The prostate is a chestnut-shaped secretion gland located at the exit of the urinary bladder in men and wraps the lower urinary tract called the urethra. As men get older, the prostate continues to grow and can compress the urinary tract. This leads to the emergence of symptoms of prostate enlargement. Common diseases of the prostate; Inflammation of the prostate (prostatitis), prostate hyperplasia (benign prostate enlargement/BPH) and prostate cancer.
Prostate examination, blood tests and prostate needle biopsy, which is thought to be benign in prostate enlargement, according to the degree of complaints, patients ' follow-up, medication or surgical treatment is decided.
Diagnostic methods for evaluating the prostate as benign; Finger Prostate Examination, serum PSA (Total and free PSA), urinary ultrasonography, urinary flow rate measurement (urflowmetry), prostate biopsy (if necessary) and cytoplopy (monitoring of the prostate and bladder with the camera).
Symptoms of benign prostate growth;
The symptoms of BPH are divided into two, both obstructive and irritative. Obstructive symptoms include hesitation, decreased urinary calibation, forked urination, non-complete bladder discharge sensation, severe urination, post-processing drip. Irritative symptoms; The immediate sense of urination includes frequent urination (Pollakuria) and nocturnal (waking up at night and urinating). These symptoms can be seen at every stage of the BPH.
Early stage; In the beginning phase of the prostate, which is described as a compensator stage, these symptoms can be seen in combination. In this stage, the bladder has suffered hypertrophy (the growth of smooth muscle cells in the bladder) to overcome increased labour force, the bladder has become trabeculated (indented and protruding), and the Place Sellül (Cepchik) and divertubclays (poor gaps from the smooth muscle cell) structure Formed.
Late stage; In other words, in the decompensated stage, the intra-bladder pressure cannot beat the obstruction and bladder output resistance formed by the prostate, and complete blockage cannot be excreated from the urinary bladder. This condition is defined as Glob Vesicale (retention). In addition, patients with hematuria (bloody urination), urinary tract infection, increased creatinine due to the exposure of kidneys can be seen.
Bladder and kidneys are affected if patients are not treated due to bladder outlet resistance. As a result of the accumulation of urine that cannot be excreted from the bladder, hypertrophy is formed in the smooth muscle cells. In the ongoing process, dilatation, urinary tract infection and acute pyelonephritis may occur in ureters depending on the bladder stone, diverticulitis, obstruction of both ureteres and urinary back escape. Most importantly, due to the disorder of the urinary bladder in the kidneys, hydronefrosis (enlargement of the kidneys with paranoiated damage) and, accordingly, impairment of renal foci can enter the process of chronic renal failure. .
When patients apply with these complaints, a careful anamnesis, physical examination and some tests are applied. The patient's anamnesis is determined by the symptoms of prostatism and what severity it is. After thorough general physical examination, it is necessary to do a finger rectal examination and examine the prostate. Then, in order to be able to evaluate the patient's objective, the urine flow rate should be examined, the symptom score questionnaire developed by the American Urology Association (AUA) should be evaluated, the amount of residual urine is measured after the bladder, the prostate Size, the patient's PSA level is determined by measuring the height of the prostate biopsy should be performed and imaging methods and the upper urinary tract and bladder should be examined.
The AUA symptom score consists of the evaluation of symptoms ranging from 0 to 35, and is the most important tool used to assess patients. The 0-7 is mild degrees, 8-19 medium degree, and 20-35 expresses severe symptoms. Urflowmetry (Pee Test) is a tool that measures the speed of the computer-assisted urine flow. The urine flow rate of a person with Normal access is 20ml/sec. The values below this indicate the output resistance.
Treatment options in benign prostate growth;
FOLLOW-Up is a good choice for patients who want to wait until their complaints become apparent in cases where the symptoms of prostate enlargement are mild. Preventive measures can be taken. These are like dietary regulations, reducing alcohol, preventing constipation, having a regular sexual intercourse, preventing long-term sitting and reducing excessive water drinking before bedtime.
DRUG THERAPY: Drugs that relieve the urinary bladder output i.e., by opening the neck of the bladder, the medications that slow the growth and bleeding of the prostate with hormonal suppressants, and herbal remedies that affect both ways.
