What men should know about prostate enlargement, or Benign Prostatic Hyperplasia
*This article has been updated from the original publication.
Benign Prostatic Hyperplasia (BPH) is a condition where the prostate gland enlarges and is a common condition among men as they grow older.
According to the Medical Management of Symptomatic Benign report by the Health Ministry, the prevalence of BPH is said to be high, but patients’ only seek treatment when they reach a critical level.
In Malaysia, the local studies on the epidemiology of BPH and the absence of a registry for BPH are lacking, which makes it difficult to estimate the prevalence of symptomatic BPH.
However, BPH may be a significant problem based on the results of a recent campaign held on the health awareness on BPH in Kuala Lumpur Hospital which has found a prevalence of symptomatic BPH of 35 per 100 in self-referred participants of the campaign aged 50 years and above.
In a recent interview with Sinar Daily, Dr Ambikai Balan, a Urologist from Pantai Hospital Kuala Lumpur said as a man grows older, their prostate grows but they will present with different urinary symptoms that can be classified as lower urinary tract symptoms (LUTS).
The prostate grows at a very slow rate throughout their life and the symptoms may be completely Ignored by the individuals.
“When they reach 50 years old, approximately 50 percent of men often have some form of trouble urinating.
“When they go to the toilet, they will have to wait for a little while for the urine to start flowing or it will not flow as fast as before and they will feel like there is still something retaining in the bladder, later stages the urine will start to dribble after peeing,” he said.
However, he emphasized that this is a normal aging process in men and not everyone develops the same experience at the age of fifty as some people might experience it at a later point in their life.
Dr Balan said that the growth of the prostate is influenced by the male hormones that come from the testis as it is where the testosterone is produced, and the prostate gland will grow.
“The original size of the prostate is the size of a walnut, and it can enlarge into a bigger size that obstructs the urinary flow,” he said.
The symptoms of BPH often include weak urinary stream, inability to completely empty the bladder, urgency, frequency as well as dribbling and if it is left untreated it could lead to urinary retention and at later stages, kidney damage as the outflow is blocked, which will cause back pressure to the kidney.
“The urine retention in the bladder will also lead to urinary tract infection (UTI) and the formation of stones in the bladder.
“The patient could also suffer from Urosepsis in which the infection will go up to the kidney and could lead the patient to have fever, chills and in older people with co-morbidities like diabetes, it could be a life-threatening condition,” he said.
When asked about the treatment of BPH, he said it can be classified into conservative, medical and surgical options.
As for the conservative treatment, we try to investigate for other causes of LUTS symptoms which could include correction of diabetes, fluid intake, lifestyle changes and follow them up to see if the symptoms improve over time. There will be required to do some simple flow study which is to see the speed at which urine is being passed out.
“For medical treatment, we use medications and this helps to open up the ‘passageway’ within 24 to 48 hours. Medication is to be taken every night and it will be prescribed according to the patient is symptoms and general condition. The medication can be continued over long-term period with minimal side-effects.
"Not everybody needs surgery, as 80 per cent of the patients can be treated through medical treatment and the surgical option comes only after the patients fails medical management.
“There are myriads of surgical options that can be used in order to make the passageway wider. The most common instrument is either the conventional TURP (transurethral resection of prostate) using saline or glycine, laser vaporisation of prostate, enucleation of prostate. After the procedure, patient needs to be in the hospital for couple of days prior to being discharged with medication," he said.
On discharge, they will be able to pass urine without any prostate medication and they will be given some simple instruction and precautions which is to be taken over the next 6 weeks. Their condition will progressively improve, and they will also be followed up with flow study.
Upon the treatment, Dr Balan said the patient usually should not have to repeat the surgery up to to 15 years.
“Currently, we have come to a stage where we want to reduce the time of the patients stay in the hospital by introducing Water Vapor Therapy, which is a new type of procedure at Pantai Hospital.
"The patient will have the procedure done on the day of the admission and will be discharged on the following day. Progressively over 3 months, the urine flow improves and patient can stop the medication," he said.
Pantai Hospital has acquired 11 to 12 patients who have undergone the surgery and the responses have been great, according to Dr Balan.
What makes it even more interesting is that the whole procedure only takes less than three minutes.
Under general anaesthesia, a small instrument with camera is inserted into the urethra and the prostate is identified. Once that is done, under controlled measurement and temperature, steam is injected into the tissue.
After the procedure, a catheter is inserted to drain the bladder and the patient is woken up and sent to the ward. “Progressively, over time, the passageway opens up and the catheter is removed. Patient is followed up monthly with a repeat uroflowmetry for a short duration of time.
According to Dr Balan, procedure is very fast and the patients only stay in the hospital for a day with no blood transfusion or close monitoring post-op.
This treatment can also be done on the patients with heart problems and the failure rate is as low as 4.4 per cent.
The risk of erectile dysfunction is very low and retrograde ejaculation risk is approximately six per cent.
Worst case scenario, Dr Balan explained that if the surgery fails, it can be repeated and if required we can go back to the conventional surgery.
Among the misconceptions regarding BPH, according to Dr Balan, most men think that it will not happen to them, he also opined that the reason why there is still a lack of awareness surrounding this condition is because men do not talk about it enough and they need to address this issue as soon as possible if they want to avoid any damage to the kidney or bladder.
“I think men need to meet and talk to their urologist or their general practitioners regarding this issue as it is the best step to take to move around it,” he added.
