Enlarged Prostate Treatment Singapore

Benign Prostatic Hyperplasia (BPH), commonly known as an enlarged prostate, is a non-cancerous growth of the prostate gland that typically occurs in men as they age. The prostate gland surrounds the urethra, the tube that carries urine from the bladder out of the body. As the prostate enlarges, it can squeeze or partially block the urethra, causing urinary symptoms that can interfere with daily activities and sleep patterns.

Dr. Lie Kwok Ying

Medical Council certified Urological specialist

BA MBBChir (Cantab)|MRCS (Edin)|FRCS (Urol)(Glasg)|FAMS

Symptoms Causes Diagnosis Treatment Prevention FAQ

Symptoms of Benign Prostatic Hyperplasia

Men with BPH may experience various urinary symptoms that can range from mild to severe, affecting their quality of life.

Frequent urination

The need to urinate more often than usual, especially at night (nocturia). This occurs because the bladder cannot empty completely, causing it to fill up more quickly.
Urgency

A sudden, compelling need to urinate that is difficult to delay. This symptom results from increased pressure on the bladder from the enlarged prostate.
Weak urine stream

Decreased force of urination, often requiring straining. The enlarged prostate narrows the urethra, reducing the pressure and flow of urine.
Intermittent stream

Starting and stopping of the urine stream several times during urination. This happens when the bladder muscle cannot overcome the increased urethral resistance.
Incomplete emptying

A sensation that the bladder has not completely emptied after urination. Residual urine in the bladder can lead to urinary tract infections and bladder stones.
Difficulty starting urination

Needing to wait or strain before urine flow begins. This delay occurs because the enlarged prostate blocks the bladder outlet.
Dribbling at the end of urination

Continued dribbling of urine after finishing urination. This symptom is due to urine remaining in the urethra after the bladder has finished contracting.

Causes and Risk Factors

Several factors contribute to the development and progression of BPH. Common contributors include:

Ageing: The likelihood of BPH increases over time, with prostate enlargement often beginning in midlife. Other age-related factors, such as reduced cellular regulation and tissue changes, may also contribute.
Hormonal changes: Changes in testosterone and dihydrotestosterone (DHT) influence prostate growth. While testosterone declines with age, DHT remains active and promotes enlargement.
Family history: Men with close relatives who have BPH face a higher risk, suggesting a genetic link in prostate enlargement.
Lifestyle factors: Poor diet, lack of exercise, and obesity may contribute to BPH progression by affecting hormone levels and increasing inflammation.
Medical conditions: Heart disease, diabetes, and metabolic syndrome are linked to a higher risk of BPH and more severe urinary symptoms, likely due to shared inflammatory mechanisms affecting prostate tissue.

Diagnostic Methods

Digital rectal examination (DRE)

A physical examination where the doctor inserts a gloved, lubricated finger into the rectum to assess the size, shape, and texture of the prostate. This helps detect enlargement and any irregularities.
Urinalysis

A urine test that checks for signs of infection, blood, or other abnormalities. It helps rule out urinary tract infections, bladder stones, or other conditions that may cause similar urinary symptoms.
Blood tests

Includes prostate-specific antigen (PSA) testing to evaluate prostate health and kidney function tests to assess whether prolonged urinary issues have affected kidney function. Elevated PSA levels may indicate BPH, prostatitis, or other prostate conditions.
Uroflowmetry

A non-invasive test that measures how fast and how much urine is passed during urination. A reduced flow rate may suggest obstruction, commonly caused by an enlarged prostate. This test helps assess the severity of urinary blockage.
Post-void residual volume measurement

An ultrasound scan that determines how much urine remains in the bladder after urination. If a significant amount is left behind, it may indicate incomplete emptying, increasing the risk of infections and bladder stones.
Transrectal ultrasound

An imaging test that uses sound waves to provide detailed measurements of the prostate’s size, shape, and structure. It helps assess prostate enlargement and can guide further investigations if needed.

Treatment Options

Management of BPH depends on symptom severity and overall health. Treatment ranges from lifestyle adjustments and medications to minimally invasive procedures and surgical interventions.

