BPH Treatment in Singapore for Enlarged Prostate

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. For men experiencing these issues, timely BPH treatment in Singapore can provide effective relief and improve quality of life.

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 Enlarged Prostate (BPH)

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 of Enlarged Prostate

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.

Understanding these factors is an important part of effective BPH treatment in Singapore, as management strategies can be tailored based on individual risk profiles and overall health.

Diagnostic Methods for BPH and Enlarged Prostate

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 for Benign Prostatic Hyperplasia (BPH) in Singapore

Management of BPH, also known as enlarged prostate, depends on the severity of urinary symptoms, prostate size, patient age, and overall health. In Singapore, men with mild symptoms may be advised to start with monitoring and lifestyle changes, while those with moderate to severe symptoms may require medication or surgical treatment. For some, minimally invasive procedures can relieve symptoms effectively without the need for major surgery. Treatment decisions are usually made after thorough diagnostic evaluation by an MOH-accredited urologist.

Non-Surgical BPH Treatment

Symptom Monitoring: For men with very mild urinary symptoms, doctors may recommend observation instead of immediate treatment. Regular follow-ups ensure any worsening of symptoms is addressed early. Lifestyle adjustments, such as reducing evening fluid intake, avoiding excessive caffeine or alcohol, and scheduling toilet visits, can help minimize disruptions to daily life and sleep.
Alpha Blockers: Widely prescribed in Singapore, these medications relax the muscles of the bladder neck and prostate, improving urine flow within days. While effective for symptom relief, they do not shrink the prostate. Possible side effects include dizziness, fatigue, or retrograde ejaculation.
5-alpha Reductase Inhibitors: These drugs target the underlying enlargement by blocking the hormone dihydrotestosterone (DHT). They may shrink the prostate by up to 30% over several months. Men on this medication should be aware of potential side effects such as reduced libido or erectile dysfunction.
Combination Therapy: In many cases, urologists in Singapore recommend a combination of alpha blockers and 5-ARIs, especially for men with larger prostates and more persistent urinary symptoms. This dual approach improves both urine flow and prostate volume reduction.
Phosphodiesterase-5 Inhibitors: Tadalafil, sometimes prescribed in Singapore, relaxes smooth muscle in the prostate and bladder, improving urinary flow. It is often considered for men who also experience erectile dysfunction. Side effects may include headache, flushing, or back pain.

Surgical and Minimally Invasive BPH Treatments

Transurethral Resection of the Prostate (TURP): This procedure removes excess prostate tissue through the urethra using an electric loop, improving urinary flow and providing lasting relief. Recovery typically takes a few weeks. Possible side effects include bleeding, urinary tract infection, and retrograde ejaculation. When medication isn’t sufficient, TURP is a common option within BPH treatment in Singapore.
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 Vapor 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 Lifestyle Management for Enlarged Prostate

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.

When to See a Urologist for BPH and Prostate Enlargement

Men should see a urologist if they experience urinary symptoms such as frequent nighttime urination, weak or interrupted urine flow, urgency, or difficulty starting urination. These are common signs of benign prostatic hyperplasia (BPH), also called enlarged prostate. Early consultation allows timely treatment, which may include lifestyle advice, medication, or procedures like HoLEP and TURP.

Common Symptoms That May Require a Urologist Visit

Frequent urination, especially at night (nocturia)
Weak urine stream or difficulty starting urination
Urgency with little warning
Intermittent or dribbling stream
Feeling that the bladder does not empty completely

When to Seek Urgent Medical Attention

Inability to urinate (urinary retention)
Blood in the urine
Severe bladder or abdominal pain
Repeated urinary tract infections

Why Early Consultation Matters

More options available. Non-surgical management may still be possible if diagnosed early.
Better outcomes. Prevents complications such as bladder stones, kidney problems, or infections.
Specialist guidance. An enlarged prostate specialist can recommend the right benign prostatic hyperplasia treatment based on prostate size, age, and health.

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At what age should men start screening for BPH?

There is no fixed age for BPH screening. Men are usually advised to discuss urinary symptoms as soon as they appear. Routine prostate checks often begin around age 50, but those with family history or risk factors may benefit from earlier evaluation.

What are the common symptoms of an enlarged prostate?

Typical symptoms include frequent urination (especially at night), weak urine flow, difficulty starting urination, incomplete emptying, urgency, and dribbling after urination.

What is the difference between BPH and prostate cancer?

BPH is a benign, non-cancerous enlargement of the prostate, while prostate cancer involves uncontrolled cell growth that may spread. Both conditions can cause urinary problems, but diagnostic tests are needed to tell them apart.

Can an enlarged prostate shrink naturally?

BPH generally does not shrink on its own. Symptoms may stabilize or progress gradually. Lifestyle changes such as exercise, a balanced diet, and reducing alcohol or caffeine may help manage symptoms, but medical treatment is often needed for long-term relief.

When should BPH symptoms require urgent medical attention?

Seek immediate care if you are unable to urinate, notice blood in your urine, develop painful urination with fever, or experience severe lower abdominal pain. These may indicate complications.

What treatment options are available for BPH?

Management options include lifestyle changes, medications, minimally invasive therapies, and surgery. The appropriate choice depends on symptom severity, prostate size, and overall health.

How does HoLEP compare to TURP in treating BPH?

Holmium Laser Enucleation of the Prostate (HoLEP) uses a laser to remove excess tissue, while Transurethral Resection of the Prostate (TURP) removes tissue with an electrical loop. Both are established procedures, and the choice depends on clinical factors such as prostate size and patient health.

What tests are used to diagnose BPH?

Diagnosis may include a digital rectal exam, urine tests, PSA blood test, ultrasound, and uroflowmetry to measure urine flow. These help determine the severity of enlargement and rule out other conditions.

Can lifestyle changes help manage BPH symptoms?

Yes. Regular physical activity, weight management, pelvic floor exercises, and limiting fluids before bedtime may reduce urinary symptoms. These strategies do not cure BPH but can support overall management.

Does having BPH increase the risk of prostate cancer?

BPH does not cause prostate cancer. However, both conditions can occur in the same patient and produce similar urinary symptoms. Regular check-ups help ensure accurate diagnosis and timely management. For those experiencing urinary issues or seeking relief from prostate enlargement, professional evaluation for BPH treatment in Singapore can help determine suitable management options tailored to your condition.

Dr. Lie Kwok Ying

Senior Consultant Urologist in Singapore

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 in Urology