Dr Lie Kwok Ying
Source: Getty Images and Shutterstock
Are you frustrated by a frequent need to urinate, and having to wake up multiple times at night to do so? Or know someone who is? This article has a potential solution to the issue.
Chances are, benign prostate hyperplasia (BPH) is the cause of these inconveniences. This refers to the enlargement of the prostate gland that commonly affects men as they age. Unfortunately, it can come with a host of symptoms that may interfere with daily life.
Read on as Dr Lie Kwok Ying, urologist at Mount Elizabeth Novena Hospital, shares how minimally invasive treatments such as HoLEP and ThuFLEP can help address BPH.
BPH refers to the enlargement of the prostate gland.
Located just below the bladder, the prostate is a gland of the male reproductive system and contributes to the production of semen as well as its ejaculation from the body.
The prostate is one of the only organs that keeps growing as a man ages. As it grows, the enlarged prostate can start placing pressure on the bladder and urethra and choke off the urinary tract, thus leading to urinary symptoms.
Did you know? An enlarged prostate is one of the only organs in the human body that keeps on growing. A man's prostate is about the size of a walnut when he is in his 20s. When a man turns 60, it may develop to the size of a lemon!
BPH symptoms include the following:
Almost all the modern surgical treatments for BPH are done via the urinary tract and do not involve any incisions.
However, the term "minimally invasive treatment" in this case usually refers to treatments done with minimal anaesthesia, as an outpatient or day surgery procedure, and generally involves a quicker recovery.
Several minimally invasive procedures are available at the IHH Healthcare hospitals in Singapore for BPH and they can help to relieve the pressure that an enlarged prostate places on the urethra.
One of these procedures involves the use of permanent physical implants to retract the prostate, thereby relieving pressure on the urethra. Another involves targeting steam energy at enlarged prostate cells to enable its shrinkage.
These minimally invasive treatments as well as the others we have available all have the advantage of preserving a man’s ability to ejaculate normally. However, there may still be a need for surgical treatment at a later point in life.
HoLEP stands for Holmium Laser Enucleation of the Prostate and ThuFLEP stands for Thulium Fibre Laser Enucleation of the Prostate.
These forms of treatment involve using a laser to cut (enucleate) the prostate tissue constricting a patient's urethra. At the same time, the heat from the laser is used to close the blood vessels. Hence, this is why only a small amount of blood is lost during this type of surgery. The second part of the surgery, called morcellation, involves using surgical equipment to retrieve the prostate tissue from the bladder.
This can be achieved using either laser system, the Holmium Laser in HoLEP or the Thulium Fibre Laser in ThuFLEP. The choice of the laser depends on the expertise of your doctor and what is available in the hospital where the treatment is taking place.
The key difference between the two treatments lie in the type of laser system used. Studies do not show significant differences in clinical outcomes between the two treatments at the moment.
The benefits of laser enucleation treatments with HoLEP and ThuFLEP include the following:
It is however, important for patients to discuss their individual situations and conditions with their doctor.
The most common side effect of laser enucleation is temporary urinary incontinence. This may last anything from a few weeks to a few months but invariably gets better with time.
Other temporary side effects include: painful urination, blood in the urine, urgency or frequency in urination and urinary tract infection. When in doubt about the side effects you are facing, consult your doctor.
Even though the lasers are very effective in arresting bleeding vessels, there is still a small risk of a significant bleed. If a patient notices their urine colour appears like red wine after surgery, they should seek medical attention.
I would advise patients who had prostate surgery to drink more fluids immediately in the first week or two after surgery. Fluids should not only be restricted to water. Isotonic drinks and coconuts can also be consumed as they also help to replace the electrolytes lost during treatment.
Patients are also advised to avoid strenuous exercises such as cycling, or heavy weight lifting (>5kg). They should also try to modify their diet to be higher in fibre so as to avoid constipation. We also advise avoiding sexual activities for 2 to 3 weeks after surgery.
It is also important to discuss with your doctor when to restart blood thinning medication such as aspirin.
Screening for prostate cancer is done by doing a blood test called prostate-specific antigen (PSA), which can offer insights into any prostate concerns, such as an enlarged or inflamed prostate, or prostate cancer.
Both prostate cancer and BPH seems to run in some families, which suggests that in some cases there may be an inherited or genetic factor. Screening can pick up conditions at an early stage so treatment can have better outcomes.
With up to 50% of men over the age of 50 and up to 80% of men over the age of 80 experiencing lower urinary tract symptoms (LUTS) from BPH, I would advise men experiencing LUTS to consult a urologist.