Prostate

The prostate (prostates, "protector") is an organ in the shape and size of a chestnut, located between the external urinary tract called the urethra and the bladder, in the section near the last part of the urinary tract, surrounding the urethra.

In the excretory system. It carries urine from the bladder during excretion and ensures the transmission of sperm during ejaculation. It also secretes a special protein contained in the seminal fluid, which nourishes the sperm and protects them as they progress into the female reproductive system.

What is prostate enlargement and who is negatively affected by prostate enlargement?

Benign Prostate Hyperplasia, or simply known as BPH, is the most common prostate disease in men. Depending on age, almost every man will one day face the problem of prostate enlargement.

The number of men suffering from BPH gradually increases with age, with 50% of men at the age of 60 and 90% at the age of 85. He begins to show symptoms of BPH. However, approximately half of these patients have symptoms that require treatment.

Does BPH disease increase the risk of prostate cancer?

Studies have shown that the risk of prostate cancer does not increase in BPH patients. However, BPH and prostate cancer can cause similar complaints, and a man with BPH may have undiagnosed simultaneous prostate cancer.

For the early diagnosis of prostate cancer, the first screening should be performed at the age of 40 and a follow-up protocol should be created by arranging intervals according to personalized patient risk. recommended. Prostate cancer screening includes measuring the PSA level by taking a blood test and anal digital examination.

What are the symptoms of BPH disease?

The prostate gland begins to grow from the age of 40. Since the prostate gland is an organ surrounding the external urinary tract called the urethra, as the prostate grows, it begins to block the urinary tract and prevent the flow of urine. During this process, complaints occur that vary from patient to patient depending on the degree of obstruction.

• Decrease in urinary strength and thickness

• Difficulty in starting urination

• Intermittent urination

• Dripping at the end of urination

• Feeling of not being able to empty urine completely

• Blood in urine

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• Increased urination frequency

• Urination at night

• Sudden desire to urinate

• Urinary incontinence when the feeling of urination occurs

• Burning sensation while urinating

• Inability to urinate

In patients whose diagnosis is delayed, bladder stones, recurrent bladder infections, bleeding in the urine, increased intra-bladder pressure due to urine accumulating in the bladder and not being fully emptied as a result of obstruction of urine flow, can cause kidney problems. Problems such as kidney failure may occur as a result of the reflection.

How is BPH diagnosed?

A detailed medical history should be taken and a physical examination should be performed. It should be questioned when the complaints started, how frequent they are, their degree, and whether there is a family history of prostate cancer. Diseases such as diuretic drugs, diabetes, urinary tract infections, bladder cancer, neurological disorders of the urinary bladder, urinary tract stenosis may also cause similar complaints, so the medications used, family history of diabetes, previous trauma, signs of infection, bleeding in the urine. should be investigated. Evaluation of the prostate by rectal digital examination is necessary for the early diagnosis of prostate cancer.

In the doctor's examination;

• IPSS: An interrogation system of seven questions that helps understand the degree of patient complaints

• Urinary analysis

• Urinary flow rate measurement (Uroflowmetry)

• PSA measurement

• Anal digital examination

• Post-void residual urine evaluation (USG)

• Urinary system ultrasonography

• Cystoscopy: It is performed when your doctor deems it necessary. The prostate and urinary bladder are evaluated with a special camera system.

How is BPH treated?

Patients with low-level complaints If the kidneys and bladder are not adversely affected, annual follow-ups may be recommended without treatment. If you experience complaints If it has reached a size that will negatively affect the quality of urine, it needs to be treated.

Surgical Treatments

There are different techniques used to remove prostate tissue that blocks urine flow.

• TURP (Transurethral Resection of the Prostate): It is widely used and is considered the "gold standard" treatment method in BPH. It can be done with many different techniques. With the help of special cystoscopic instruments, prostate tissue is cut into small pieces and cleaned. It can be performed with general or regional anesthesia and the hospital stay is 1-2 days. Although it is an effective treatment method, bleeding, infection, urinary incontinence, loss of ejaculation and loss of sexual function are among the possible side effects.

• Transurethral electrovaporization: Rapidly destroying the prostate tissue through an electrode to which electrical energy is applied. It evaporates by heating.

• Greenlight Laser (PVP: Photoselective Vaporization of the Prostate): It is the process of vaporizing the prostate tissue along with the blood vessels thanks to the laser energy absorbed by the hemoglobin in the blood.

• TUIP (Transurethral Incision of the Prostate): It is the process of widening the urethra by transurethral cutting of the bladder neck and prostate tissue instead of tissue removal in the TURP operation.

Minimally Invasive Treatments

Recently, new treatment methods have been developed that reduce the size of the prostate and relieve urinary tract obstruction. The most common side effects of these treatment methods are increased urinary frequency and a feeling of irritation during the healing process of the prostate tissue. Patients remain catheterized for 5-7 days after the operation.

However, the long-term effectiveness and side effects of minimally invasive methods, which shorten the hospital stay, have fewer side effects, have a shorter recovery period and are less costly. There is not enough data about it.

• TUMT (Transurethral Microwave Thermotherapy): It is a method of shrinking the prostate tissue by increasing the tissue temperature using microwave energy with an applicator placed on the prostate tissue with the help of a special catheter.

• TUNA (Transurethral Needle Ablation): Low level radiofrequency injection into enlarged prostate tissue. It is a method of shrinking the prostate tissue by applying energy.

• ILC (Interstitial Laser Coagulation of the Prostate): Thanks to the high heat applied to the prostate tissue with the help of laser energy, prostate cells lose their vitality and dead cells disappear for about 2-5 years. It is eliminated by the body within a period of 3 months.

Another minimally invasive treatment option is the Prostatic Urethral Sling method. In this method, the lateral prostate lobes are suspended towards the edges via permanent intraprostatic suspension implants, allowing the urinary tract to be opened without applying any thermal energy or tissue removal. According to scientific research, while this method provides a rapid and significant improvement in the treatment of BPH, it has a better profile than surgery or ablation in terms of side effects, and it is stated that sexual functions can only be fully preserved with this method. Although it is a promising method, new scientific research is needed along with developments to determine the position of this application in the treatment of BPH.

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