Men’s Health (Part : 1 of 3)
Wed 30 March 2021 | 12pm - 1:30pm
The speaker Doctor Lim Kok Bin is a urologist from Raffles Urology Centre that specializes in prostate diseases. In this event, he covers topics pertaining to men’s health particularly prostate enlargement or Benign Prostatic Hyperplasia (BPH). He discussed the symptoms that may arise, the risk factors that may cause prostate enlargement, how they are diagnosed, and the treatments available for this condition.
This series aims to deliver beneficial information to help participants identify and recognize common signs for men who may be at risk of prostate enlargement so they can take appropriate steps before it becomes an issue with more serious implications.
Dr. Lim Kok Bin
Consultant Urologist, Raffles Urology Centre
“Dr. Lim Kok Bin has a particular interest in prostate diseases, voiding dysfunction, male infertility, and sexual dysfunction.
He is trained in the artificial urinary sphincter and penile prosthesis implantation, correction of penile curvature, and various microsurgical works such as microsurgical ligation of varicocele and reanastomosis of the previous vasectomy.
Trained in endourology, Dr. Lim performs a variety of minimally invasive surgeries for urinary stones and prostate diseases, including percutaneous nephrolithotripsy, rigid and flexible ureteroscopy, and laser prostatectomy.”
Prostate Enlargement or Benign Prostatic Hyperplasia (BPH)
Fadyl (ESG host): Hi, a very warm welcome to ESG virtual wellness series Men’s Health: hard and fast truths. My name is Fadyl Irham and I am your moderator. We have a list of activities planned out for you where you can learn more about our sponsors. There will also be a one-on-one Q&A from 1:30 to 2:30. Do head down to the group and reach out to the speakers, to the meet function under there. Finally, you do stand a chance to win prizes when you participate in each (inaudible). Lookout for the leaderboard menu icon to see how you can earn points for our top three winners.
Before I begin, here are some housekeeping rules. During the session, slides will be shared. If you wish to make the screen larger, just click on the full screen at the optimized button on the right side of the screen. At any point of time, if you have any questions for the speaker, I would encourage you to submit them on the Q and A portion on the right side of your screen. We will try our best to answer as many as possible.
All right, so first up we are joined by Dr. Lim Kok Bin, a consultant urologist from Raffles Urology Center. Dr. Lim has a particular interest in prostate disease, voiding dysfunction, male infertility, and sexual dysfunction. He has been awarded the prize essay in clinical research for his work on Peyronie’s disease. Today you’ll learn the truths about most common myths in men’s health and get some advice on improving overall health and fitness.
Dr. Lim Kok Bin: Hi everyone. All those guys in front of your desktop or laptop, I hope you have a good morning today. For today we’re gonna have a white banner on men’s general health and fitness. My name is Kok Bin, I’m a Urologist.
For our video, it’s mainly issues with the urinary tract. But for today, we’re going to focus only on two urological conditions.
The commonest health problem faced by men in Singapore is mainly cancer and vascular conditions like diabetes, heart disease, and stroke.
Of the list of cancer, the number two killers are actually prostate cancer. It is just one of the things that I (inaudible) go through on a daily basis. However, we’re not going to deal with prostate cancer today. Our focus will be on the two most common conditions: prostate enlargement and erectile dysfunction.
The first thing I like to elaborate first is the prostate gland. Some of you might not know what it is. Although it causes urinary tract symptoms, the gland itself is a sexual organ. It is situated right in front of your rectum where the feces go through and just beneath the bladder. Its function is to provide nutrition to the sperm.
Unfortunately, the problem with the prostate is that it grows larger as the man gets older. Theoretically, almost 50% of men once he reaches the age of 50 has a chance of getting urinary tract symptoms.
So, what happens is that you can see from this light, right? The prostate is down below the bladder and largest constrictor urethra, urine passage, causing problems with urination. As a result, the bladder has to work harder. Because of that, the bladder wall muscle also thickens, which is not good. Why? Because the space will become smaller and that’s why you also experience frequent urination.
What are symptoms that you might face when you’re having this problem? As I said before: frequent urination, frequent urge to want to go to the toilet. Could be happening in the daytime or nighttime, you might have difficulty starting the urination or difficulty to actually urinate at all. The stream will be slow, you might not be having a good ending – it dribbles, and some of this situation may worsen developing urinary tract infection and sometimes blood in the urine.
Now, what are the risk factors that cause prostate enlargement? Age, unfortunately, as I said before is one of those things that face all men as you get older. If you’re a person who doesn’t do much physical activities resulting in a higher body mass index, you live a very sedentary lifestyle, you do put yourself at risk of getting prostate enlargement.