Non-Surgical Treatment

Symptom Monitoring: This approach is suitable for men with mild symptoms that do not significantly affect daily activities. It involves regular observation without active treatment. Lifestyle adjustments, such as reducing evening fluid intake, limiting caffeine and alcohol, and following a scheduled voiding routine, may help manage symptoms. Routine follow-ups ensure that any changes are detected early.
Alpha blockers: These medications relax the prostate and bladder neck muscles, improving urine flow. They work within days but do not shrink the prostate. Side effects may include dizziness, headache, and retrograde ejaculation.
5-alpha reductase inhibitors: These medications reduce prostate size by blocking dihydrotestosterone (DHT), a hormone that stimulates prostate growth. They can reduce prostate volume by 20–30% but may cause side effects such as reduced libido, erectile dysfunction, and decreased ejaculate volume.
Combination therapy: Using both alpha blockers and 5-alpha reductase inhibitors can provide greater symptom relief than either medication alone. This approach is especially beneficial for men with larger prostates and moderate to severe symptoms, as it targets both muscle relaxation and prostate enlargement.
Phosphodiesterase-5 inhibitors: Medications like tadalafil can also help with BPH symptoms by relaxing the smooth muscle in the lower urinary tract and improving blood flow. This option is particularly useful for men with both BPH and erectile dysfunction. Possible side effects include headache, flushing, and back pain.

Surgical Treatment

Transurethral resection of the prostate (TURP): This procedure removes excess prostate tissue through the urethra using an electric loop. TURP improves urinary flow and provides lasting relief. Recovery typically takes a few weeks, with possible side effects including bleeding, urinary tract infections, and retrograde ejaculation.
Holmium laser enucleation of the prostate (HoLEP): A laser-based procedure that removes excess prostate tissue, particularly in larger prostates. The laser cuts and removes obstructive tissue, which is then extracted through the bladder. HoLEP has a low risk of bleeding and offers longer-term relief compared to TURP. It is also suitable for men on blood thinners.
GreenLight laser therapy: A minimally invasive procedure that uses high-powered laser energy to vaporise excess prostate tissue. It is suitable for men on blood thinners or those seeking a shorter recovery time. GreenLight laser therapy reduces obstruction while minimising bleeding and hospital stay.
Prostatic urethral lift (UroLift): A minimally invasive procedure that places small implants to hold the enlarged prostate away from the urethra, improving urine flow without removing tissue. UroLift preserves sexual function and has a shorter recovery time compared to other surgical options.
Water vapour therapy (Rezūm): A minimally invasive treatment that uses steam to destroy excess prostate tissue. The heat from the water vapour causes cells to die, and the body gradually reabsorbs the treated tissue. It can be performed as an outpatient procedure and helps relieve symptoms while preserving sexual function.

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Prevention and Management

While BPH cannot be fully prevented, lifestyle changes may help manage symptoms and slow progression. Regular exercise, a balanced diet rich in fruits, vegetables, and whole grains, and limiting red meat may support prostate health. Pelvic floor exercises can improve bladder control, while scheduled voiding and double voiding techniques aid in bladder emptying. Limiting evening fluids, especially caffeine and alcohol, may reduce nighttime urination. Addressing symptoms early can prevent complications such as urinary retention, bladder stones, or kidney problems.

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At what age should men start screening for BPH?

There is no fixed age for screening, but any urinary symptoms should be discussed as soon as they appear. Routine prostate checks typically begin around age 50 for men at average risk and earlier for those with a family history or other risk factors.

Can prostate enlargement improve without treatment?

BPH does not usually shrink on its own. While symptoms may remain stable or fluctuate, the condition tends to progress over time. Early management can help control symptoms and prevent complications.

When should BPH symptoms require urgent care?

Seek immediate medical attention for an inability to urinate, painful urination with fever, blood in the urine, or severe lower abdominal pain. These symptoms may indicate complications needing prompt evaluation.

Dr. Lie Kwok Ying

Senior Consultant Urologist

BA MB BChir (Cantab)|MRCS (Edin)|MMEd (Surg)|FRCS (Glasg)(Urol)|FAMS

Dr. Lie Kwok Ying is a Senior Consultant Urologist and pioneered the use of HoLEP (Holmium Enucleation of Prostate) for benign prostatic hyperplasia (BPH) in Singapore.

He graduated from Queens’ College in Cambridge University with triple First Class Honours and subsequently qualified in 2001 with degrees in Medicine and Surgery.

Clinical Interests