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Benign Prostatic Hyperplasia (BPH) Treatment in Singapore

Benign Prostatic Hyperplasia (BPH), or enlarged prostate, is a common non-cancerous condition that affects urinary function in men, especially those over the age of 50. It can cause symptoms such as frequent urination, weak urine flow, and disrupted sleep. At our clinic, BPH is one of the most frequently managed conditions. Dr Tan provides thorough evaluation and evidence-based treatment tailored to each patient’s symptoms and prostate profile.

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Dr Tan Teck Wei

MBBS|DFD (CAW)|MRCS|MMed (Surgery)|FAMS (Urology)

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Types Causes Symptoms When to see a Urologist Diagnosis Treatment Complications & Prevention FAQ
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Types
Causes
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When to see a Urologist
Diagnosis
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Complications & Prevention
FAQ

What is Benign Prostatic Hyperplasia (BPH)?

Benign Prostatic Hyperplasia is a non-cancerous enlargement of the prostate gland that commonly occurs as men age. The prostate, a walnut-sized gland located below the bladder and surrounding the urethra, gradually increases in size over time. As the prostate enlarges, it can compress the urethra and affect normal urine flow, leading to various urinary symptoms.

In Singapore, studies show that approximately 50% of men in their 50s and up to 90% of men over 80 have some degree of BPH. Despite its prevalence, many men delay seeking treatment due to embarrassment or the misconception that urinary problems are an inevitable part of ageing.

Types of BPH Presentation

Obstructive BPH

This type causes blockage symptoms due to physical compression of the urethra. Men experience difficulty starting urination, weak urine stream, and incomplete bladder emptying. The enlarged prostate tissue directly obstructs urine flow.

Irritative BPH

Characterised by bladder irritation symptoms including frequent urination, urgency, and nocturia (night-time urination). The bladder muscle becomes overactive in response to the obstruction, causing these symptoms.

Mixed BPH

Most patients experience a combination of both obstructive and irritative symptoms. This mixed presentation is the most common form seen in clinical practice and requires comprehensive management addressing both symptom types.

Complicated BPH

This occurs when untreated BPH leads to complications such as acute urinary retention, bladder stones, or kidney damage. Immediate medical intervention is necessary to prevent permanent damage.

Causes & Risk Factors of BPH

Causes

The exact cause of BPH remains unclear, but several factors contribute to prostate enlargement:

  • Hormonal changes: Age-related shifts in testosterone and dihydrotestosterone (DHT) levels influence prostate growth.
  • Cellular growth: Increased proliferation of prostate cells in the transitional zone.
  • Chronic inflammation: Long-standing prostatic inflammation may stimulate enlargement.
  • Genetics: A family history of BPH increases the likelihood of developing the condition.

Risk Factors

  • Age: Primary risk factor; rare before 40, common after 50
  • Family history: Men with relatives who have BPH face higher risk
  • Metabolic syndrome: Obesity, type 2 diabetes, and hypertension are linked to increased BPH risk
  • Lifestyle factors: Sedentary lifestyle and poor diet may contribute

Signs & Symptoms of BPH

Mild Symptoms
  • Slightly increased urination frequency during the day
  • Occasional difficulty starting urination
  • Reduced force of urine stream
  • Minor dribbling after urination
  • Feeling of incomplete bladder emptying
Moderate Symptoms
  • Urgent need to urinate with little warning
  • Frequent urination (every 2 hours or less)
  • Waking 2-3 times nightly to urinate
  • Straining required to start urination
  • Intermittent or weak urine stream
  • Longer time needed to empty bladder
Severe Symptoms
  • Inability to urinate (acute retention)
  • Painful urination or blood in urine
  • Waking more than 4 times nightly
  • Frequent urinary tract infections
  • Bladder stones formation
  • Kidney function deterioration

BPH symptoms typically develop gradually over years. Many men adapt to mild symptoms, but progression can significantly impact quality of life and lead to serious complications if left untreated.

Experiencing these symptoms?
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When to See a Urologist

Immediate medical attention is necessary if you experience acute urinary retention (complete inability to urinate), blood in urine, severe pain during urination, or signs of kidney problems such as back pain with fever. These symptoms may indicate complications requiring urgent treatment.

