It is a non-cancerous benign enlargement of the prostate gland. As a result of a healthy lifestyle and advances in medicine, life expectancy is increasing and as a result, the number of people needing treatment due to BPH is increasing.
BPH symptoms are very rare before the age of 40, whereas in those who are in their 60s. BPH symptoms are observed in 50% of the ages and in 90% of the ages of 70 and 80.
What is the prostate gland and what are its functions: The prostate gland is a small chestnut-sized organ in young men and is a part of the male reproductive system. is part of it. It is located in the lowest part of the abdominal cavity, just below the bladder (urinary bladder), in front of the last part of the large intestine called the rectum.
After the bladder, it also surrounds the urethra, which is the tube through which the urine passes and is excreted outside the body. Therefore, when it grows, it squeezes this tube and makes urine flow difficult. Although all its functions are not clearly known, it is one of the sex glands in the male reproductive system. The prostate fluid it creates constitutes a large part of the semen volume, contains energizing substances that nourish the sperm, contains enzymes that contribute to the liquefaction of the semen and makes the vaginal canal less acidic.
BPH Symptoms: Symptoms It can be examined in two groups.
1- Obstructive (Blockage) symptoms: These are the symptoms that occur due to the blockage of the urinary tract as a result of growth.
- Difficulty in starting urination, straining to urinate.
- Weak flow and intermittent urination
- Dripping at the end of urination.
2- Irritative symptoms: Symptoms due to changes in the bladder that is strained as a result of obstruction.
-Sudden feeling of urination (urgency) and sometimes not being able to reach the toilet and incontinence
(urge incontinence)
- Frequent urination.
- Feeling of not being able to empty the bladder after urinating.
- Nocturnal urination (nocturia)
Also, in case of infection and stone formation resulting from residual urine remaining in the bladder, the patient may experience pain and burning sensation while urinating (dysuria). may occur. Although less common, blood in the urine (hematuria) may be observed.
There is no direct relationship between the severity of these symptoms and prostate size. Even though he has a fairly large prostate, there is less blockage and symptoms and a much smaller prostate. ostat may cause more serious symptoms with further obstruction.
DIAGNOSIS:
1- Medical history: important in differential diagnosis, urethral stricture, bladder cancer or stones. It helps to distinguish conditions that may be confused with BPH, such as abnormal bladder function due to neurogenic bladder.
2- Physical examination: The presence of a full bladder that cannot be emptied can be understood by abdominal examination. The most important examination is digital rectal examination, here the size of the prostate as well as the formation of nodules. Prostate cancer findings such as and hard areas may be obtained.
3- Laboratory tests: Urinalysis and urine culture are performed in case of suspicion of infection. Urea and creatinine values are important for kidney functions. PSA (prostate specific antigen) provides important information along with digital rectal examination in detecting prostate cancers.
4- Measurement of urine flow rate (uroflowmetry) and determination of residual urine in the bladder.
5- International Symptom Scoring: It is a test that consists of 7 questions and subjectively evaluates the patient's obstructive and irritative complaints.
6- Ultrasonography and cystoscopy can be performed when necessary.
TREATMENT:
6-Ultrasonography and cystoscopy can be performed when necessary.
TREATMENT: strong>
There are definitely situations that require surgical treatment:
1- Kidney damage as a result of insufficient emptying of the bladder.
2- After an acute urinary obstruction. Inability to urinate despite treatment.
3- Recurrent urinary infections as a result of infected residual urine.
4- Bladder stones.
5- Recurrent severe hematuria (blood in the urine )
6- Decreased bladder sensation and overflow type urinary incontinence.
Except for these cases requiring absolute surgery, the severity of the symptoms (frequent urination at night, frequent urination during the day and The sudden feeling of urgency and the inability to reach the toilet, incontinence, difficulty in initiating urination, etc.) and the degree of negativities it causes in the quality of life are important. Treatment is shaped according to the patient's complaints and expectations.
Treatment options:
1- Follow-up
2- Medical treatment (Drug treatment)
3-Surgical treatment.
Follow-up: For those with minimal complaints, report once a year. Physical examination and some laboratory tests are performed to evaluate whether there is an increase in blood pressure.
Medical Treatment: Two drug groups can be used in this treatment, which can be applied to those with moderate symptoms.
1- 5-Alpha-Reductase inhibitors: Drugs in this group act by preventing the conversion of testosterone into dihydrotestosterone, which is its active form in the prostate. They provide a 20-30% reduction in prostate volume in 2/3 of the patients, an increase in urine flow rate in 1/3, and partial relief of prostate symptoms in 2/3. It may take 6-12 months for the effects to fully appear. Basal PSA value must be measured before starting these medications because they cause a 50% decrease in PSA value. As side effects, they may cause sexual reluctance and erection problems and a decrease in ejaculate (semen) in 3-4% of patients.
2- Alpha-adrenergic receptor blockers: They show their effects by relaxing the smooth muscles in the prostate and bladder neck. Unlike 5-alpha reductase inhibitors, they act faster and provide relief in a few weeks. In addition to their effects such as an increase in urine flow rate, a decrease in the number of urinations during the day and night, and a decrease in urge incontinence, they also reduce the possibility of patients experiencing sudden urinary retention. Although the most important side effects are hypotension, fatigue and headache, they are generally well tolerated.
Surgical Treatment: With the operation called prostatectomy, the inner part of the prostate is emptied and the urinary tract is relieved. It can be performed in two ways: TUR-P (closed operation) and open prostatectomy.
TUR-P : Today, it is still considered the gold standard in prostate surgery and 90% of the operations performed due to BPH are performed. It forms close to a. Without any incision, the inner part of the prostate (core part) is emptied by entering the urinary tract inside the penis, called urethra, with a special tool called resectoscope. Prostate tissues are cut using electric current. The average duration of catheterization and hospital stay is 2-3 days.
Complications: In the early period; bleeding, urinary infection and inability to urinate. In the late period; urethral stenosis (4%), bladder neck stenosis (4%), urinary incontinence often stress type (2.5%), erection problems (5-10%), retrograde ejaculation �lation (dry orgasm) (70%), need for re-operation (10%)
Open Prostatectomy: It is a preferred method for large prostates (over 80-90 grams). Unlike TUR-P, there is an incision below the umbilicus, catheterization time and hospital stay are longer, on average 4-5 days, bleeding may be slightly more during and after the operation.
Complications: Bleeding in the early period, infection. Late urinary incontinence, bladder neck stenosis, retrograde ejaculation.
Minimally invasive methods: Although their results are not as good as TUR-P and open prostatectomy, especially Laser prostatectomy, surgery and anesthesia have been performed in recent years. They are applied to people with high risk.
The main ones are:
1- Thermal effective treatments: most of these are methods under development, they are not widely used.
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Transurethral and transrectal hyperthermia
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HIFU(high intensity focused ultrasound)
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TUNA (Transurethral needle ablation)
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TUMT (transurethral microwave therapy)
2- Laser Treatments: These are the most commonly used and effective minimally invasive treatments. . They act by causing coagulation necrosis in the tissue or by vaporizing the tissue. Laser types used in BPH
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Neodmium Yag Laser
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Diode laser
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KTP Laser (green light)
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Holmium laser
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Thulium laser
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