BPH

WHAT IS PROSTATE ENLARGEMENT, BENIGN PROSTATE HYPERPLASIA (BPH)?

Changes in the prostate gland begin around the age of 45 and show itself in the form of growth at the age of 50. This growth continues at varying rates until the end of life. Benign prostatic enlargement (BPH) is a development that goes in parallel with the increase in age, almost as a part of aging. Therefore, its incidence increases with age. While it is present in approximately half of men in the early fifties, the incidence reaches 90% in men over the age of eighty.

WHAT ARE THE SYMPTOMS OF BPH?

Because the prostate surrounds the urethra, it compresses as it grows and can make it difficult to pass urine from the bladder. Thus, comfortable urine drainage will be disturbed and a feeling of congestion will occur, as well as disturbing symptoms such as frequent urination and burning. Frequent urination, which is one of the most common symptoms, is an important irritating complaint as it also occurs at night. Some other symptoms are the feeling of not being able to empty the bladder completely and the inability to delay urination when the need arises. BPH can cause difficulty in initiating urination, weak urine stream, post-void dripping, and intermittent urination. In very advanced cases, complete obstruction may occur and requires urgent intervention.

HOW IS BPH DIAGNOSED?

• Prostate specific antigen (PSA) test: It is a blood test for the possibility of prostate cancer.
• Urine flow test (Uroflowmetry) Shows the urine flow rate and voiding pattern.
• Measurement of the amount of urine remaining after voiding: It shows how effectively urine discharge can be achieved.
• Ultrasonography: It provides visualization of kidney, bladder and prostate.
• Cystoscopy: Direct visual inspection of the urethra and bladder using an instrument.

DOES BENIGN PROSTATE ENLARGEMENT CAUSE PROSTATE CANCER?

Benign prostate enlargement and prostate cancer are separate diseases. The two conditions can coexist, but one cannot be the cause of the other. The reason for the coexistence of the two diseases is that they occur in the same age groups. Prostate cancer often does not show symptoms in the early stages.

TREATMENT OPTIONS

The main determinant in the treatment of BPH-related complaints is the severity of the complaints and the occurrence of some effects in the body that are thought to be caused by prostate enlargement. Together with your doctor, you can decide which treatment method is most suitable for you. Information about the main treatments used in the treatment of BPH will be given below.

Drug Treatments

Today, it is the most commonly used method in the treatment of patients with moderate complaints. There are several groups of drugs in use for treatment. The effect of all drugs is possible with continuous use.

Alpha Blockers

5-Alpha Reductase Inhibitors

Herbal Medicines

SURGICAL METHODS

When drug treatments are insufficient, removal of the obstructive prostate tissue, in other words, surgical treatments will be on the agenda. In addition, surgical treatment becomes mandatory in cases of deterioration in kidney functions, recurrent urinary tract infections, inability to urinate, urinary bladder stones, and severe and recurrent bleeding.

Compared to non-surgical methods, urinary complaints have a higher chance of improvement. However, surgical treatments are more likely to cause risks and adverse events. Treatments for benign prostate enlargement do not cure prostate cancer and do not reduce the risk of subsequent cancer development, as in other methods. Surgical treatments can be applied either closed or open.

CLOSED PROSTATE SURGERY- STANDARD CLOSED PROSTATE SURGERIES ARE KNOWN AS TRANSURETHRAL PROSTATE RESECTION (TURP).

TURP is the most commonly used surgical method in the treatment of BPH. As in all closed surgeries, the enlarged prostate tissue is cut into small pieces by entering the urinary canal and removed. Since there is no open surgical incision, removal of the urinary catheter and hospital stay are limited to a few days.

The aim of all treatments is to reduce or eliminate the symptoms related to the disease and to prevent other bodily harms that may result from the disease. Urinary complaints improve significantly in approximately 90% of patients with TURP and 95% with open surgery.

There may be some temporary or permanent problems in the early and late period after surgery. Bleeding and infection in the early post-TURP period; In addition, wound healing problems may occur after open surgery. In the late period, leakage of ejaculation fluid (semen) back into the bladder, rarely stenosis in the urinary canal or weakening in penile erection (erection) can be observed.

Laser Surgery – One of the energies used in the surgical treatment of enlarged prostate tissue is laser energy. Surgery using laser is performed using closed, in other words, endoscopic, prostate surgeries using methods and instruments very similar to those of the prostate. Method definitions differ according to the type of laser energy used. Two techniques are more widely used than the others. These are Holmium laser prostate surgeries (HoLAP and HoLEP) and photoselective prostate vaporization (PVP), known as green light.

HoLAP and HoLEP are methods applied in the form of vaporizing the prostate or removing it by cutting it using Holmium laser energy. Its advantages are that it causes less bleeding, has a short recovery time, and can be applied to large prostates (HoLEP).

HOLEP: A NEW GENERATION TREATMENT IN BENEFITS PROSTATE GROWTH

It is a non-invasive surgical method used in the treatment of prostate enlargement. It provides removal of tissues obstructing urine flow due to BPH by enucleation (stripping from the capsule) with holmium laser energy.

HOLEP is a method similar to open surgery except that it is non-invasive. Through the endoscope and laser fiber sent through the urethra, high-energy holmium energy separates the tissues from the capsule photo-mechanically.

Advantages:

– Non-invasive

– Minimum hospital stay

– Can be used even in large prostates

– Fast recovery

– Very good bleeding control

ROBOTIC SURGERY OF BENIGN PROSTATE HYPERPLASIA (BPH)

(MILLIN ADENEMECTOMY)

  Adenomectomy surgery is the most effective treatment in the treatment of patients with large prostates. In recent years, it has come to the fore with the development of robotic surgery.

In addition, it may be preferred in the presence of a large bladder stone with BPH or when there are orthopedic problems that may prevent positioning for closed surgeries. Mild to moderate pain may occur after the operation. The urinary catheter is usually withdrawn in 4-7 days and a hospital stay may be required during this time.

The fact that patients consult the doctor earlier and the diagnosis is made in the early period, and that the endoscopic methods have shown great improvement, have enabled the majority of surgical treatments to turn into closed interventions. Closed surgeries are interventions that are performed using special instruments under direct observation through the camera view through the urinary tract.

The common method used for prostates over 100Gr was open prostatectomy and was first described and applied by Millin in 1947. With the development of technology, the laparoscopic technique, which was first applied and described by Mariano et al., started to be used in 2002. With the use of laparoscopic prostatectomy, it was observed that there was a greater improvement in the quality of life with a greater improvement in complaints compared to open surgery, and also less blood loss, shorter hospital stay, and less urethral catheterization time.

With the developments in the last 20 years, we started to use the robotic method in surgery. Robotic surgery has emerged as a more effective surgical method than laparoscopic surgery because it provides a three-dimensional image, surgical sutures are applied more precisely, and its 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 done easily.

 We applied a new method in our robotic prostatectomy (adenomectomy) series and achieved more success compared to the surgical methods performed so far.