Why do some men find it hard to pee? An enlarged prostate could be the problem - Channel NewsAsia

Patients with high degrees of obstruction may even develop urinary tract infections and bladder stones, said Dr Thiruchelvam Jegathesan, a consultant with Tan Tock Seng Hospital's Department of Urology.

"The exact reason for BPH is not known but is postulated to be related to age and male hormones causing a proliferation of the prostate cells," he said. "Typically, BPH can happen after 50 years old and it becomes more prevalent with age."

A study done in Singapore supports the age link that Dr Jegathesan mentioned. As the population ages, the incidence of local patients with moderate to severe BPH symptoms has been increasing – from 10 per cent in 1997 to 14 per cent in 2005, and 16.5 per cent in 2012.

Greater awareness of BPH could have also led to a higher incidence rate recorded over the years, said Dr Fiona Wu, a consultant urologist with Aare Urocare. "Generally, more people are aware of the condition and seeking professional advice earlier. In fact, some of the male patients have seen how their elderly fathers suffered from BPH and are more likely to seek help early," she said.

WHAT ARE THE TREATMENT OPTIONS?

Since an enlarged prostate is the root of the trouble, the treatment generally focuses on removing or shrinking the organ, or widening the constriction for urine to flow through better. Most options involve minimally invasive procedures that can be performed "through an endoscope inserted through the urethra", said Dr Wu. "A urinary tube (catheter) to drain urine is usually required post-surgery."

The not-so-good news is, prostate enlargement and its accompanying urinary issues can recur after treatment. "Sometimes, the urologist may use different methods to treat BPH recurrence such as medical treatment or another surgical option depending on the situation and the patient's age and fitness level," said Dr Wu.

Here's a look at the treatment options available and how they work.

• The gold standard: Transurethral resection of the prostate (TURP)

An instrument called a resectoscope is inserted into the urethra to reach the prostate. The resectoscope is like a multi-function Swiss Army knife that has a light, camera and tool that uses electric current to cut, remove, or destroy tissue and control bleeding. TURP may be performed under general or regional anaesthesia, said Asst Prof Chua Wei Jin, a senior consultant with the Department of Urology at National University Hospital.

This is the "gold standard surgery that revolutionised BPH surgery", said Dr Colin Teo, a senior consultant urologist with Gleneagles Hospital. And unlike the other methods, TURP allows tissue samples to be taken to test for cancer, he said.

However, TURP has "up to 70 per cent risk of ejaculatory dysfunction, which may concern younger sexually active men", said Dr Jegathesan.

Who it's for: Patients with acute or chronic urinary retention, recurrent urinary tract infections, bladder stone, renal insufficiency, large bladder diverticulum/diverticula and/or failed medical therapy.