What is benign prostatic hyperplasia and what are the treatment methods for benign prostatic hyperplasia?
Prostatic hyperplasia is an increase in the size of the prostate gland. The prostate goes through two major cycles of growth during a man's life. The first occurs when the prostate doubles in size early in puberty. The second stage of growth begins around the age of 25 and continues for the rest of a man's life.
BPH often occurs during the second growth phase. When the prostate becomes enlarged, it puts pressure on the urethra. To push urine out during urination, the muscles in the bladder wall become thicker.
In the future, because of this large inflation, the blood supply decreases, and thus the bladder may weaken and lose its ability to empty completely, leaving some urine in the bladder. Urethral stricture and urinary retention — the inability to completely empty the bladder — lead to many problems.
What is benign prostatic hyperplasia?
An enlarged prostate is called benign prostatic hyperplasia (BPH), and it occurs when the cells of the prostate gland begin to multiply. These extra cells cause the prostate gland to enlarge, pressing on the urethra and restricting the flow of urine.
Benign prostatic hyperplasia is different from prostate cancer It does not increase the risk of cancer. However, it can cause symptoms that can affect your quality of life. Although it does not cause cancer, BPH and cancer can occur at the same time.
Benign prostatic hyperplasia is very common. About half of men between the ages of 51 and 60 have BPH. It reaches 90% of men over the age of 80.
What is the prostate?
The prostate is part of the male reproductive system. The size of a walnut and weighs about 30 grams.
The prostate is located below the bladder and in front of the rectum. They are all the way around a tube called the urethra, which carries urine from the bladder out through the penis.
The prostate's main job is to make fluids that nourish the sperm.
During ejaculation, sperm from the testes travel into the urethra. At the same time, fluid from the prostate and seminal vesicles also travels into the urethra. This mixture - semen - passes through the urethra and exits through the penis.
Symptoms of benign prostatic hyperplasia
When the prostate becomes enlarged, it can disturb or block the bladder. A constant need to urinate often is a common symptom of BPH. This may be every one to two hours, especially at night.
Other symptoms of an enlarged prostate include:
- Feeling of fullness in the bladder even after urination.
- Feeling that urination "can't wait."
- poor urine flow
- The need to stop and start urinating several times.
- Difficulty starting urination.
- The need for intense pressure while urinating.
If BPH becomes severe, you may not be able to urinate at all. This is an emergency that must be addressed immediately.
How can benign prostatic hyperplasia or enlargement affect your life?
In most men, BPH increases with age, and this can lead to bladder damage or infection, and can cause blood in the urine or damage to the kidneys.
Causes of enlarged prostate in young and old people
The causes of BPH in young men and older adults are not well understood. Some researchers believe that factors related to aging and the testicles may cause BPH, because BPH does not develop in men who have their testicles removed before puberty.
Throughout life, men produce both testosterone, the male hormone, and small amounts of estrogen, the female hormone. As men age, the amount of active testosterone in the blood decreases, resulting in a higher proportion of estrogen.
Studies have indicated that BPH may occur because the increase in the proportion of estrogen in the prostate increases the activity of substances that stimulate prostate cells to grow.
indicate Another theory to Dihydrotestosterone (DHT), a male hormone that plays a role in the growth and enlargement of the prostate. Some research has shown that even when blood levels of testosterone begin to drop, high levels of DHT can still build up in the prostate.
This rise may prompt prostate cells to continue growing. Scientists have observed that men who do not produce DHT do not develop benign prostatic hyperplasia.
Who is at risk of benign prostatic hyperplasia?
Older age and a family history of BPH increases a man's risk of BPH.
Obesity, inactivity, and erectile dysfunction can also increase the risk.
Can benign prostatic hyperplasia be prevented?
There's no sure way to stop BPH, but losing weight and eating a healthy diet that includes fruits and vegetables may help reduce your risk of BPH.
Having a lot of fat in the body may increase the levels of hormones and other factors in the blood, thus stimulating the growth of prostate cells.
Staying active also helps control weight and hormone levels.
Diagnosing an enlarged prostate
See your doctor if you have symptoms that may be benign prostatic hyperplasia. Also see your doctor right away if you have blood in your urine, pain or burning when urinating, or if you cannot urinate.
Your doctor can diagnose BPH based on a personal or family history, a physical exam or medical exams.
The American Urological Association (AUA) has built a BPH Symptom Score Index. It is a series of questions about how often urinary symptoms occur. The BPH score rates from mild to severe.
Take the test and talk to your doctor about your results. You can scroll down and try the test. Your doctor will review the score of your symptoms and take a medical history.
