Poor urine flow can be due to obstruction to flow such as a stricture urethra (narrowing in the urine tube) or prostatic enlargement. Occasionally this can be due to weak bladder musculature.

This is a normal process of ageing whereby the prostate enlarges in size. It can obstruct the flow of urine by impinging on the urethra.

BPH treatment is aimed at improving the lifestyle of the person involved and treatment is only necessary if the symptoms are moderate to severe. Mild symptoms require lifestyle modifications. A consultation with a Urologist is required to discuss this further.

For moderate and severe symptoms –

1. Medical management – This involves taking oral pills to improve urine flow.
2. Endoscopic management – Patients with inability to pass urine, failed medical treatment, recurrent infection, recurrent bleeding from prostate or kidney dysfunction due to obstruction to the flow of urine require endoscopic management.

Several options include – urolift procedure, transurethral surgery and Greenlight laser ablation to remove the enlarged portion of the prostate.

3. Open surgery – this is reserved for large prostate glands blocking the flow of urine.

Surgery for the treatment of BPH, by either TURP or open prostatectomy, only removes a part of the prostate gland; the section around the urethra that is blocking urine flow is removed. Prostate cancer is often treated by a radical prostatectomy where the whole prostate gland is removed.

1. Medical treatment

Alpha blockers (Prazosin, Tamsulosin, Alfuzosin, Terazosin) – giddiness, dizziness, nasal congestion, retrograde ejaculation (semen goes back in the bladder rather than out the urethra on ejaculation), fatigue, precipitation of narrow angle glaucoma.

Caution – avoid if undergoing cataract surgery in the near future. Please refer to specific drug pamphlet for drug interactions and further useful information.

5 Alpha Reductase Inhibitors (Finasteride, Dutasteride) – fatigue, tiredness, decrease in libido decrease in ejaculate, erectile dysfunction, breast tenderness.

Caution – needs regular PSA assessment. This drug reduces the PSA levels and prostate cancer can occur at lower levels of PSA. Please refer to specific drug pamphlet for drug interactions and other useful information.

Combination therapy – alpha blocker along with 5 ARI.

2. Endoscopic or surgical treatment – There is a risk of bleeding, retrograde ejaculation (permanent), narrowing of the urethra, bladder neck, and regrowth of the prostate in the future. Please discuss with our Urologists for more information.