After a certain age, the subject that people talk about the most is diseases. When it comes to illness and medicine, everyone loves to pass on their own experience. Among the topics discussed, cardiovascular diseases come first. This is followed by uterine and chest diseases in women and "prostate diseases" in men. In men over the age of 45, prostate enlargement begins due to hormonal changes in the body, and 50 percent of men over the age of 60 and 80 percent of men aged 70-80 have prostate enlargement (BPH - Benign Prostate Enlargement). The prostate is part of the male reproductive system and is the size of a walnut. It is a gland that weighs approximately 20 g and is 3.5 x 2.5 cm in size. This organ is part of the male reproductive and excretory system. The prostate is located just in front of the rectum and in the lower part of the bladder where urine collects. The prostate also surrounds the urethra, the canal through which urine passes. The prostate aids in reproduction. It adjusts the acid-base ratio of semen and sperm motility. With prostate enlargement, the urethra narrows and as a result causes various complaints.
Complaints caused by prostate enlargement:
frequent urination,
Don't get up to urinate at night
Feeling as if you are constantly urinating
Inability to fully relax, even after urinating
Feeling burning while urinating
intermittent peeing,
bleeding urine
Urinating in a fringed-forked style by scattering,
Difficulty urinating
Decreased urine flow
Difficulty urinating, incontinence
In fact, even if a man over the age of 45 does not have any complaints, he should be examined by a urologist once a year. First of all, it is determined how much the patient is affected by prostate enlargement by listening to the patient's complaints. It should be determined whether there are other diseases associated with it. Then, the patient undergoes a detailed physical examination. Digital rectal examination, srotal and penile examination, and whole body physical examination should be performed. The size of the prostate is not proportional to the complaints. In other words, a small prostate will cause many complaints, while a large prostate may not cause a problem in the patient. The reason is whether the prostate is infected or not and the presence of the prostate middle lobe.
Many tests that vary from patient to patient are applied to diagnose BPH. Complete urinalysis, urinary system ultrasonography, direct urinary system radiography, biochemistry tests including kidney functions and urine flow rate test are the most frequently applied tests. Intravenous pyelography (IVP) has a place in very special situations. It no longer has a place in the routine like it used to be.
Prostate cancer, urinary infection, bladder dysfunction, diseases that reduce bladder capacity, urethral strictures, stones stuck in the urethra, and bladder tumors extending to the bladder neck will also cause voiding problems, so care should be taken when making a diagnosis. It should not be confused with the complaints of prostate enlargement.
• Medication
• Closed Prostate Surgery (TUR)
• Open prostate surgery
• PV Laser System (Photoselective Vaporization Method of Prostate)
There are different approaches to treatment for each patient. Which of these treatment options will be appropriate is decided by considering the patient's age, general condition, degree of complaints, and laboratory data. Of course, the first option should be medical. However, in cases where there is no complete response from medical treatment, or patients who cannot (unwillingly) use drugs, surgical treatment is recommended. If the patient has a catheter, if there is hydronephrosis in both kidneys, if there is a large amount of residual urine, emergency surgery is recommended as the first choice before medical treatment is started.
In a patient for whom both medical and surgical treatment is planned, prostate cancer should be ruled out first. For this, a prostate specific antigen (PSA) test should be performed in the blood. If it is higher than 4 ng/ml, which is the upper limit of the normal value, pathological evaluation should be performed with prostate needle biopsy. If organ-confined prostate adenocarcinoma is detected, complete treatment will be provided with radical surgery. Therefore, early diagnosis is important. If the PSA is high and the pathology is not malignant, it is either due to prostate inflammation, the tumor could not be reached, or the prostate is too large.
No medical treatment has yet been as successful as surgical treatment. Among the surgical treatments, the most frequently used and accepted gold standard surgery technique is "transurethral prostatectomy", that is, TUR-P. Under anesthesia, a device is entered through the urethra, and the prostate tissue, which causes obstruction around the urinary tract, is cut using electric current and taken out of the same channel in pieces. It is a very effective method in small and medium-sized prostates. The patient usually stays in the hospital for one day, there is no need for blood transfusion and it gives effective results. Open surgery is still used in very large prostates. Open surgery has a higher complication rate.
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