You'll also undergo a physical exam, including a digital rectal exam (DRE). Your doctor may also want to perform some or all of these tests:
- Cystoscopy to look at the urethra or bladder.
- Residual volume of urine after emptying the bladder to measure the urine remaining in the bladder after urination.
- PSA blood test for prostate cancer screening.
- Ultrasound of the prostate.
- Urinalysis (urine test).
- Urinalysis to measure the speed of urine flow.
- Urodynamic pressure test of pressure in the bladder during urination.
- Urinary blood test to check for bladder cancer.
- Prostate-specific antigen (PSA) is a protein made only by the prostate. When the prostate is healthy, it secretes less PSA into the blood.
- By measuring the level of PSA in the blood, it is possible to predict the state of the prostate in the presence of prostate cancer. You should not ejaculate for two days before the PSA test. This is because ejaculation can raise the PSA level for 24 to 48 hours.
- Low PSA is better for prostate health. A rapid rise in PSA may be a sign that something is wrong. BPH is one possible cause of an elevated PSA level. Prostatitis is another common cause of an elevated PSA level.
Digital rectal examination
The DRE test is performed with the leg bent or lying on its side. The doctor places a finger in the rectum to feel the shape and thickness of the prostate. DRE can help your doctor find prostate problems.
Medicines used to treat benign prostatic hyperplasia
Alpha blockers, which relax the muscles of the prostate and bladder neck to relieve symptoms.
Examples of alpha blockers include:
- alfuzosin (Uroxatral),
- doxazosin (Cardura),
- tamsulosin (Flomax),
- Terazosin (Hytrin).
5-alpha reductase inhibitors (5-ARIs), which help shrink the prostate and prevent further growth.
These include dutasteride (Avodart) and finasteride (Proscar).
Phosphodiesterase 5 inhibitors (PDE5 inhibitors), which have been shown to improve prostate symptoms by increasing blood flow. Examples of available PDE5 inhibitors include sildenafil (Viagra, Pfizer).
Medications can help most men with an enlarged prostate, but for some, they may not always be enough to relieve symptoms such as poor urine flow.
When you're one of these men, you have surgical options to treat benign prostatic hyperplasia, or BPH.
5 Questions to Ask Before BPH Surgery
When you consider surgery options, ask your doctor these questions:
- Is there a good chance my condition will improve?
- What is the rate of improvement when treating benign prostatic hyperplasia?
- What are the chances of side effects of BPH treatment?
- How long will the side effects last?
- Will I need to repeat this treatment?
Using the latest technologies in Turkey, the doctor can perform the largest operations by making small incisions (such as robotic surgery), and sometimes he may not need these incisions, but the treatment is done through vascular or urinary catheters.
The choice of treatment method for BPH varies according to the patient's condition, and the extent to which the patient is affected by symptoms.
Minimally invasive operations for benign prostatic hyperplasia in Turkey
With the latest technology in treatment, an enlarged prostate can be treated without surgery, either by vascular catheterization or urinary catheterization; Through this method, the size of the prostate is reduced without the need to cut it or make any surgical incision.
Some types of minimally invasive surgery include:
First: The latest methods of treating prostate enlargement are thrombosis or catheterization
The vessels are entered through the inguinal artery under local anesthesia as in cardiac catheterization by interventional radiology. The arteries supplying the prostate are identified and then very small particles are administered to the vessels that supply the prostate with very thin tubes called catheters, and these vessels are closed.
Prostate tissues whose vessels are clogged gradually become smaller and the pressure on the urinary ducts that pass through the prostate tissue is relieved, so the problems caused by an enlarged prostate in the patient are significantly reduced or eliminated.
After embolization, the prostate shrinks but does not lose its vitality or function because it continues to nourish, even a little, from the vessels of the surrounding organs. NSYou can read about it in detail on our website.
Second: The technique of treating prostate swelling with water vapor by evaporation
The device is inserted, attached to the urinary catheter, and through water vapor the prostate is evaporated without the need for a surgical incision. It is one of the modern techniques in this field. Here is a video showing this procedure:
Third: Treatment of benign prostatic hyperplasia with small waves (microwave) MİCROWAVES through the urethra (TUMT)
This non-surgical procedure uses a transurethral catheter Insertion of a tube through the urethra that sends microwaves Which increases temperature in the prostate.
This heat destroys the enlarged prostate tissue.
Fourth: the UroLift system for the treatment of the prostate
The UroLift device is a device that is placed in the prostatic urethra and pushes aside the enlarged tissue so that it does not close the urethra.
