At What Size Of Prostate Does Surgery Require?

One of the questions frequently asked by patients who are monitored for prostate enlargement is after what volume the prostate should be operated. When deciding on prostate surgery, just the size of the prostate is not enough. In addition, the size of the prostate is also a relative concept.

Should a large prostate be removed?

A large prostate volume alone is not an alarming sign. The larger the prostate, the greater the likelihood of needing surgery. However, a patient whose prostate volume is large, who is diagnosed with benign prostatic hyperplasia after the necessary blood and examination, and who has a good urine flow rate and empties his bladder well, will not undergo surgery just because the prostate volume is large.

When should prostate surgery be performed?

Prostate surgery is performed for two main reasons; prostate cancer and benign prostatic hyperplasia. Surgery is necessary for benign prostatic hyperplasia;

• Symptoms that continue despite drug treatment and affect quality of life
• Formation of stones in the bladder
• Bleeding in the urine due to prostate hyperplasia
• Recurrent urinary tract infections
• Inability to empty the bladder
• Deterioration in the kidney structure and kidney failure due to prostate obstruction
• Patients who have a catheter inserted as a result of complete obstruction of the urinary tract.

What happens if prostate surgery is delayed?

If there is partial or complete obstruction in the bladder outlet due to benign prostatic hyperplasia, treatment is necessary. In cases where there is no response to drug treatment, surgical intervention is required. If these surgeries are delayed;

• Recurrent urinary tract infections
• Deterioration in the bladder muscle structure (sometimes paralysis may develop in the bladder muscle as irreversible deterioration)
• Bladder stones
• Kidney failure
• Persistent urinary bleeding
• Deterioration in quality of life may occur.

Is surgery necessary for prostate enlargement?

Not every prostate enlargement requires surgery. Patients who have a large prostate volume, have moderate symptoms, have a good urine flow rate, empty their bladder well, and do not urinate frequently do not need surgery. These patients can be given auxiliary medications if necessary.

Can prostate come back after surgery

With laser prostate surgeries (Thuflep, Thulep and Holep) that we frequently use nowadays, the possibility of recurrence of benign prostatic enlargement is very low. However, the possibility of recurrence is higher in other endoscopic methods such as TUR-P. Laser prostate surgeries are advantageous in this regard.

Does the prostate shrink on its own?

It is very rare for the prostate to shrink on its own. Since the mechanism of its growth is not fully understood and hormonal effects are blamed, hormonal withdrawal due to aging may also be effective in its shrinkage.

Does the prostate shrink with medication?

5 alpha reductase inhibitors used in the treatment of benign prostatic hyperplasia can cause approximately 20% reduction in prostate volume after long-term use. However, these drugs must be used for at least 6-12 months to show this effect. They also have side effects that cause loss of erection. For these reasons, they are not drugs with good patient compliance. Some hormone suppressing drugs used in the treatment of prostate cancer can also cause reduction in prostate size, but again due to various side effects, they are not approved for use in the treatment of benign prostatic hyperplasia.

What is the alarming size of the prostate?

In prostate diseases, we decide whether there is a pathology that requires treatment; with examination, PSA measurement, urine flow rate testis (uroflowmetry) and, if necessary, ultrasonography or MRI. Having a large or small volume prostate does not have any significance on its own for both prostate cancer and benign prostatic hyperplasia.

Normal prostate volüme by age

The normal volume of the prostate according to age is also one of the frequently asked questions. It is known that the prostate volume of a young adult male is 15-20 ml. This increases with hormonal exposure with age. Although it is not correct to give an exact figure, prostates with a volume of 25-30 ml in the 50s are generally considered normal. However, we often come across men with larger prostate volumes due to genetic and familial characteristics.

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