Of course, if there’s a strong family history of prostate enlargement, where the grandfathers, uncles, fathers, all have prostate enlargement, chances are you might get it one day.
So how do we diagnose prostate enlargement? First, of course, we ask about the urinary symptoms, we may ask how your bowel habits are. Because constipation actually worsens the symptom. We may do some urine tests, as I said before, you might be having an infection, and then do a simple test like how fast or how strong your pee is, we do a urine flow test. And in order to exclude prostate cancer, especially in men above the age of 50, we will do a blood test called the PSA.
But essentially, with all the tests I mentioned, a critical component of the diagnosis is a physical examination where we have to do a rectal exam. That’s where we can feel the prostate gland by putting our fingers into the rectum. And we can feel whether it is regularly enlarged or is it small, does it move, is it hard, is there any lumps that can be felt and that give us some form of the idea of what’s happening.
Of course, that’s not enough, especially in this day and age where there’s scientific improvement. So, we go on to do simple tasks like an ultrasound scan of the bladder where we can see how the bladder looks like, whether it’s thickened, how’s the size of the prostate gland. We can measure the size of the prostate gland. In a situation where there’s a bit of a (inaudible), then we might proceed to do a Flexible Cystoscopy where we introduce a small tube into the bladder and have a look inside to find out more about the reason for the urination problem. Only if there’s a worry about cancer, then we might do an ultrasound scan and biopsy of the prostate gland. But essentially, most of the time an ultrasound scan of the bladder can suffice.
What are the treatments that we can do to help alleviate the symptoms? One of the things will be to change some of your habits, for example, if you’re regularly ten cups of coffee a day, that could be something you can cut down because caffeine tends to irritate your bladder and causes you to have frequent urination.
Others would be alcoholic drinks that also cause a lot of (inaudible) disease. In terms of medical treatment, we have two main medicines available to help the patients having this problem. One would be the (inaudible) called an alpha-blocker. What it does is that it relaxes the bladder muscle, a sort of muscle fibers around the prostate gland, allowing the urine to flow easier. The other would be the 5-alpha reductase inhibitors where it shrinks the prostate gland by doing self hormonal changes. And in a severe situation, we will do a combination treatment where we will give both alpha-blocker and 5-alpha reductase inhibitors to give a combined effect in reducing those symptoms that it faces.
But sometimes, medical treatment might not help or it does but still having quite a number of (inaudible) problems. In this case, then we might have to proceed to the second level of treatment, meaning a non-surgical treatment such as microwave therapy, needle abrasion, BOTOX injection, and Prostate Artery Embolisation. The advantage of this treatment is that they are less invasive, you probably could have the procedure done on the same day and go home the same day. There’s no need to insert a urine catheter after the procedure. The disadvantage, of course, is the timeline of benefit might be a bit shorter, maybe eight-ten years.
So what are the gold standard treatments available for prostate enlargement? The traditional surgical treatment would be a TURP or Transurethral Resection of the Prostate gland which I’ll elaborate on later.
Now if the prostate is a bit small and not that large, we can just do an incision. There are many ways of doing it, a lot of time we use (inaudible) but we can use lasers, and very rarely we do open surgery nowadays.
So, what is transurethral resection of the prostate gland? Essentially we do an endoscopy of the prostate gland. At the end of the endoscope, there’s an electric wire that helps us to cut away the prostate tissue that is blocking the urethra. At the same time, this electrical wire will also seal the blood vessel reducing bleeding. All these tissues that’s cut away will be flushed into the bladder and later on at the end of the procedure we use equipment to evacuate all these tissues out.
What are the things or maybe a disadvantage is that you do have to leave the urine catheter inside for one or two days to make sure that the bleeding stops. To make sure that you recover from the surgery, because some of the people who had the surgery done may not be able to pee straight away after the operation. So a couple of days will help to reduce the inflammation and swelling as a result of the surgery. And because of the catheter, you might be in the hospital for 2-3 days.
Prostate enlargement is a common occurrence in all men and is more common in those over the age of 50. This condition may be avoided by reducing caffeine and alcohol intake, as well as having an active lifestyle that promotes healthy living habits.
When it occurs, there are a number of treatments available such as medications, non-surgical treatments that are non-invasive, as well as traditional surgical treatments for men who begin to see signs of prostate enlargement.
It’s beneficial to understand what’s going on with your body through the eyes of expert doctors in the field. It is highly encouraged to seek proper medical care as soon as you notice early signs of prostate enlargement or BPH.