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Benign Prostate Hyperplasia (BPH) In singapore

Your full medical check up comes complete with physician consult, results explanation and lifestyle recommendations, in person or over our teleconsult platform.

Dr Tan Teck Wei

Senior Consultant Urologist

MBBS|DFD (CAW)|MRCS|MMed (Surgery)|FAMS (Urology)

Diagnose and Treat

Overview Symptoms Treatment Options Prevention FAQ

What is Benign Prostatic Hyperplasia (BPH)?

Benign Prostatic Hyperplasia is a non-cancerous enlargement of the prostate gland that commonly occurs as men age. The prostate, a walnut-sized gland located below the bladder and surrounding the urethra, gradually increases in size over time. As the prostate enlarges, it can compress the urethra and affect normal urine flow, leading to various urinary symptoms.

In Singapore, studies show that approximately 50% of men in their 50s and up to 90% of men over 80 have some degree of BPH. Despite its prevalence, many men delay seeking treatment due to embarrassment or the misconception that urinary problems are an inevitable part of ageing.

What are the Symptoms of Prostate Enlargement?

Mild Symptoms

Slightly increased urination frequency during the day
Occasional difficulty starting urination
Reduced force of urine stream
Minor dribbling after urination
Feeling of incomplete bladder emptying

Moderate Symptoms

Urgent need to urinate with little warning
Frequent urination (every 2 hours or less)
Waking 2-3 times nightly to urinate
Straining required to start urination
Intermittent or weak urine stream
Longer time needed to empty bladder

Severe Symptoms

Inability to urinate (acute retention)
Painful urination or blood in urine
Waking more than 4 times nightly
Frequent urinary tract infections
Bladder stones formation
Kidney function deterioration

BPH Treatment Options in Singapore

Lifestyle Modifications

Simple lifestyle adjustments such as reducing caffeine and alcohol intake, practising bladder training, and managing fluid consumption can alleviate mild symptoms.
Alpha Blockers

Alpha blockers like tamsulosin and alfuzosin work by relaxing the smooth muscles in the prostate and bladder neck, improving urine flow within days to weeks. These medications are typically the first-line treatment for moderate BPH symptoms. Most patients tolerate them well, although some may experience dizziness or reduction in the ejaculate volume. They provide symptom relief without shrinking the prostate.
5-Alpha Reductase Inhibitors

Medications such as finasteride and dutasteride reduce prostate size by blocking conversion of testosterone to DHT. These drugs work gradually over 3-6 months and are effective for larger prostates. They can reduce prostate volume by 20-30% and lower the risk of acute retention and need for surgery. Some men may experience decreased libido or erectile dysfunction with these medications.
Combination Therapy

Using both alpha blockers and 5-alpha reductase inhibitors provides improved symptom relief. This approach offers immediate symptom relief from alpha blockers while achieving long-term prostate size reduction. Studies show combination therapy reduces progression risk and need for surgery.
Anticholinergic And Beta-Agonist Medications

For patients with predominant irritative symptoms like urgency and frequency, anticholinergic or beta-agonist drugs may be added. These medications calm overactive bladder muscles but must be used cautiously in BPH as it can rarely result in urinary retention. Regular monitoring ensures safe, effective treatment.
Phosphodiesterase-5 Inhibitors

Medications like tadalafil, traditionally used for erectile dysfunction, also improve BPH symptoms. They work by relaxing smooth muscle and improving blood flow in the prostate and bladder. This dual benefit makes them attractive for men with both conditions.
Transurethral Resection of Prostate (TURP)

TURP remains the standard surgical treatment for BPH. Using a scope inserted through the urethra, excess prostate tissue is removed to create a wider channel. This procedure provides long-lasting symptom relief with success rates exceeding 85%. Most patients stay 1-2 nights in hospital.
UroLift System

This innovative procedure uses small implants to hold enlarged prostate tissue away from the urethra. Performed under local anaesthesia, UroLift preserves sexual function while improving urinary symptoms. Suitable candidates can return home the same day with minimal downtime.
Rezum Water Vapour Therapy

Rezum uses thermal energy from water vapour to reduce prostate tissue. This procedure takes under 20 minutes and preserves sexual function. Symptom improvement occurs gradually over 1-3 months as the treated prostate tissue is absorbed by the body.
iTind (Temporary Implantable Nitinol Device)

This is a minimally invasive procedure which involves the temporary insertion of a stent into the prostatic urethra for about a week. The stent will reshape the prostatic urethra tissue and improve urine flow. The stent is removed after a week, and the procedure preserves sexual function.