In medical treatment, drugs that reduce the volume of the prostate by preventing the conversion of testosterone from alpha-blockers and 5-alpha reductase inhibitor to dihydrotestosterone are utilized. Alpha blockers reduce the resistance of the output by preventing the contractivity of the smooth muscle cells in the prostate strobe and bladder neck. The side effects of these drugs are dose-dependent and orthostatic hypotension, dizziness, fatigue, retrograde ejaculation (back of the semen), rhinitis and headache. Nowadays, the side effects that we count together with the development of ALFA1A receptor specific drugs have decreased.
5 alpha reductase inhibitors can provide a reduction in symptoms with a decrease in the size of the prostate. However, for these drugs to take effect, the size of the prostate should be greater than 40cc. The most important side effects are impotence, loss of libido (decrease in sexual request) and decrease in semen volume. In addition, a 50% decrease in PSA values makes cancer detection difficult, the measured PSA value of patients using the drug should be multiplied by 2.
Nowadays, drugs made from plant extracts called phytotherapy are also used in BPH. Chopped palm tree fruit, Pygeum afrinacum's bark, Echinaccea purpurea and Hypoxis rooperi, a few plant extract containing the root has been promoted in Europe. The mechanism of action of these phytotherapy is unknowable, but its reliability and effectiveness are not tested with multicentric, randomized, double-blind, placebo-controlled trials.
SURGICAL TREATMENT: There are severe signs of benign prostate growth, medical treatment does not suffice, blood comes to urine, inflammation of the urinary tract (cystitis, prostatitis) in the bladder, the complete cessation of urine flow (probe And the onset of renal failure, surgical treatment is planned.
Surgical treatment alternatives;
TUR-P (TRANSURETHRAL PROSTATE RESECTION):
In other words, closed surgery is a common surgical method in benign prostate growth (BPH). Bipolar Energy is applied with plasmachinetic energy or monopolar energy. The enlarged tissues are removed by cutting these energy sources. This surgery, which is quite confured, does not have any incision or suture outside the body, until the last two to three days, the patient stays in the probe and the duration of hospital stay is an average day. After a well-made TUR-P (closed surgery) surgery, it is seen that many years of complaints have improved rapidly. Following the surgery, he can easily maintain his daily life activities.
OPEN PROSTATECTOMY (OPEN SURGERY):
It is valid in the treatment of patients with a very large (over 100-150 grams) prostate. The prostate is removed by an incision under the abdomen. The disadvantage is the risk of bleeding, prolonged hospitalization and the duration of the probe.
TRANSURETHRAL INCISION OF THE PROSTATE (TUIP)
This procedure is applied in patients with moderate or mild symptoms, and the prostate is inoculation with the help of electrocation from the posterior alignment. Small well-chosen patients with prostate size benefit from this procedure. In this process, the prostate is not removed and there is a high risk of postoperative repeated prostatism symptoms. The advantage of the process is short-term and the relative decrease of morbidity.
Nowadays, laser use has become widespread in prostatectomy with the increase in the use of lasers. The working principle of lasers is the stimed emission of radiation. There are 4 types of lasers used as prostate treatment (Nd YAG laser, KTP, Ho YAG LASER, DIODE LASER). The effect of lasers on the prostate is the way of coagulation or evaporation. In these ways, prostatectomy can be done by providing bleeding control. The length of hospital stay is shorter than other methods. Patients may have complaints of postoperative dyspuria (burning in the urine) or late-term bleeding. The advantage of this method is that it is an alternative to patients with bleeding disorder and not suitable for spinal or general anesthetics.
Patients with non-treated, late benign prostate enlargement will increase the intra-bladder pressure because the urinary flow of urine from the bladder decreases due to the pressure of the prostate. This increased intra-bladder pressure can cause kidney failure by stretching the bladder, thickening in the muscles first, and slimming in the advanced period; the urinary excretion into the kidneys.
The weakness in the bladder muscle, the postvoiding residence (PVR) in the bladder, which now leads to urine. The presence of urine in the bladder is a potential risk for infection, which can reach up to the urinary tract, kidneys.
Patients with severe complaints of benign prostate enlargement are delayed for surgery; urinary bladder and urinary tract can lead to permanent, non-recyclable damages and to sustain quality of life at a higher level Important.
Apart from this, our patients; To avoid oversight of an underlying prostate cancer; after the age of 50 (if you have a relative diagnosed with prostate cancer in your family, after the age of 40) we periodically recommend PSA Measurement and urology examination every year.
With the development of today's technological conditions, benign prostate enlargement and prostate cancer can be treated fairly quickly.