethra. It does not reduce the size of the prostate. It is usually done under local anaesthesia in a clinic setting or day surgery centre. A catheter is not typically required after the procedure and patients can return home the same day. There is rapid relief of symptoms and patients can return to normal activities after a few days.
- STEAM WATER VAPOR THERAPY
Steam Water Vapor Therapy is a minimally invasive procedure which involves injecting sterile water vapor (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 to resolve symptoms caused by enlarged prostate. Patients can expect gradual improvement of symptoms in two weeks. Patients no longer need to take any BPH medications and clinical studies show that Steam Water Vapor Therapy is safe and effective. The need for retreatment at 5 years is rare. It can be used in a wide variety of enlarged prostates including those with a large median lobe. There is no risk of incontinence and patients are able to preserve sexual function. Lastly, patients are able to return to regular activities within a few days. We are fully accredited to perform this procedure.
- PROLIEVE THERMODILATATION SYSTEM
Prolieve is a minimally invasive day procedure that utilizes heat to treat the enlarged prostate gland. It is a combination treatment using microwave heating together with pressurized balloon dilatation. This technology has been around since 2004. In some studies it has been shown to be safe for patients and less invasive than surgery. The procedure lasts about 45 minutes and can be done under local anaesthesia. The treatment has been shown to improve symptoms but no significant reduction in prostate size.
- HOLMIUM LASER ENUCLEATION (HOLEP)
HoLEP is another minimally invasive option for treating enlarged prostate glands. The advantage of HoLEP is that it is able to treat prostate of any size with no surgical incisions and lesser bleeding. The procedure involves using a small laser and scope to cut away excess tissues in the prostate which are causing the patient’s BPH symptoms.
Every patient is different and so is every prostate. It is important to consult an experienced urologist in all the minimally invasive treatments for BPH so that he or she can best advise you on the most suitable BPH treatment based on your condition and concerns. The ideal treatment will result in long-term relief of BPH symptoms and low retreatment rates.
