It is the enlargement of the prostate, which is the organ located between the bladder and the urethra, and forcing the urine flow.
Benign prostatic hypertrophy (BPH),which is seen in one of every two men over the age of 60, is a pathologic disorder that usually requires treatment. It can also lead to serious diseases such as kidney failure and bladder stones with an important deterioration in quality of life.
The most common benign prostatic enlargement symptoms are weakening of the urine stream, urinating by straining, scattered and forked urination, long duration of urination, frequent urination during the day or night, painful urination (dysuria),urinary incontinence. Sometimes there may be visible bleeding in the urine. One or more of them can be seen.
If you have the above-mentioned symptoms or any other urinary tract related symptom you think, you should apply immediately. It is also known that the second most common cancer in the male gender is prostate cancer. If there are no symptoms, every man over the age of 50 should definitely visit a urology speacialist for early and low stage diagnosis.
This visit should be after the age of 45 for individuals with a family history of prostate cancer. Your doctor will tell you the next control time interval according to your personal risk.
The disease can progress insidiously without showing any signs of benign prostate enlargement and especially prostate cancer. Your doctor will perform the necessary tests and examinations for both early diagnosis and differentiation of these diseases.
When you apply to your doctor for prostate diseases, he will suggest you various tests for both correct diagnosis and treatment. Although these vary according to the characteristics of each patient; kidney function tests (urea, creatinine),urine analysis, PSA (prostate specific antigen),uroflowmetry (the test that measures the urine flow rate) and ultrasonography are the most frequently requested tests.
Apart from the tests, examination of the prostate has great importance, especially in the differentiation of benign prostate enlargement and prostate cancer. Since the prostate is located just in front of the rectum, which is the part of the large intestine close to the exit, its examination can be easily done from the anus with a finger. However, it is obvious that this situation also causes concerns in patients, especially in some societies.
I would like to state that the worries and fears in the prostate examination are mostly improper. This examination can be done painlessly within seconds. Moreover, considering that it is very valuable for the early diagnosis of cancer, it should be known that it is very beneficial for our patients.
It is a fact that we urology physicians frequently encounter the existence of patients who have symptoms but do not apply to the doctor just because of the fear of finger examination. I recommend our patients who have concerns about this examination and do not want to have it done in any way, to apply to their urology physician.
Do not forget that your doctor will not perform any tests or examinations that you do not want. Even without this examination, your doctor will try to diagnose and treat you with other tests.
Patients with mild symptoms and no serious deterioration in life comfort can be followed up at certain intervals without recommending medication or surgery. We can make some suggestions about lifestyle for such patients. These are generally;
The main main group drugs; alpha blockers, 5 alpha reductase inhibitors and phosphodiesterase 5 (PDE-5) inhibitors. Sometimes anticholinergics and desmopressin-containing drugs can be added to the main group of drugs to relieve symptoms and improve quality of life.
Alpha-blocker drugs are aimed at making urination more comfortable by causing relaxation in the smooth muscles that move from the bladder neck to the prostate. It has no therapeutic properties. Since the effect will end after 24 hours, they will need to be used 1 daily. They do not have obvious advantages over each other in terms of both symptom relief and side effect profiles.
The most common side effects are dizziness, fatigue, nasal congestion and reflux of semen. These side effects are not seen in the majority of patients and will usually be mild and disappear over time. In case of serious side effects, your doctor will either change the active ingredient or the surgical method will be considered in the treatment plan.
Although 5 alpha reductase inhibitors have therapeutic properties, they can show these effects after months. With the hormonal effect they make, they can stop the enlargement of the prostate and miniaturize it. However, with the mentioned hormonal alteration, they can also cause some side effects (erectile dysfunction and sexual reluctancy).
Phosphodiesterase 5 inhibitors act on smooth muscles and provide comfortable urine output, like alpha blockers. At the same time, they have a therapeutic side on erectile dysfunction. This feature makes PDE-5 inhibitors advantageous over other pills. Tadalafil is the only FDA-approved PDE5 inhibitor for prostate enlargement.
Although the decision is made according to each patient's own specific situation, the conditions of necessity for surgery in benign prostate enlargement are as follows;
The choice of the surgical method should be decided according to the specific situation of each patient. Although new energy methods have been developed for endoscopic removal of prostate tissue, the gold standard surgical method in benign prostate enlargement below 80-100 cc volume is TUR-P (transurethral resection of the prostate),which is applied with plasma kinetic energy both in Europe and in other developed countries of the world.
In patients with larger prostates(>100-150 cc),the two most commonly used methods are open prostate surgery (open prostatectomy),laser enuclation of prostate method (HOLEP (holmium laser) or THULEP (thulium laser). Both have several advantages over each other. The surgeon's experience with the methods, the patient's suitability for these methods and the technical condition of the hospital are important in the selection of these methods.
Benign prostate surgeries, like all other surgical methods, have some undesirable side effects. The situation that is often misunderstood in the society is that after these surgeries, erectile dysfunction will occur and the patient's sexual life will deteriorate. This information is not correct.
There is almost no possibility of erectile dysfunction after benign prostatic enlargement surgeries. Only a limited number of patients may experience some orgasmic disorder due to the semen going into the bladder rather than forwards. In addition, the probability of urinary incontinence after these surgeries is around 1-2%.
Both erectile dysfunction and urinary incontinence problems are not seen in benign prostate surgeries, but they can sometimes be encountered in prostate cancer surgeries.
Urethral stenosis that can be seen after benign prostate surgeries is one of the most annoying conditions. Although it can be seen up to 10% after endoscopic methods, this rate is around 2% after open prostate surgeries.
In order to minimize the development of urethral stenosis and to ensure that the patient does not need surgery again, the correct selection of the first operation method, the experience and ability of the surgeon, and the technical equipment of the hospital should be at a high level. Apart from all these, patient factors are also important.
Wound healing process depending on the patient's heart health status, smoking consumption and genetic characteristics will also affect whether urethral stenosis will develop or not.
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Note: Page contents are for informational purposes only and a doctor's application is required for your diagnosis and treatment.