DR CHEW-LIN YIP | UROLOGIST

Dr Chew-Lin Yip assesses men with urinary symptoms associated with benign prostate enlargement at his consulting rooms in Mandurah, Murdoch and Rockingham. Depending on the individual assessment, management may include monitoring, medicines, hospital procedures such as Rezūm or UroLift, or surgery such as TURP. The options considered depend on the size and shape of the prostate, symptom severity, test results, general health and the patient’s priorities.

The prostate sits below the bladder and surrounds the urethra, the tube urine passes through. From middle age, the prostate commonly enlarges. Benign prostate enlargement is not cancer and does not itself become cancer, although the two conditions can coexist. Enlargement can narrow the urethra and obstruct urine flow.

• a slow or interrupted stream

• hesitancy before the stream starts

• straining to pass urine

• a sense of incomplete emptying

• passing urine frequently, or urgently

• waking at night to pass urine

• dribbling after finishing

Some men present instead with complications: an inability to pass urine at all, requiring a catheter; recurrent urinary infections; bladder stones; or blood in the urine.

Symptoms do not reliably indicate prostate size. Men with large prostates may have few symptoms, and men with modest enlargement may be significantly troubled.

Assessment usually includes a symptom history, often recorded using the International Prostate Symptom Score, examination including the prostate, a urine test, and a PSA blood test where appropriate. Further tests may include a urinary flow rate, measurement of urine remaining in the bladder after voiding, an ultrasound, or a flexible cystoscopy to inspect the prostate and bladder directly.

An IPSS score sheet and bladder diary can be downloaded from patient information and forms. If the practice has asked you to complete either form, bringing it to your appointment may help with assessment and discussion.

Watchful waiting. Mild symptoms that are not troubling may need only periodic review.

Medication. Alpha blockers relax smooth muscle in and around the prostate and may begin improving urinary symptoms within days. 5-alpha-reductase inhibitors can gradually reduce prostate volume and may be considered when the prostate is enlarged; benefit usually takes several months. Their benefits generally continue only while the medicine is taken. Possible side effects differ between medicines and may include dizziness, changes in blood pressure and changes in sexual or ejaculatory function.

Rezūm water-vapour therapy. Controlled water vapour is delivered to selected areas of obstructing prostate tissue. Symptoms usually improve gradually as the treated tissue reduces over the following weeks and months. In Dr Yip’s practice, Rezūm is usually performed as a day procedure. See Rezūm.

UroLift. Small permanent implants hold selected areas of prostate tissue away from the urethra. Suitability depends on the individual prostate anatomy and other assessment findings. In Dr Yip’s practice, UroLift usually involves an overnight hospital stay. See UroLift.

Transurethral resection of the prostate (TURP). TURP removes obstructing prostate tissue through the urethra. It may be considered for some men with larger prostates, urinary retention or other complications, or when less invasive options are unsuitable. See TURP.

These options differ in how quickly symptoms may improve, the available evidence about durability, recovery, risks and possible effects on ejaculation. Dr Yip will discuss the options that may be suitable after individual assessment.