You should consult a urologist if you notice progressive worsening of urinary symptoms, frequent night-time urination disrupting sleep, or any urinary symptoms affecting your daily activities and quality of life. Early evaluation helps as BPH symptoms can mimic other conditions including prostate cancer, bladder problems, or urinary tract infections.

During your first consultation, your urologist will conduct a comprehensive evaluation including medical history, symptom assessment using standardised questionnaires, physical examination and necessary diagnostic tests. This thorough approach ensures accurate diagnosis and appropriate treatment planning.

Diagnostic Investigations

  • Medical History

    A thorough evaluation of symptoms, lifestyle, and relevant medical history helps assess the severity of benign prostatic hyperplasia (BPH).

  • Digital Rectal Examination (DRE)

    A physical examination where the doctor assesses prostate size, consistency, and shape. This quick procedure helps detect enlargement and rule out suspicious nodules. Results are immediately available during consultation.

  • Prostate-Specific Antigen (PSA) Test

    A blood test measuring PSA levels, which can be elevated in BPH and other prostate conditions. This helps differentiate between BPH and prostate cancer. Results typically available within a day.

  • Urinalysis and Urine Culture

    Urine tests check for infection, blood, or other abnormalities. These tests rule out urinary tract infections that can mimic BPH symptoms. Results are available within 48 to 72 hours.

  • Urine Flow Test (Uroflowmetry)

    A non-invasive test measuring the strength, amount, and pattern of urine flow. Patients urinate into a special device that records flow characteristics. This provides objective data about the severity of urinary obstruction.

  • Bladder Scan (Post-Void Residual (PVR) Measurement)

    An ultrasound imaging test to measure how much urine remains in the bladder after urination. High residual volumes indicate significant obstruction and inability to empty the bladder, requiring treatment. This painless test takes less than a minute to perform.

  • Urodynamic Testing

    In selected cases, tests measuring bladder pressure and function may be recommended to further evaluate bladder and urethral performance.

  • Bedside Ultrasound Scan Of The Prostate

    Ultrasound imaging of the prostate can be done in the clinic to accurately measure the size and assess the anatomy. This helps plan treatment approaches, especially for larger prostates. The scan takes less than 5 minutes.

BPH Treatment Options in Singapore

  • Lifestyle Modifications

    Simple lifestyle adjustments such as reducing caffeine and alcohol intake, practising bladder training, and managing fluid consumption can alleviate mild symptoms.

  • Alpha Blockers

    Alpha blockers like tamsulosin and alfuzosin work by relaxing the smooth muscles in the prostate and bladder neck, improving urine flow within days to weeks. These medications are typically the first-line treatment for moderate BPH symptoms. Most patients tolerate them well, although some may experience dizziness or reduction in the ejaculate volume. They provide symptom relief without shrinking the prostate.

  • 5-Alpha Reductase Inhibitors

    Medications such as finasteride and dutasteride reduce prostate size by blocking conversion of testosterone to DHT. These drugs work gradually over 3-6 months and are effective for larger prostates. They can reduce prostate volume by 20-30% and lower the risk of acute retention and need for surgery. Some men may experience decreased libido or erectile dysfunction with these medications.

  • Combination Therapy

    Using both alpha blockers and 5-alpha reductase inhibitors provides improved symptom relief. This approach offers immediate symptom relief from alpha blockers while achieving long-term prostate size reduction. Studies show combination therapy reduces progression risk and need for surgery.

  • Anticholinergic And Beta-Agonist Medications

    For patients with predominant irritative symptoms like urgency and frequency, anticholinergic or beta-agonist drugs may be added. These medications calm overactive bladder muscles but must be used cautiously in BPH as it can rarely result in urinary retention. Regular monitoring ensures safe, effective treatment.

  • Phosphodiesterase-5 Inhibitors

    Medications like tadalafil, traditionally used for erectile dysfunction, also improve BPH symptoms. They work by relaxing smooth muscle and improving blood flow in the prostate and bladder. This dual benefit makes them attractive for men with both conditions.

