Scientifically, the cause of prostate enlargement (benign prostatic hypertrophy, BPH) has not been fully elucidated. The effect of testosterone, which is the male hormone, and the deterioration of hormonal balance with aging are blamed.
Benign prostate enlargement surgery (prostatectomy) requirements are as follows;
If the patient with signs of obstruction due to prostate enlargement is not operated on time, kidney failure, bladder stones and complete obstruction, the necessity of insertion of a catheter, serious urinary system infection, deterioration and formation of pockets (diverticulum) in the bladder wall due to long-lasting obstructions. In delayed patients, the benefit of prostate surgery is limited when permanent deterioration of the bladder wall and chronic kidney failure occur.
When to be operated on prostate enlargement is listed above. The need for surgery for the prostate is not directly related to its volume, grams or size. Of course, the larger the prostate volume, the greater the possibility of surgery.
However, sometimes 40-50 cm3 prostate can cause obstruction, sometimes around 100 cm3 prostate does not cause any symptoms and does not require surgery.
The main cause of the problem in prostate enlargement is that the prostate closes the urinary canal (urethra) and makes it difficult to urinate. The target of endoscopic prostate surgery is these prostate tissues. The prostate is reached by entering through the tip of the penis with a camera and optical instruments, and the prostate tissues blocking the urinary tract are removed by various energy methods (laser, plasma kinetic, electrocautery, water vapor).
It is a type of endoscopic prostate surgery. The advantage is that it can remove more prostate tissue. It provides good bleeding control, short hospital stay, short catheter time and fast recovery. Prostate surgery performed with a holmium laser is abbreviated as HOLEP. Laser prostate surgery performed with Thulium laser is called ThuLEP. They have no advantage over each other.
Please contact us for endoscopic prostate surgeries to be performed at Doruk Nilüfer Hospital, one of the most modern comfortable and equipped with superior medical devices in Turkey.
Please contact us for THUFLEP surgery. It is a novel laser system for laser prostatectomy and have low side effect about erectile function and continance.
Endoscopic prostate surgery with the TUR-Prostatectomy (TRANSURETHRAL RESECTION OF PROSTATE) method is also an effective surgical method, especially in benign prostate enlargement below 80-100 cm3. Its advantage over HOLEP is that it is less costly and is the classical method known by most urologists. The HOLEP (laser prostatectomy) method, on the other hand, provides an advantage with more tissue removal and less bleeding.
It is performed by shrinking the enlarged prostate tissue that blocks the urinary tract (urethra) with water vapor. It is a endoscopic prostate surgery performed by entering from the tip of the penis, as in the TUR-P, HOLEP and ThuLEP methods. The advantage is that the procedure takes a short time and can be performed even with local anesthesia. This provides an advantage in very elderly patients with high risk of anesthesia. Please contact us for comfortable REZUM treatment at Doruk Nilüfer Hospital.
The ideal method varies according to the prostate volume, general condition of patient, age and expectations of each patient from prostate surgery. In addition, the ability, experience and interest of the urologist related to this job are also decisive. For more information; Which is The Best Methode for Prostate Surgery?
In endoscopic prostate surgeries, the probability of recurrence is almost non-existent in patients in whom the right method is chosen. Recurrence is not expected in the short and medium term in TUR surgeries performed by experienced urologists for prostate patients with a volume of 80-100 cm3 and in laser enucleation (HOLEP, TULEP, THUFLEP) surgeries for prostates with larger volumes.
Endoscopic prostate surgeries for prostate enlargement are not difficult surgeries in today's conditions. It can be applied comfortably with both regional (spinal anesthesia) and general anesthesia. The possibility of serious bleeding is very low with new generation laser systems.
Endoscopic prostate enlargement surgeries (TUR, HOLEP, ThuLEP) generally take 45-60 minutes.
After endoscopic prostate surgeries, the patient is usually hospitalized for 1-2 days. Rarely, this period may be extended.
Endoscopic prostate surgeries provide rapid recovery. The patient starts to return to his normal life after about 3-5 days.
Of course, there are some risks in prostate enlargement surgeries, as in any surgical method. If the risks related to anesthesia and surgical stress are left aside; Mostly solvable problems such as bleeding, infection, temporary urinary incontinence, temporary inability to urinate may develop.
Prostate enlargement surgery fees vary according to the method performed, the factors of the patient, the hospital's hotel services and the factors of the surgeon.
Trans Urethral Resection of Prostrate (TURP) in Turkey costs about $4000.
Laser enuclation of prostate (HOLEP, ThuLEP) in Turkey costs about $4000-6000.
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Especially in endoscopic prostate surgeries performed with laser such as HOLEP and ThuLEP or TURP, there is an average of 1-2 days of cathater residence time. Therefore, endoscopic prostate surgeries are very comfortable.
It is important not to be constipated, not to lift heavy and not to have sexual intercourse in the first 1 month, as pushing after endoscopic prostate surgeries will increase the possibility of bleeding. Therefore, fibrous foods, vegetables and fruits should be consumed abundantly rather than just solid nutrition.
Walking for 1 hour daily will increase intestinal motility and should be done. Sitting too much is also not recommended, and it increases the pressure on the prostate area. Water consumption should be adjusted to be 3 liters on average and in a balanced way. Thus, the coagulation in the bladder that will occur after the surgery is also reduced.
Burning on urination, clouding of urine color and bleeding to the extent of pinkness, which last for several weeks, can be seen in most patients and these should not worry you. It is also normal for clots to come from time to time. The possibility of serious bleeding and inability to urinate after endoscopic prostate surgeries applied with laser is extremely low.
Bleeding after prostate surgery: As I mentioned above, slight changes in urine color are not significant and will pass within a few days. However, you should contact your doctor in case of ongoing fresh red bleeding and heavy clots in the urine and inability to urinate due to these clots.
Inability to urinate after prostate surgery: It is a rare condition and mostly develops due to the accumulation of clots in the bladder and edema. After medical treatment and 1-2 days of extra probe treatment, the problem will be resolved.
Urinary incontinence after closed prostate surgery: The probability of permanent urinary incontinence in endoscopic prostate surgeries performed for benign prostatic enlargement is 1%. This problem mostly develops after prostate cancer surgeries. Temporary urinary incontinence for a few days should be ignored.
Approximately 50% of patients who have undergone endoscopic prostate surgery due to prostate enlargement may experience ejaculation at the end of sexual intercourse backwards (to the bladder). This situation is not related to erection mechanism which is not impaired.
Another undesirable but possible side effect is urethral stricture. Studies have shown that urethral stenosis may occur in the medium and long term at a rate of 7% after endoscopic prostate surgery.
The probability of experiencing erectile dysfunction after endoscopic prostate surgeries due to benign prostate enlargement is close to zero. The public's concern, "Will my erection deteriorate after prostate surgery?" is unfounded.
Erectile dysfunction develops not after prostate enlargement surgeries, but after surgeries performed for prostate cancer. However, benign prostate surgeries may cause enlargement of the bladder neck, disrupting the forward throwing action of the semen that occurs at the end of sexual intercourse and may cause it to escape a little backwards (retrograde ejaculation). This deterioration is almost absent in REZUM surgery.
We recommend that you avoid sexual intercourse for the first month after laser or TUR-P surgery for prostate enlargement (BPH),as it will increase the risk of bleeding. Then there is no need to constraint.