Introduction: What is the prostate?

The prostate is a gland in the male reproductive system which has the main function of making a fluid to nourish and transport sperm. This fluid makes up part of semen and hence, is imperative for a man’s fertility. The urethra is positioned in between the bladder and the penis as seen in the diagram below.

What is Benign Prostate Hyperplasia (BPH)?

Benign prostatic hyperplasia is the non-cancerous enlargement of a man’s prostate gland as men get older. It is a common occurrence as men age and is the most common urological condition in Singapore.

There are 2 main growth periods that the prostate goes through. The first growth period occurs early in puberty, when the prostate doubles in size. The second phase of growth begins in the mid-twenties and continues throughout a man’s lifetime. This condition often occurs during the second growth period.

Why does BPH have to be treated?

BPH is not a serious condition but may cause complications if not taken care of. As the prostate grows, it squeezes the urethra and the bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty all the urine completely. The uncomfortable urinary symptoms would go on to cause the symptoms of BPH.

Symptoms of BPH

Symptoms for BPH vary for each individual depending on their severity. A more enlarged prostate does not equate to more severe symptoms. At times, symptoms may stabilise and improve over time.

Common symptoms include:

• Frequent or urgent need to urinate
• Increased frequency of urination at night (nocturia)
• Difficulty starting urination
• Weak urine stream or a stream that stops and starts
• Dribbling at the end of urination
• Inability to completely empty the bladder

Less common signs and symptoms include:

• Urinary tract infection
• Inability to urinate
• Blood in the urine

At the advanced stage, symptoms may lead to urinary stones or kidney damage. If BPH becomes serious, one might not be able to pass urine at all. This has to be treated immediately.

Cause of BPH

The exact cause of BPH is not known as of yet but is said to be linked to aging. It is thought that hormone changes play a role as well.

Who’s at risk?

Certain factors do put an individual at a higher risk of developing BPH. Some of these factors include:

• Men aged 40 years and older
• Having a family history of BPH
• Being diagnosed with medical conditions such as diabetes and heart disease
• Lack of an active lifestyle
• Erectile dysfunction
• Men who are obese or overweight

How is BPH diagnosed?

BPH is diagnosed by a healthcare provider through three primary methods:

• Taking one’s personal and family medical history
• A physical examination
• Medical tests

1. Taking one’s personal and family medical history

This is one of the first things used to help diagnose BPH. Questions asked may include:

• What symptoms are observed?
• When did the symptoms begin and how often do they occur?
• Do you have a history of recurrent Urinary Tract Infections?
• What medications do you take (both prescription and over the counter)?
• How much water do you drink a day?
• Do you consume caffeine and alcohol?
• Questions regarding his general medical history, including any significant illnesses or surgeries

2. Physical examination

The healthcare provider would examine the patient’s body, which can include checking for

• discharge from the urethra
• enlarged or tender lymph nodes in the groin
• a swollen or tender scrotum

A digital rectal exam is often performed as well. During this examination, you lie on your side or bend over. The doctor inserts a finger into your rectum to feel the prostate gland to look for growth, tenderness, lumps or hard spots. (Diagram below is a visual representation of the procedure)

3. Medical Tests

A urologist would use medical tests to help diagnose lower urinary tract problems related to BPH and recommend treatments.

Urinalysis

This procedure involves testing a urine sample. A strip of chemically treated paper is placed into the urine. Patches on the dipstick would change color to indicate signs of infection in urine.

Prostate-Specific Antigen (PSA) blood test.

Blood will be drawn for a PSA test by a healthcare provider. Prostate cells create a protein called PSA and BPH often causes high PSA levels.

Urodynamic tests

Urodynamic tests observe how well the urine is stored and released by the bladder and the urethra. Urodynamic tests may include the following:

• uroflowmetry → measures the rate of flow of the bladder releasing urine
• post void residual measurement → surveys how much urine remains in the bladder after urination

Reduced urine flow or residual urine in the bladder often suggests urine blockage due to benign prostatic hyperplasia.

Cystoscopy

Cystoscopy is a procedure which uses a cystoscope to look inside the urethra and bladder. The cystoscope is inserted through the opening at the tip of the penis and into the lower urinary tract. Patients are usually given local anesthesia but in some cases, the patient may require sedation and regional or general anesthesia.

Transrectal ultrasound

Transrectal ultrasound uses a device, called a transducer, to bounce sound waves off organs to create an image of their structure. In a transrectal ultrasound, a transducer is inserted into the man’s rectum, next to the prostate. The ultrasound image will then show the size of the prostate and any abnormalities.

Biopsy

A biopsy is a procedure that involves taking a small piece of prostate tissue for examination. Light sedation and local anesthesia is given to the patient but in some cases, some patients will require general anesthesia. The urologist uses imaging techniques to guide the biopsy needle into the prostate. The prostate tissue is then examined in a lab.

If you feel that you have symptoms of an enlarged prostate leading to BPH, consult a medical doctor for advice and treatments will be recommended if the symptoms become too uncomfortable.

For more information or if you require a medical consultation, please contact My Healthcare Collective here.