  • Transurethral Resection of Prostate (TURP)

    TURP remains the standard surgical treatment for BPH. Using a scope inserted through the urethra, excess prostate tissue is removed to create a wider channel. This procedure provides long-lasting symptom relief with success rates exceeding 85%. Most patients stay 1-2 nights in hospital.

  • UroLift System

    This innovative procedure uses small implants to hold enlarged prostate tissue away from the urethra. Performed under local anaesthesia, UroLift preserves sexual function while improving urinary symptoms. Suitable candidates can return home the same day with minimal downtime.

  • Rezum Water Vapour Therapy

    Rezum uses thermal energy from water vapour to reduce prostate tissue. This procedure takes under 20 minutes and preserves sexual function. Symptom improvement occurs gradually over 1-3 months as the treated prostate tissue is absorbed by the body.

  • iTind (Temporary Implantable Nitinol Device)

    This is a minimally invasive procedure which involves the temporary insertion of a stent into the prostatic urethra for about a week. The stent will reshape the prostatic urethra tissue and improve urine flow. The stent is removed after a week, and the procedure preserves sexual function.

Every patient’s condition is unique.

Dr Tan Teck Wei will assess your medical condition and recommend the most suitable treatment approach for you.

Schedule Consultation

Complications If Left Untreated

Untreated BPH can lead to serious complications affecting overall health and quality of life. Acute urinary retention, the sudden inability to urinate, is a medical emergency requiring immediate catheterisation. This painful condition often necessitates surgical intervention.

Chronic retention and incomplete bladder emptying increase infection risk, leading to recurrent urinary tract infections and potential kidney infections. Bladder stones may form in stagnant urine, causing pain, bleeding, and further obstruction.

Long-term obstruction can cause bladder muscle damage, reducing its ability to contract effectively. In severe cases, back-pressure on the kidneys leads to hydronephrosis and potential kidney failure. Early treatment prevents these complications and preserves urinary tract health.

BPH Prevention

While BPH cannot be entirely prevented due to age and genetic factors, certain lifestyle modifications may reduce risk and slow progression. Regular physical exercise, particularly aerobic activity, helps maintain prostate health and reduces BPH risk. Studies show sedentary men face higher rates of moderate to severe symptoms.

Dietary changes including increased vegetable intake, reduced red meat consumption, and maintaining healthy weight may help. Limiting caffeine and alcohol, especially before bedtime, reduces irritative symptoms.

Regular medical check-ups enable early detection and intervention before symptoms become severe. Men over 50 should discuss prostate health with their doctor annually. Managing conditions like diabetes and hypertension helps reduce BPH progression risk.

Dr Tan Scrubs Photo

Dr Tan Teck Wei

MBBS (S’pore)

DFD (CAW)

MRCS (Edin)

MMed (Surgery)

FAMS (Urology)

Dr Tan Teck Wei is a Senior Consultant Urologist in Singapore who specialises in the management of complex urological cancers, including those affecting the kidneys, prostate, and bladder.

He is fellowship-trained in open, laparoscopic and robotic surgery. He also specialises in the management of other urological conditions including:

  • Prostate Enlargement
  • Recurrent Urinary Tract Infections
  • Stones

To date, Dr Tan Teck Wei has been involved in more than 500 robot-assisted surgeries, building up his volume of cases from his fellowship training days and cementing his expertise in robotic surgery.

Dr Tan Teck Wei believes in the holistic management of his patients, and seeks to journey with them from diagnosis to cure.  Dr Tan is effectively bilingual in English and Mandarin, making him a popular choice with the young and old, as well as international patients.

Dr Tan Teck Wei possesses a wealth of specialist experience in the field of Urology. He has previously held positions as a Consultant Urologist and Director of Genitourinary Oncology at Tan Tock Seng Hospital.

Dr Tan’s expertise in conducting MRI-targeted Prostate Biopsies led to his advisory role with the Ministry of Health’s Agency for Care Effectiveness. Furthermore, he has served as an Adjunct Assistant Professor and Clinical Teacher at the National University of Singapore (NUS) Yong Loo Lin School of Medicine and the Nanyang Technological University-Imperial College London’s Lee Kong Chian School of Medicine respectively.

