Enlarged prostate treatments that won’t affect your sex life

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As men get older, many will experience urination issues due to an enlarged prostate. This is a common condition known as Benign Prostatic Hyperplasia (BPH). At age 40, 8 per cent of men have BPH. By the time men hit 60 years of age, one out of two have BPH, according to the Singapore Urology Association clinical guidelines for BPH 2017.

A prostate that is larger than usual puts pressure on the urethra, which can cause uncomfortable symptoms, such as an urgent or frequent need to urinate, increased frequency of urination at night, and difficulty starting urination. Other symptoms include a weak urine stream or a stream that stops and starts, dribbling at the end of urination, or the inability to completely empty the bladder. This can affect quality of life, especially in cases where you have to get up several times at night to pee.

Dr Tan Yung Khan, a senior consultant urologist and medical director of Urohealth Medical Clinic, says genetics accounts for the majority of BPH cases, but it can also be associated with diabetes, obesity and a diet high in fat.

Advancements in treatment options  

Drugs and surgery are two ways to treat BPH. Drugs are often the first line of treatment. They relax the bladder neck muscles and muscle fibres in the prostate, making urination easier. Known as alpha blockers, they are effective in patients who suffer from severe enlarged prostate conditions, but they often need to be taken for life. Side effects include headache, constipation, hypotension, and retrograde ejaculation. According to Dr Tan, another type of medication, known as 5 alpha reductase inhibitors, can partially reduce the size of the prostate by reducing testosterone activity, but this may also result in erectile dysfunction, fatigue and enlargement of the breast. 

Surgery is another way used to treat BPH. Traditional surgery, known as a transurethral resection of the prostate (TURP), removes excess prostatic tissue through the penis. Its potential side effects include sexual dysfunction, urinary tract infection, heavy bleeding, incontinence, and retrograde ejaculation, where semen goes backward into the bladder during orgasm, leading to little or no semen being ejaculated.

Some men who have problems with an enlarged prostate avoid seeing a doctor as they worry about side effects from traditional surgery or being on long-term medication. Others may dismiss BPH symptoms as signs of ageing.

However, left on its own, BPH could get harder to treat. Dr Tan says: “The bladder could be further damaged. And the more serious the condition, the longer and harder the recovery is likely to be.

“Severe cases may even end up on long-term catheterisation,” he adds. Catheterisation involves inserting a tube known as a catheter in the bladder to drain urine.

The good news is that advances in the field in recent years have meant that minimally invasive procedures are now available to treat the condition effectively without any troubling side effects. 

“Some men still do not know that there are newer minimally invasive therapies that do not affect sexual function,” says Dr Tan.  

“There is thus a need for more education on the many minimally invasive treatment options now available,” he adds.



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