Types of BPH Presentation

Obstructive BPH

This type causes blockage symptoms due to physical compression of the urethra. Men experience difficulty starting urination, weak urine stream, and incomplete bladder emptying. The enlarged prostate tissue directly obstructs urine flow.
Irritative BPH

Characterised by bladder irritation symptoms including frequent urination, urgency, and nocturia (night-time urination). The bladder muscle becomes overactive in response to the obstruction, causing these symptoms.
Mixed BPH

Most patients experience a combination of both obstructive and irritative symptoms. This mixed presentation is the most common form seen in clinical practice and requires comprehensive management addressing both symptom types.
Complicated BPH

This occurs when untreated BPH leads to complications such as acute urinary retention, bladder stones, or kidney damage. Immediate medical intervention is necessary to prevent permanent damage.

Causes

The exact cause of BPH remains unclear, but several factors contribute to prostate enlargement:

Hormonal changes: Age-related shifts in testosterone and dihydrotestosterone (DHT) levels influence prostate growth.
Cellular growth: Increased proliferation of prostate cells in the transitional zone
Chronic inflammation: Long-standing prostatic inflammation may stimulate enlargement.
Genetics: A family history of BPH increases the likelihood of developing the condition.

Risk Factors

Age: Primary risk factor; rare before 40, common after 50
Family history: Men with relatives who have BPH face higher risk
Metabolic syndrome: Obesity, type 2 diabetes, and hypertension are linked to increased BPH risk
Lifestyle factors: Sedentary lifestyle and poor diet may contribute

When to See a Urologist

Immediate medical attention is necessary if you experience acute urinary retention (complete inability to urinate), blood in urine, severe pain during urination, or signs of kidney problems such as back pain with fever. These symptoms may indicate complications requiring urgent treatment.

You should consult a urologist if you notice progressive worsening of urinary symptoms, frequent night-time urination disrupting sleep, or any urinary symptoms affecting your daily activities and quality of life. Early evaluation helps as BPH symptoms can mimic other conditions including prostate cancer, bladder problems, or urinary tract infections.

During your first consultation, our urologist will conduct a comprehensive evaluation including medical history, symptom assessment using standardised questionnaires, physical examination and necessary diagnostic tests. This thorough approach ensures accurate diagnosis and appropriate treatment planning.

Complications If Left Untreated

Untreated BPH can lead to serious complications affecting overall health and quality of life. Acute urinary retention, the sudden inability to urinate, is a medical emergency requiring immediate catheterisation. This painful condition often necessitates surgical intervention.

Chronic retention and incomplete bladder emptying increase infection risk, leading to recurrent urinary tract infections and potential kidney infections. Bladder stones may form in stagnant urine, causing pain, bleeding, and further obstruction.

Long-term obstruction can cause bladder muscle damage, reducing its ability to contract effectively. In severe cases, back-pressure on the kidneys leads to hydronephrosis and potential kidney failure. Early treatment prevents these complications and preserves urinary tract health.

BPH Prevention

While BPH cannot be entirely prevented due to age and genetic factors, certain lifestyle modifications may reduce risk and slow progression. Regular physical exercise, particularly aerobic activity, helps maintain prostate health and reduces BPH risk. Studies show sedentary men face higher rates of moderate to severe symptoms.

Dietary changes including increased vegetable intake, reduced red meat consumption, and maintaining healthy weight may help. Limiting caffeine and alcohol, especially before bedtime, reduces irritative symptoms.

Regular medical check-ups enable early detection and intervention before symptoms become severe. Men over 50 should discuss prostate health with their doctor annually. Managing conditions like diabetes and hypertension helps reduce BPH progression risk.

Diagnosis & Testing Methods

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