Benign prostate hyperplasia (BPH) therapy
New minimally invasive BPH therapy improves urinary function with quick recovery time and minimal sexual adverse effects
The transurethral resection of prostate (TURP) is regarded as the standard surgical care for men with persistent (medical-refractory) BPH symptoms. The TURP can be performed using electrical current or laser vaporisation. However, in recent times, there is increased emphasis on the preservation of sexual function following BPH therapy. Contemporary minimally invasive BPH therapies have been shown to improve various parameters in voiding domains with minimal recovery time, while minimizing adverse effects in erection and ejaculation functions.
Professor Chung has published extensively on BPH surgery (see below) and is the Chair of the male lower urinary tract symptoms for the Urological Society of Australia and New Zealand. He is considered the leading international surgeon expert in male voiding dysfunction and is the only surgeon from Australia and Asia-Pacific invited to serve on the male surgery for urinary incontinence committee at the International Consultation on Incontinence, the peak body for International Continence Society. He has mentored many surgeons over the years including invitation as surgeon expert at various hospitals and surgical workshops around the world.
What preparation is required?
BPH surgery can be often performed under general or spinal anaesthesia. You should be fasted (nothing to eat or drink) for 6 hours prior to surgery. Regular medications can be taken with a sip of water and depending on the type of your BPH surgery, you may need to stop blood thinning agents (such as warfarin, clopidogrel) or non-steroidal anti-inflammatory drugs a few days before your surgery. A mid stream urine (MSU) test is required to ensure the urine is sterile before treatment is undertaken.
What happens in the operating room?
You will meet Professor Chung and your anaesthetist prior to surgery. Your procedure will be performed under general or spinal anaesthesia with appropriate anti-microbial cover.
What are the risks?
Common complications involve:
- Pain when pass urine (dysuria from urinary catheterisation)
- Blood in urine
- Urinary urgency and persistent or recurrent urinary symptoms
- Temporary urinary retention
- Decreased or absent of ejaculate volume
Potential serious complication include
- Urinary incontinence
- Sexual dysfunction
- The need for additional surgery related to bleeding or prostate regrowth
What to expect afterwards?
The timing of discharge from hospital is largely dependent on the types of BPH surgery and whether you have any issue passing urine after surgery. When you are comfortable and passing urine satisfactory, you will be discharged with appropriate oral antibiotics. At home you should rest and avoid strenuous physical exertion for 4-6 weeks. You are encouraged to take regular bowel aperients to soften your bowel motion and prolonged squatting is discouraged as it will potentially loosen the sling.
You will have a follow-up visit with Dr Chung scheduled at 4-6 weeks postoperatively.
Some of the key articles published by Professor Chung on BPH surgery
- 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