This brace does not affect sexual function. It is usually done in the doctor's office and requires only a local anesthetic.
Fifth: Resection of the prostate with a needle through the urethra (TUNA)
This method is no longer used to treat BPH.
Invasive prostate surgeries performed under general anesthesia include:
Transurethral resection of the prostate (TURP)
This is the most important BPH treatment and is currently the gold standard, but if your symptoms are severe or minimally invasive treatments aren't helpful for BPH, your doctor will likely recommend another type of surgery.
Other prostate procedures include:
This is the most common treatment in the treatment of benign prostatic hyperplasia.
During this procedure, the urologist will insert a rigid instrument called a resectoscope into the urethra.
That is why it is called transurethral.
Inserting the endoscope in this way means not cutting the prostate.
Then they use a resectoscope to remove excess tissue that is preventing urine from leaving the bladder.
General anesthesia or local anesthesia may be performed.
Local (lumbar) anesthesia of the lower body may be used for this procedure.
Average hospital stay for TURP It is one to two days.
Transurethral incision of the prostate (TUIP)
This is a similar procedure to TURP. Instead of removing prostate tissue, the bladder neck and prostate are cut to loosen the bladder opening, allowing urine to flow more freely.
TUIP is more successful in men with smaller prostates.
Laser prostatectomy HoLEP
This procedure is very similar to transurethral resection, but instead a laser is used.
Its benefits are that the side effects are significantly less likely (bleeding and impotence).
The effectiveness of laser treatments and their comparison with TURP is still being studied.
It can also beUltrasound treatment of an enlarged prostate High intensity, which is used in the treatment of prostate cancer
Major invasive prostate surgery
More invasive surgery may be needed. You and your doctor will decide which is best for you. Doctors often consider invasive surgery to be the best long-term solution for relieving bothersome urinary symptoms.
Most of these cases involve removal of the enlarged portion of the prostate.
Doctors usually recommend surgery to treat moderate to severe BPH symptoms under these conditions:
- You cannot urinate at all.
- Or lifestyle changes, medications or minimally invasive treatments haven't helped.
- You find blood in your urine.
- Bladder stones form.
- You get frequent urinary tract infections.
- You have kidney damage.
Types of surgery
Types of surgery to treat BPH can include:
Open prostatectomy (open surgery), this operation is often performed when the prostate becomes too large and cannot be treated by urethral or minimally invasive methods, or when there is damage to the bladder and needs repair, in this method there are incisions in the abdomen The prostate tissue is cut and removed outside the bladder.
Laparoscopic and robotic prostatectomyIn open surgery, laparoscopic or robotic surgery differs from traditional open surgery by making four small incisions versus one large (in open surgery) to remove the enlarged prostate tissue.
General notes about the methods of treating an enlarged prostate in Turkey
Before undergoing one of these options, talk to your doctor about the best options available as well as what degree of anesthesia will be applied.
Surgery eliminates most of the symptoms caused by BPH, but it may not eliminate them all. Some complications may form, such as weakness of the bladder wall muscles or bleeding, urethral strictures known as urethral strictures, urinary incontinence, erectile dysfunction, and retrograde ejaculation. Although this is extremely rare, there may still be urinary problems after surgery.
The best treatment for an enlarged prostate in Turkey is not the same for every man, so we at Bimaristan offer you the best option by presenting your case to the most skilled doctors in Turkey.
Calculation of the degree of symptoms of an enlarged prostate, according to the American Journal of Urology
This table is used if there are no other urinary problems such as cystitis or diabetes.
0-7 points are considered light. 8-19 points The symptoms of an enlarged prostate are considered moderate. 20-35 points The symptoms of an enlarged prostate are considered severe.
|Questions to answer about your benign prostatic hyperplasia||None at all||Less than a fifth of the time||Less than half the time||about half the time||More than half the time||Most of the time|
|Over the past month, how often have you felt that your bladder hadn't completely emptied after you finished urinating?||0||1||2||3||4||5|
|Over the past month, how many times have you had to urinate again less than two hours after you finished urinating?||0||1||2||3||4||5|
|Over the past month, how often have you found it difficult to delay urination?||0||1||2||3||4||5|
|Over the past month, how often have you had a weak urethra?||0||1||2||3||4||5|
|Over the past month, how many times have you stopped and started again several times while urinating?||0||1||2||3||4||5|
|Over the past month, how often have you had to strain to start urinating?||0||1||2||3||4||5|
|Over the past month, how often have you woken up to urinate from the time you went to bed at night until the time you woke up in the morning?||0||1||2||3||4||5|