What is the Prostate and What are its Functions?

It is a gland tissue approximately the size of a walnut (10-20gr) that passes through the external urinary tract, located just below the urinary bladder in men. The prostate gland secretes the fluids necessary for sperm cells in the semen. What are the Most Common Prostate Diseases? Prostatitis (Inflammation of the Prostate Gland) is an inflammatory disease of the prostate tissue and the most common symptoms are fever, weakness, pain, burning during urination, difficulty urinating, sudden urgency, painful ejaculation and erectile dysfunction. It usually improves with medical treatments.

Benign Prostate Enlargement What is Benign Prostate Enlargement?

As the prostate gland grows with age, it compresses the urinary tract passing through it, resulting in urination problems. Problems increase in the 50s and 60s. Its incidence increases with age. Early diagnosis and treatment of benign prostatic hyperplasia protects against kidney failure, urinary incontinence, bladder stone formation, and bladder cancer due to chronic irritation. In addition, it significantly improves the life comfort of patients.

What are the symptoms?

Frequent urination, frequent urination at night (more than 2) Sudden urge to urinate, urinary incontinence Burning or bleeding in the urine Weakening of the urine stream Difficulty urinating Intermittent urination Feeling of not being able to fully empty the bladder and dripping at the end of urination.

Prostate Enlargement is Most Often Confused with Which Diseases?

External urinary tract strictures and stones Bladder tumor Urinary tract infection Overactive bladder Neurogenic bladder Pelvic pain syndrome Bladder stones.

How is Benign Prostatic Enlargement Diagnosed?

The first evaluation is made based on the medical history and complaints of the incoming patient. Physical examination and when necessary; PSA (prostate specific antigen) test, Uroflowmetry (urine flow rate), Ultrasonography, Cystoscopy (examination of the external urinary tract and bladder with a special tool) are used. How to Treat Benign Prostate Enlargement? Treatments for benign prostatic hyperplasia: Close monitoring Drug treatment Focal treatments (REZUM) Surgical methods (TUR-P, Prostate Vaporisation, HOLEP) Drug Treatment Alpha blocker (channel expanders) 5alpha reductase inhibitor (prostate shrinker) Muscarinic receptor antagonists (to reduce frequent urination) Pd5 inhibitor (urination difficulty in erection and erectile dysfunction) Phytotherapy (herbal treatment) Combination treatments Focal Treatments (Rezum) What is Rezum? In patients with benign prostate enlargement, the prostate tissue is reduced in size with the water vapor generated as a result of thermal energy and the part blocking the urinary tract is opened. Under local or sedoanalgesia, resum is entered through the urinary tract (closed) with a camera and water vapor is injected into the (closed) prostate tissue with a needle, destroying the tissue and opening the part blocking the duct.

What is the difference between rezum?

Rezum is the ideal choice for elderly patients who have health problems that prevent them from having surgery or who do not want to take the risk of anesthesia. The procedure takes 10 minutes and there is no need to stay in the hospital after the procedure. Recovery after the procedure and return to daily life are faster than after surgery. In young patients, the risk of retrograde ejaculation, which is common after surgery, is almost non-existent. The effect of Rezum usually becomes evident in 2-3 weeks, but this period can last up to 6 weeks. Rezum has protective properties for the external urinary tract.

Rezum has been administered to over 35,000 patients in developed countries since 2017. Surgical Methods Transurethral Prostate Resection (TUR-P) is an endoscopic (closed) surgical method that is considered the most commonly applied gold standard technique in the surgical treatment of benign prostatic hyperplasia (BPH). How is Transurethral Prostate Resection (TUR-P) Surgery Performed? Under general or spinal anesthesia, a special tool is entered through the external urinary tract, accompanied by a camera, and the prostate tissue is cut into small pieces and removed. It can be done with two energy sources: monopolar and bipolar.

Bipolar energy can be used safely in patients with pacemakers because no electrical current passes through the patient's body. Today, the most commonly used energy source in TUR-P methods is bipolar energy. After the operation, a catheter is placed in the urinary tract for 2-3 days. Since the surgery is performed by the endoscopic (closed) method, no incisions are made. Therefore, recovery is very rapid. Patients start eating and drinking 6 hours after the surgery and are generally discharged on the 2nd day. Prostate Surgery with Holep What is Holep? (Prostate Enucleation with Holmium Laser) It is a surgical method using advanced laser technology in the treatment of benign prostate hyperplasia (BPH). It is a closed procedure that can clean and remove the entire part of the prostate tissue that covers the urinary tract. Prostate surgery with Holep is a comfortable method.

What are the Benefits of Holep Surgery?

Even for very large prostates, the procedure is performed without making any incisions on the body. It is an alternative method to open surgery. The possibility of having surgery again is almost non-existent. It does not harm sexual functions. There is no need for blood transfusion during the surgery. In necessary cases, the procedure can be performed even in people using blood thinners. Since it is applied with the principle of laser separation in patients whose catheter is removed after surgery, the patient whose catheter is removed does not experience a burning sensation while urinating. Holep surgery; Since it offers advantages such as low bleeding risk, short hospital stay and rapid recovery period, patients can return to their normal lives in a short time. The nerves that regulate sexual functions are not damaged. Therefore, patients are not expected to have erection problems after surgery. Since no burning defect develops in the tissues removed after surgery, pathologists can examine the tissue more easily and the possibility of missing possible malignant formations decreases.

Who is Holep Surgery Suitable for?

The majority of patients with prostate disease who are considered for surgery are suitable for Holep. Holep is a suitable surgical method for anyone who needs prostate surgery. The Holep technique is applied safely. In the presence of bladder stones accompanying prostate enlargement, it is successfully applied in the same session, and the stones can be broken with a closed laser at the same time. Again, in patients with stenosis in the urinary tract, this stenosis can be opened with laser during the procedure. It can be applied more safely than other techniques in patients with cardiovascular diseases, those who have a stent in their cardiovascular system, those who have undergone bypass, or those who use blood thinners due to vascular occlusion. 

How is HOLEP surgery performed?

General anesthesia or spinal anesthesia (anesthesia from the waist down) is performed. It is performed by entering the urinary tract with an endoscope. Since no incision is made, the patient can return to daily life very quickly. The growing prostate tissue is carefully separated from the capsule by laser and thrown into the bladder. The prostate tissue thrown into the bladder is broken up with another tool (morcellator) and vacuumed and taken out of the body. The procedure is terminated by inserting a catheter. The removed prostate tissue is sent to pathology to evaluate the possibility of possible cancer. Generally, patients start eating and drinking 6 hours after the surgery and are usually discharged on the 2nd day.

Kiss. Dr. Serhat Ozgun

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