Lower urinary tract symptoms due to benign prostatic hypertrophy (BPH) are one of the most common medical problems in aging men. The first method applied in the symptomatic treatment of BPH is DRUG TREATMENT, medical treatment. Surgical treatment varies according to the size of the prostate gland and the presence of bladder stones or diverticula.
When drug treatments are inadequate, surgical treatments, in other words, removal of the obstructive prostate tissue, will come to the agenda. In addition, surgical treatment becomes mandatory in cases of impaired renal function, recurrent urinary tract infections, inability to urinate at all, stones in the bladder, severe and recurrent bleeding.
Compared to non-surgical methods, the chance of improvement in urinary complaints is higher. However, surgical treatments are more likely to cause risks and undesirable conditions. As with other methods, treatments for benign prostate enlargement do not cure prostate cancer and do not reduce the risk of subsequent cancer development. Surgical treatments can be closed or open.
Adenomectomy surgery is the most effective treatment for patients with large prostate. It has come to the forefront with the development of robotic surgery in recent years. It may also be preferred in the presence of a large bladder stone with BPH or orthopedic problems that may prevent positioning for closed surgeries. There may be mild to moderate pain after the operation. The urinary catheter is usually withdrawn in 5-7 days and hospitalization may be required during this period.
The fact that patients apply to the doctor earlier and are diagnosed at an early stage and that endoscopic methods have shown great improvements have enabled the majority of surgical treatments to be closed interventions. Closed surgeries are interventions that are performed by entering through the urinary tract and using special instruments under direct observation through a camera view.
The most widely used surgical method for benign prostate enlargement is the electrosurgical transurethral resection of prostate (TUR) first described by HUGH Young in 1911. However, with the development of technology, holmium, photoselective vaporization (green light laser) and bipolar resection methods are also used in prostate surgery for large prostate glands.
For prostates over 100 g, the common method used to be open prostatectomy, first described and performed by Millin in 1947. With the development of technology, the laparoscopic technique was introduced in 2002, first described by Mariano et al. With the use of robotic prostatectomy, it has been observed that there is a greater improvement in complaints and a greater increase in quality of life compared to open surgery, as well as less blood loss, less hospital stay and less urethral catheterization time.
Robotic surgery has emerged as a more effective surgical method compared to laparoscopic surgery due to the fact that robotic surgery provides three-dimensional images, surgical sutures are applied more precisely and mobility is better. Robotic surgery is the most common method I use for prostates over 100 grams. It is also an important advantage that stone surgery can be performed easily.
In our robotic prostatectomy (adenomectomy) series, we applied a new method and achieved more success than the previous surgical methods. In this method, the incision made in the bladder reduced the risk of urinary incontinence and accelerated healing. In the treatment of lower urinary tract symptoms caused by large prostate adenomas, we found that the modified robotic prostatectomy (adenomectomy) method we applied was safer, less blood loss, less need for blood transfusion and less hospital stay compared to other methods. The need for bladder flushing in the postoperative period was less with the robotic method we applied.
Robotic surgery is a high success rate and low risk of complications in patients with large prostates and bladder stones.