Published: Sunday December 8, 2013 MYT 12:00:00 AM
Updated: Sunday December 8, 2013 MYT 9:17:45 AM

Treating enlarged prostates

A diagram illustrating TURP, the gold standard in treating BPH.

A diagram illustrating TURP, the gold standard in treating BPH.

Men suffering from benign prostatic hyperplasia have a few options to manage their condition.

MANY men with enlarged prostates (benign prostatic hyperplasia, BPH) find their lives drastically changed after the lower urinary tract symptoms (LUTS), such as urgency or frequency of urination, incontinence or incomplete voiding, set in.

With such a fundamental routine becoming disrupted, many men stop going out for social activities because they worry about not having easy access to a toilet.

Or they may not sleep well at night because they keep waking up to urinate.

Fortunately, there are several types of therapies available to treat BPH and relieve those bothersome urinary symptoms.

Depending on the severity of their condition and their individual needs, men with BPH can choose from medications, minimally-invasive therapies, non-surgical therapies or herbal medicine.

Medical therapies

The three types of medications for BPH include alpha-1-adrenergic antagonists (alpha-blockers), 5-alpha reductase inhibitors (5-ARIs) and anti-muscarinics (if BPH is present with overactive bladder symptoms).

Alpha-blockers provide immediate relief and are useful for mild to moderate BPH, while 5-ARIs require long-term treatment and are more effective in men with larger prostates.

Alpha-blockers relax the smooth muscle in the bladder neck, prostate capsule and prostatic urethra, therefore, making it easier for the urine to flow.

The main side effect from certain alpha-blockers is dizziness, due to your blood pressure dropping suddenly when you stand up from a lying-down position. Other common side effects are weakness, blocked nose and retrograde ejaculation.

Meanwhile, another type of medication, 5-ARIs, reduce the size of the prostate. They need to be taken for six to 12 months before the prostate shrinks and symptoms of BPH improve.

Two types of 5-ARIs, finasteride and dutasteride, are able to significantly reduce the need for surgery and lower the risk of acute urinary retention.

However, these drugs can cause adverse side effects, such as lowered libido and erectile dysfunction (ED).

Men who do not find either alpha-blockers or 5-ARIs to be as effective as desired, may choose to be treated with a combination of both medications.

Finally, men who have BPH together with symptoms of an overactive bladder, including frequency, urgency, and incontinence, may find relief with anti-muscarinics.

These medications act on the smooth muscle to reduce involuntary bladder contractions.

Minimally-invasive therapies

Although oral medications are generally safe and effective to treat BPH, some men may find that these are not adequate to treat their condition.

This is when minimally-invasive surgical techniques may be more appropriate.

Prostate procedures may be recommended if you have incontinence, recurrent blood in the urine, inability to fully empty the bladder, recurrent urinary tract infections, kidney failure, bladder stones, and/or do not respond to medications.

Transurethral resection of the prostate (TURP) is currently the gold standard for the treatment of BPH.

TURP involves removing prostatic tissue from within the urethra to enlarge the passage for urine to flow through. It has a good outcome, and generally, very low complication rates.

Another procedure, called transurethral incision of the prostate (TUIP), involves putting a scope into the bladder via the urethra, and widening the bladder neck and prostatic urethra.

TUIP is more suitable for men who do not have very enlarged prostates.

It takes a shorter time, and there is a lower risk of requiring blood transfusion, but it has a significantly higher re-operation rate compared to TURP.

Choosing which procedure to undergo also depends on whether your age and health status allows you to tolerate long surgical procedures.

Non-surgical therapies

Alternative therapies are available for men who do not find surgical procedures suitable for their condition.

The transurethral needle ablation (TUNA) and transurethral microwave thermotherapy (TUMT) are aimed at shrinking the prostate, while prostatic stents improve urinary flow.

Prostatic stents are recommended for elderly, frail men with multiple co-existing conditions, for whom more invasive procedures requiring general anaesthesia are not suitable.

TUNA and TUMT are procedures that can be done under local anaesthesia in the clinic and do not require a hospital stay.

However, these procedures do not produce the kind of results and long-term outcome TURP does.

There are also laser procedures to reduce the size of the prostate through coagulation, vapourisation, enucleation or resection of the prostate.

However, overall, laser vapourisation, enucleation and resection have higher rates of post-operative pain and dysuria (painful urination), compared to other methods.

Herbal therapies

Many men who have been diagnosed with BPH will seek out herbal supplements from their doctor, pharmacy or Chinese medicinal stores.

Some men do not even see their doctor when they suffer from urinary problems, preferring to self-medicate with herbs instead.

Herbal therapies for prostate problems are quite common, including saw palmetto, the bark of the African plum tree, stinging nettle roots, South African star grass and rye pollen.

Saw palmetto is the most popular herbal therapy among men with LUTS.

However, more and more scientific studies are showing that saw palmetto has no benefits in the treatment of BPH.

The only advantage of this herb is its safety, as there are hardly any side effects or drug reactions from consuming it.

The most important thing to remember about herbal therapies is not to stop prescribed therapy without consulting your doctor, or to consume supplements sold by dubious manufacturers.

Always talk to your doctor and discuss why you want alternative treatment, and what your concerns are with mainstream therapy.

For more medical information, you may want to read the newly-published Men’s Health and the Prostate by the Malaysian Men’s Health Initiative (MMHI). Members of the MMHI include Prof Dr Tan Hui Meng, Prof Dr Ng Chirk Jenn, Prof Dr Low Wah Yun, Prof Dr Khoo Ee Ming, Assoc Prof Dr Tong Seng Fah, Dr Verna Lee Kar Mun, Dr Lee Boon Cheok, Prof Dr George Lee Eng Geap, Assoc Prof Dr Zulkifli Md. Zainuddin, Assoc Prof Christopher Ho Chee Kong, Assoc Prof Dr Ong Teng Aik, Dr Yap Piang Kian and Dr Goh Eng Hong. For more information, e-mail The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.

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