He has actively participated in humanitarian initiatives as a member of the Singapore Navy surgical team, collaborating with the Indonesian Navy to provide healthcare services to the communities in Padang and Ambon. It is his passion to improve the standards of healthcare to patients both in Singapore and overseas.

  • Former Consultant Urologist and Director of Genitourinary Oncology, Tan Tock Seng Hospital
  • Adjunct Assistant Professor, National University of Singapore (NUS) Yong Loo Lin School of Medicine
  • Clinical Teacher, Nanyang Technological University-Imperial College London’s Lee Kong Chian School of Medicine
  • Advisor, Ministry of Health’s Agency for Care Effectiveness
  • Surgical Team, Singapore Navy
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Living with BPH can be challenging, but you do not have to face it alone. Dr Tan Teck Wei is experienced in diagnosing and treating benign prostatic hyperplasia using evidence-based approaches.

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    Frequently Asked Questions

    Is BPH the same as prostate cancer?

    No, BPH is completely different from prostate cancer. BPH is a benign (non-cancerous) enlargement of the prostate that does not increase cancer risk. Both conditions can occur simultaneously and share some symptoms, which is why proper medical evaluation is essential. Dr Tan uses various tests including PSA levels and physical examination to distinguish between these conditions.

    How long does BPH treatment take to show results?

    Treatment timeline varies by approach. Alpha blockers typically improve symptoms within 1-2 weeks, while 5-alpha reductase inhibitors take 3-6 months for full effect. Surgical procedures like TURP provide immediate improvement once the catheter is removed (usually 1-3 days post-surgery). Newer treatments like Rezum show gradual improvement over 1-3 months. Dr Tan will explain expected timelines for your specific treatment plan.

    Will BPH treatment affect my sexual function?

    Treatment effects on sexual function vary. Alpha blockers may reduce the volume of ejaculation but do not affect erection quality. Some men on 5-alpha reductase inhibitors experience reduced libido or erectile dysfunction. Newer procedures like UroLift, iTind and Rezum are designed to preserve sexual function. Dr Tan discusses these considerations when recommending treatments, helping you make informed decisions.

    Can BPH symptoms improve without treatment?

    While mild BPH symptoms may fluctuate, the condition typically progresses over time without treatment. Some men experience temporary symptom improvement, but the underlying prostate enlargement continues. Lifestyle modifications can help manage mild symptoms, but moderate to severe BPH usually requires medical intervention to prevent complications and maintain quality of life.

    What happens during a BPH consultation?

    Your consultation begins with discussing your symptoms and medical history. Dr Tan performs a physical examination including a digital rectal exam to assess prostate size. You will complete a symptom questionnaire (IPSS score) to quantify severity. Based on the findings, diagnostic tests like urine flow study or ultrasound may be recommended. The consultation concludes with discussing test results and treatment options suited to your condition.

    How do I know if I need surgery for BPH?

    Surgery is typically considered when medications fail to provide adequate relief, or when patients improve with medications but do not wish to continue on it for the long term, or complications develop. Complications that can develop include recurrent urinary retention, bladder stones, kidney damage, or frequent infections. Dr Tan evaluates your medical condition, considering symptom severity, prostate size, overall health, and personal preferences before recommending surgical options.

    Are there any new treatments for BPH available in Singapore?

    Singapore offers access to modern minimally-invasive BPH treatments including UroLift, Rezum water vapour therapy, and iTind. These minimally invasive options provide effective symptom relief with shorter recovery times and preserved sexual function. Dr Tan stays updated on emerging treatments and can discuss whether newer options suit your condition and lifestyle needs.

    Can younger men develop BPH?

    While BPH predominantly affects older men, younger men in their 30s and 40s can develop early prostate enlargement, especially those with a family history. Symptoms in younger men warrant thorough evaluation to rule out other conditions like prostatitis or bladder dysfunction. Early diagnosis and treatment in younger patients can prevent progression and maintain long-term prostate health.