Helpful Information for Patients
YOUR PROSTATE AND YOU
What is a prostate?
The prostate gland is part of the male reproductive system and is responsible for producing fluid that helps to keep the sperm healthy. It is roughly the size of a walnut and is found beneath the bladder, wrapping around a tube that transports urine out of the body, called the urethra. As men grow older, the prostate enlarges as part of the natural ageing process.
When the prostate gets too large
Often as men grow older, their prostate may get too large and cause complications. This is known as benign prostatic hyperplasia (BPH). An enlarged prostate can squeeze the urethra and restrict the flow of urine, leading to complications.
Do you have BPH?
One of the most common ways to tell if you have BPH is an increase in the urge to urinate or waking up to urinate at night. This is due to the bladder being unable to completely empty itself. You may find yourself still feeling you have a full bladder after urinating, having a weaker flow of urine, having difficulty starting to urinate or having to force your urination. In certain cases, you might not be able to urinate at all, which is an emergency.
How we determine if you have BPH?
Determining if you have BPH is relatively simple and a few tests can be done to confirm this.
The first is a blood test known as the prostate-specific antigen (PSA) test. If you have a healthy prostate, PSA levels in your blood would be low. If your PSA levels are high, it is usually a sign that your prostate is abnormal.
Urinary tests such as a uroflowmetry or a post-void residual (PVR) volume test may also be used to ascertain if you have a reduced urine flow or urinary retention, respectively. Both of which are common in BPH cases.
In certain cases, the doctor may want to examine the prostate itself. An ultrasound of the prostate and the surrounding areas would be able to provide more information and may be done. Additionally, a scope called a cystoscope can also be inserted through the urethra to examine the urinary tract directly.
A physical examination of the prostate called a digital rectal examination (DRE) may also be done by your doctor. During the procedure, the patient is required to lie on their side and the prostate is felt for any abnormalities.
How is BPH treated?
Milder cases of BPH usually do not need to be treated and a routine examination by your doctor would suffice. Lifestyle changes such as avoiding the consumption of fluids before bedtime may also help reduce any discomforts associated with urination.
In moderate to severe cases, however, medical intervention would be required. Medications that help to relax or shrink the prostate may be prescribed to relieve the discomfort caused by BPH. This is usually an effective treatment for the initial stages of BPH.
When you do need surgery
If medications do not help with your BPH and your symptoms are severe affecting your quality of life or you are experiencing complications of BPH like repeated urine infections, bladder stones, bloody urine or retention, it is likely that your doctor would recommend a surgical procedure. Surgeries are a very effective treatment for BPH.
We recommend two highly effective procedures. The first is the transurethral resection of the prostate (TURP). Patients will be under anaesthesia and an apparatus known as a resectoscope with an electrical loop at the end will be passed through the urethra. The loop is then used to cut the prostate tissue causing the obstruction, whilst sealing the blood vessels at the same time. The cut tissue is then flushed out of the body. The patient recovers comfortably after surgery with a 1-2 night hospital stay and is usually passing clear urine smoothly over the next 2 weeks by his next review.
The other option is a more recent innovation known as the photoselective vaporization of the prostate (PVP), which makes use of a high energy Greenlight Laser. Under anaesthesia, a scope along with the greenlight laser device is passed through the urethra to the prostate gland. Once there, the surgeon activates the laser and the released energy is absorbed by blood, causing the surrounding prostate tissue to vaporize and clearing the obstruction. As the tissue vaporizes, heat from the laser seals the blood vessels and minimizes bleeding. Greenlight laser is especially important for patients on anticoagulation blood thinners.
Why should you choose Dr Colin Teo to perform your BPH treatment?
Dr Colin Teo is a respected ex-founding Head of Urology Department with year’s of experience in minimally invasive key-hole surgery operating with precision surgical techniques and has trained many of his trainees and fellows. He did a Fellowship in EndoLaparoscopy and Andrology in St James’s Hospital in Leeds, UK, and was sponsored for a Senior Healthcare Medical Development Program (HMDP) in Advanced Laparoscopic and Robotic Surgery in University of Southern California (USC) Keck Hospital in Los Angeles, USA.
Dr Teo was a co-author in the Urological Association of Asia BPH Consensus Committee and was involved in the Singapore Urological Association BPH Guidelines and also the Society for Men’s Health Better Prostate Health Guidelines committee. He also piloted and published the ePOD (early post-operative discharge) Prostate Bipolar Surgery Study that translated bipolar prostate surgery technology to shorter hospitalization and catheter dependence in peer reviewed journals that has since changed the clinical practice in his department and was invited for presentations for his BPH work in regional and international conferences.