Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland. The word “benign” means the prostate cells are not cancerous.

 

“Hyperplasia” means an increased number of cells. It is common for the prostate gland to become enlarged as a man gets older. The prostate gland encircles the urethra, so problems with urination can occur if the gland restricts urine flow through the tube.

As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. There is strong association between BPH symptoms and erectile dysfunction.

 

 

Professor Chung is the Chair of Male Lower Urinary Tract section for the Urological Society of Australia and New Zealand. He has published extensively on various male urinary conditions including prostatic diseases (see below) and is considered the leading surgeon expert in Australia in this field.

He is the only surgeon in Australia invited to serve on working group on the male sexual health, lower urinary tract and pelvic floor dysfunction at the International Continence Society, and serves as committee member on the male surgery for urinary incontinence at the International Consultation on Incontinence. He has mentored many surgeons over the years and organised numerous surgical workshops around the world.

Some problems associated with BPH are

  • Urinating more often during the day and night (urinary frequency)
  • Urinary urgency, which means the urge to urinate is so strong and sudden, you may not make it to the toilet in time
  • Poor urine stream and terminal dribble towards the end
  • A sensation that the bladder isn’t fully emptied after urination
  • The sensation of needing to go again a few minutes after urinating
  • Urinary retention
  • Hematuria (bleeding in urine)
  • Urinary tract infection

Diagnosis

You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine check-up. The various tests for BPH include blood tests (e.g. PSA test), renal tract ultrasound, urodynamic study and cystoscopy examination.

 

Treatment options

  1. Conservative treatment
    If the person has BPH but is not bothered by the symptoms, you and your doctor may decide to simply wait and monitor the condition regularly. This option requires regular check-ups with your doctor – usually once a year – to see if the condition is getting any worse. Your doctor may advice you some lifestyle changes to minimise your symptoms.

  2. Drug Therapy
    Your doctor may advise drug therapy which aims at relaxing or shrinking the enlarged prostate. The doctor will select the medication that best suits your condition, keeping in mind your general health condition, medical history, and your quality-of-life considerations.

  3. Surgery
    Surgery is another option for the treatment of BPH. The most common type of surgery for BPH is TURP (TransUrethral Resection of the Prostate). A TURP can be performed with electrical cautery or laser, and is effective at relieving symptoms quickly. Nowadays, there are several effective minimally invasive prostate surgical options such as prostatic urethral lift (UroLift®) and Rezum®. Professor Chung will discuss with you the pros and cons of each therapy.

Some of the key articles published by Professor Chung on BPH

  • Chung E, Ng BHS, Wang J, Can malleable penile prosthesis implantation improve voiding dysfunction in men with concurrent erectile dysfunction and buried penis? Investig Clin Urol. 2021;62(3):305-309
  • Ng BHS and Chung E. A state-of-art review on the preservation of sexual function among various minimally invasive surgical treatments for benign prostatic hyperplasia: Impact on erectile and ejaculatory domains. Investig Clin Urol. 2021;62(2):148-58
  • Chung E, Lee D, Gani J, Gillman M, Maher C, Brennan J, Johns Putra L, Ahmad L, Chan L. Position statement: a clinical approach to the management of adult non-neurogenic overactive bladder. Med J Australia 2018;208(1):41-45
  • Morton A, Williams M, Perera M, Teloken PE, Donato P, Ranasinghe S, Chung E, Bolton D, Yaxley J, Roberts MJ. Management of benign prostatic hyperplasia in the 21st century: temporal trends in Australian population-based data. BJU Int. 2020;126 Suppl 1:18-26
  • Katz DJ, Love C, Kim SHK, Barrett T, Spernat D, Chung E. For men’s problems, we need a women’s approach: equality in treatment care planning. BJU Int. 2020;126 (Suppl.1):46-47
  • Chung E, Katz DJ, Love C. Adult male stress and urge urinary incontinence- A review of pathophysiology and treatment strategies for voiding dysfunction in men. Aust Fam Physician. 2017;46(9):611-666
  • Katz DJ, Love CJ, Chung E. Lower urinary tract symptoms and benign prostatic hyperplasia: old problems, new solutions. Medicine Today. 2016;17(11):14-25
  • Chung E. Stem-cell-based therapy in the file of urology: A review of stem cell basic science, clinical applications and future directions in the treatment of various sexual and urinary conditions. Expert Opin Biol Ther. 2015;15(11):1623-32
  • Chung E. Underactive bladder and detrusor underactivity: A review of pathophysiology and management strategies for this poorly understood bladder syndrome. Curr Bladder Dysfunct. Rep. 2014;9(3):250-53
  • Chung E. Medical treatments of overactive bladder: Current and future therapeutic applications. In: Urinary Incontinence: Causes, Epidemiology and Treatment. Nova Science Publishers, Inc, NY
  • McKenzie I and Chung E. Overactive bladder and benign prostatic hyperplasia: Pathophysiology, diagnosis and treatment. In: Urinary Incontinence: Causes, Epidemiology and Treatment. Nova Science Publishers, Inc, NY