İyi Huylu Prostat Büyümesi

Benign Prostate Hyperplasia

The prostate is a small gland located in the male reproductive system that surrounds the urethra (external urinary tract), which is a structure that expels urine, right after the bladder. Most of the semen fluid in which sperms (fertilizer cells) are carried is formed in the prostate gland. During intercourse, muscle spasms evacuate the fluid in the prostate into the urethra, and this fluid (semen) helps the sperm to be alive and active in the vagina. Prostate gland theoretically begins to enlarge microscopically by the age of 30. However, by middle ages, radiological and clinical symptoms related to prostate enlargement appear. This condition is called Benign Prostate Hyperplasia (BPH). When the prostate enlarges, it causes difficulty in urination by narrowing the external urinary canal (urethra) that it surrounds. As a result, the bladder wall thickens to overcome this narrowing and becomes more sensitive to urine accumulation. Thus, even a smaller amount of urine accumulation causes contractions in the bladder and the patient urinates more frequently. If the bladder is left this way for a long time, irreversible damage occurs in the bladder and it becomes unable to empty its contents completely, and residual urine begins to remain in the bladder. This reduces the functional capacity of the bladder and can lead to complications such as recurrent urinary tract infections. In this advanced stage of benign prostate hyperplasia, the patient’s quality of life will be deteriorated, urinary incontinence will be present, and the success rate of medical or surgical treatments will be decreased. For this reason, it is recommended that BPH, which is not a cancerous condition but occurs as a result of aging, should be monitored closely and every man by the age of 40 should be checked-up by a urologist.

What Are the Signs of BPH?

  • Difficult urination, delay in starting urination
  • Cessation and resumption of urination
  • Dripping more than normal at the end of urination
  • Feeling incomplete after urinating
  • Waking up to urinate at night
  • Difference in urine flow/calibration compared to the past
  • Sudden urge to urinate and sometimes incontinence
These signs are related to BPH. However, they do not have to be observed at the same time. It is recommended that men with one or more of these symptoms apply to a urologist.

What Are the Tests to Be Done for BPH?

As stated in the 2018 European Urology Guidelines, a number of tests should be performed on a patient who presents with complaints considered to be related to BPH:
  • Digital rectal exam
  • Urinalysis
  • Blood PSA, urea and creatinine levels
  • Urinary tests (urine flow rate and residual urine measurement)
  • Urinary ultrasonography for the examination of the kidneys, urinary tracts, bladder and the prostate
  • Urodynamic studies if needed (a study that evaluates the flow and storage functions of the bladder)

Treatment of BPH

The condition that requires treatment in BPH is not the prostate enlargement, but the complaints related to the blockage of the bladder outlet. Even if the prostate is enlarged, it may not block the bladder outlet and treatment may not be required. However, on the contrary, a slightly enlarged prostate may cause obstruction in the urinary bladder outlet that requires treatment.

If the quality of life is negatively affected by the symptoms mentioned above or bladder outlet obstruction due to BPH, treatment is required.

Treatment Options:

  • Surveillance: It is performed at regular intervals to follow-up complaints and evaluate bladder outlet obstruction. Patients with mild complaints, normal PSA values and no suspicious prostate examination can be included in the annual follow-up protocol.
  • Medical Treatment: Treatment is provided by using drugs that relax the smooth muscles in the prostate and bladder outlet or by drugs that facilitate urinary flow with hormonal effects. Thanks to these drugs, complaints can be improved and urine flow rate can be increased.
  • Surgical Treatment (Endoscopic or Open Prostate Surgery)

Indications for Surgery:

  • Inadequate response to medical treatment
  • Severe complaints and very poor quality of life
  • Recurrent urinary tract infections due to BPH
  • Recurrent obstructions due to BPH (being unable to urinate)
  • Hematuria

In the presence of these indications, prostate surgery is recommended. Today, thanks to technological developments, endoscopic surgeries are the most widely used surgical techniques. Prostate surgeries performed with the open surgical method (with an incision through the skin) are performed if the size of the prostate has drastically increased and are rarely preferred.

Techniques that have proven successful among endoscopic (closed system) surgeries and are recommended in European Urology Guidelines are TUR (monopolar, bipolar) and Laser Prostate surgeries. In all endoscopic prostate surgeries, the prostate tissue is cut/vaporized and taken out of the body by entering through the external urinary canal with a camera system. Although many endoscopic prostate surgery methods have been described, the techniques with proven mid-to-long term success are TUR, Green Light Laser and Holmium Laser Prostate Surgery in larger prostate sizes.

Prof. Dr. Hakan KOYUNCU