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Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia (BPH) is one of the most common urological diseases for aged males. International medical statistics show that  one in three men aged 50 or above suffer from the disease, whereas the prevalence is as high as 90 percent for those aged 80 or above.1 Although no formal survey has been conducted locally in Hong Kong, there is a direct positive correlation between risk and age.2 80% of the men experience BPH in their lifetimes, with 30% of them requiring surgery.2

 

Among middle-aged males, the prostate may begin to grow in size and this is a normal physiological change. However, in the majority of cases, the enlargement of tissue often constricts the urethra, causing urethral traction and thereby obstructing the normal flow of urine. Medical practitioners refer to these symptoms as Benign Prostatic Hyperplasia, or BPH. As the condition in itself results in no immediate harm, it is deemed a benign disease whose cause remains unknown from a medical perspective.

 

Broadly speaking, patients display the following symptoms of BPH:

  • urinary hesitancy instead of immediate urine discharge
  • intermittent or slow stream of urine flow and unable to empty the bladder immediately
  • urge incontinence, i.e. loss of control over urination and sudden compelling urge to urinate
  • post-micturition dribbling
  • frequent urination (polyuria), especially an increased need to urinate at night (nocturia)
  • a sense of incomplete voiding

These symptoms alone, though, are not sufficient to conclude the diagnosis of Benign Prostatic Hyperplasia, as they are also common symptoms of other urological disorders. In case of any doubt, please consult your urologist as soon as possible!

 

In general, treatment for Benign Prostatic Hyperplasia comes in two forms: medication and surgery. Physicians will advise the most appropriate therapy in accordance with the conditions of the individual patient. Drugs such as alpha-blockers directly relax the urethra and prostate muscle, easing urethral pressure and facilitating micturition. Common side effects of alpha-blockers are dizziness, upset stomach and orthostatic hypotension. Thanks to the medical advancement, the latest generation of alpha-blockers is now able to alleviate these common side effects considerably. 5-alpha-reductase inhibitors (5-ARI), the other class of medicine for BPH, are able to reduce an enlarged prostate but at a slower pace. It normally requires a consecutive six-month therapy to be effective. Moreover, 5-ARI treatment might be more effective in patients with an enlarged prostate and not to those who have developed the symptoms without presenting an enlarged prostate. The side effects of 5-alpha-reductase inhibitors include loss of libido, erectile dysfunction and less seminal fluid.

 

Should symptoms worsen, surgery might be necessary to remove the enlarged prostatic tissue. Other than transurethral resection of prostate (TURP), the primary operation performed, two newly introduced techniques include transurethral vaporization of prostate (TUVP) and green laser prostatectomy, all classified as minimal invasive surgery. The kind of surgical techniques significantly reduce blood loss during the operation procedure due to smaller surgical incision, leading to shorter hospitalization time.

 

Reference:

1. Nguyen, DQ et al. (2006) BJU.

2. Okada, H et al. (2000) BJU.

 

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