Our Services

Benign Prostatic Hyperplasia (BPH)

Urology

Benign Prostatic Hyperplasia (BPH), also known as prostate enlargement, is a common condition in men characterized by symptoms such as difficulty urinating and frequent urination. It requires attention to treatment and lifestyle improvements.

Symptoms

According to statistics, about half of patients with benign prostatic hyperplasia (BPH) may not have any symptoms. As for those with symptoms, common signs include:

Frequency: The need to urinate more often.
Urgency: The need to find a restroom immediately.
Nocturia: The need to urinate multiple times during the night.
Weak urine stream: Reduced force in the flow of urine.
Urinary retention: Difficulty in completely emptying the bladder.

In severe cases, the bladder may be unable to void, leading to lower abdominal swelling and pain.

Factors

The exact cause of benign prostatic hyperplasia (BPH) is not fully understood, but age and changes in male hormone levels are the main influencing factors. As men age, the levels of the male hormone testosterone increase, which may lead to the proliferation of prostate cells.

Risk factors include:

Age	As age increases, the risk of developing benign prostatic hyperplasia also increases. In Hong Kong, over half of men aged 60 or above are affected, and for men over 80, 90% are patients.
Family History	If there is a family history of benign prostatic hyperplasia, the risk of developing the condition may be higher.
Race	The risk of benign prostatic hyperplasia is relatively lower in Asian men, while it is higher in African-American men.
Lifestyle	Unhealthy lifestyle habits, such as lack of exercise and poor dietary habits, may also influence the risk of developing the condition.

International Prostate Symptom Score (IPSS)

The American Urological Association proposes the International Prostate Symptom Score (IPSS). It is used as a self-assessment to determine the presence of benign prostatic hyperplasia (BPH) and its severity.

Criterion		Not at all: 0 Very few: 1 Less than half: 2 About half: 3 More than half: 4 Almost always: 5	Score
Urination condition	Weak Stream	Slow and weak urine stream
	Straining	Requires abdominal force during urination
	Intermittency	Intermittent urine flow during urination
	Incomplete Emptying	A feeling of incomplete emptying of the bladder after urination

Symptoms of urinary retention	Frequency	Need to urinate again within two hours after urination
	Urgency	Intolerable urgency to urinate immediately
	Nocturia	Waking up several times to urinate during the night after falling asleep
			Total Score
🙂Mild：0-7 🥶Moderate：8-19 🤢Severe：20-35			Total Score

Diagnosis

The medical diagnosis of benign prostatic hyperplasia includes:

Medical History	This includes a detailed description of symptoms and other possible related conditions.
Digital Rectal Examination (DRE)	A preliminary diagnosis of prostate abnormalities is made as the doctor inserts a finger into the rectum to feel the prostate.
Blood Tests	Conditions like benign prostatic hyperplasia (BPH), prostatitis, urinary tract infection, or prostate inflammation can cause an elevated Prostate-Specific Antigen (PSA) level in the blood.
Uroflowmetry	This test examines the speed of urine flow during urination to understand the voiding function of the bladder and urethra.
Ultrasound	It assesses the size and shape of the prostate and the residual urine volume in the bladder to diagnose the presence of benign prostatic hyperplasia.

Treatment

The treatment methods for benign prostatic hyperplasia (BPH) include the following:

Watchful Waiting: Doctors may recommend regular observation and monitoring for patients with mild symptoms to ensure that symptoms do not worsen. It typically involves regular medical check-ups and assessments.

Medication Therapy: Doctors may prescribe medications such as α-1 receptor blockers, 5α-reductase inhibitors, or combination drugs to alleviate symptoms. These medications can slow down the enlargement of the prostate and relieve urinary symptoms.

For moderate to severe Benign Prostatic Hyperplasia (BPH), when medication is insufficient to control the condition, doctors may recommend minimally invasive surgical procedures. Common options include:

Minimally Invasive Surgical Procedures for BPH

Prostate Steam Thermal Therapy (Rezum): Utilizes steam-generated heat to destroy overgrown prostate tissue.
Prostatic Urethral Lift (UroLift): Employs permanent implants to lift and hold the enlarged prostate tissue outward, expanding the urethra.
Aquablation Therapy: It uses high-pressure water jets, guided by imaging, to precisely remove overgrown prostate tissue.
Bipolar or Holmium Laser Enucleation of the Prostate (HoLEP): Employs electrosurgical or laser energy to enucleate and remove excessive prostate tissue.
GreenLight Laser Therapy: Vaporizes overgrown prostate tissue using a specialized green laser.
Prostatic Artery Embolization (PAE): It involves blocking blood flow to the prostate by embolizing its arteries, causing the gland to shrink and relieve pressure.
Open Surgery: For very severe cases, an open prostatectomy may be necessary to remove the prostate tissue.

Comparison and Selection

Procedure	Invasiveness	Recovery Time	Impact on Sexual Function	Suitable Candidates
Prostate Steam Thermal Therapy (Rezum)	Low	Short	Minimal	Patients with mild to moderate BPH
Prostatic Urethral Lift (UroLift)	Low	Short	Very minimal	Younger patients with a need to preserve sexual function
Aquablation Therapy	Moderate	Moderate	Minimal	Patients with medium to large prostate size
Bipolar / Holmium Laser Enucleation (HoLEP)	Moderate	Moderate	Possible impact on ejaculation	Moderate to severe BPH, especially with large prostate
GreenLight Laser Vaporization	Low	Short	Minimal	Small prostates or patients with bleeding risks
Prostatic Artery Embolization (PAE)	Low	Short	Almost none	High-risk patients or those unsuitable for anaesthesia
Open Surgery	High	Long	Possible impact on ejaculation	Very large prostates (>80g), or patients with bladder stones