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Prof. Dr. Tahir Karadeniz, Üroloji Uzmanı

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Prostate Enlargement (Benign Prostatic Hyperplasia)

Prostatic enlargement is a medical condition which describes an enlarged prostate in men and it is called Benign Prostatic Hyperplasia (BPH). This may be the most common health problem of urology as life span increases in general population more cases of BPH are encountered in daily practice. In men prostate gland surrounds urethra just below the bladder and urine passes through it. With aging, usually during the 4th decade the cells in prostate begins to increase due to reasons precisely undefined. This is considered as a normal aging process. As a result, the enlarged gland squeezes the urethra and the flow of urine is diminished; thus, symptoms of difficulty in micturition may arise.

Prostat Büyümesi (BPH)

Figure 1: Schematic representation of normal and enlarged prostate

Symptoms of the disorder are evaluated mainly in 2 groups:

1. Symptoms due to the obstruction of urethra:

  • Weak flow of urine stream
  • Difficulty and straining in starting micturition
  • Intermittent micturition (stop-start voiding)
  • Dribbling of urine, especially at the end
  • Sense of inadequate emptying of bladder
  • Leakage of urine during sleep; especially in advanced and undiagnosed disorder

2. Symptoms due to persistent stimulation and exhaustion of bladder:

  • Frequency in micturition
  • A strong and urgent desire to void
  • Sense of leaking urine before getting to restroom; accidental urine leakage (urinary incontinence)
  • Burning sensation in voiding (Dysuria)

Why Do We Treat Prostate Enlargement?

If untreated, prostate enlargement may lead adverse consequences as follows:

  • Acute urinary retention is the situation when enlarged prostate completely obstructs flow of urine and bladder gets distended with the accumulated urine. This is an uncomfortable situation necessitating urgent management by inserting a catheter via urethra and draining bladder. Sometimes it may not be possible to insert a urethral catheter and a tube must be inserted into the bladder through the body wall suprapubically.
  • Urinary tract infections; often resistant to antimicrobial therapy
  • Stone formation in the bladder
  • Impairment of bladder functions; in delayed circumstance this may be permanent even after relief of obstruction
  • When bladder deterioration worsens, rise of intravesical pressure may affect the kidneys and renal failure may ensue

Diagnosis of Prostatic Enlargement (BPH)

After evaluation of complaints we perform:

  • Urinalysis
  • Ultrasonography of Urinary Tract (Kidneys, Bladder and Prostate)
  • PSA in blood
  • Uroflowmetry (Measurement of urine flow rate; must be over 12 ml/sec in adult)

Treatment Modalities

Medical Treatment

There are 2 groups of drugs in this modality:

  1. The group of drugs named as ‘alpha blockers’ (Xatral, Cardura, Flomax; Urorec etc.) which do not have permanent effect. They affect the bladder neck and relieve the obstruction as long as they are consumed.
  2. 5-alpha reductase inhibitors (Avodart, Proscar) reduce the volume of enlarged prostate by 25 % following at least 6 months of treatment. These have side effects as loss of libido and erectile dysfunction.

Surgical Management

Today the preferred surgical treatment of BPH is the ‘Plasma kinetic technology’. Specially designed surgical instruments which are attached to a video camera system are introduced to the enlarged prostate through the urethra. Under direct vision electrical current is applied and the enlarged prostate is cut to small pieces which are then removed through these instruments. This Plasma kinetic technology is a novel and bloodless technology which is a safer method than the conventional Trans Urethral Resection of Prostate (TUR-P).

 

You can get information about TUR-P operation through the video below

Plasma Kinetic Technology

There are certain advantages of this method when compared to conventional TUR-P:

  • The energy used in TUR-P is ‘Monopolar current’ which demands flow of electrical current through the body. On the contrary Plasma kinetic technology consumes ‘Bipolar Currency’ that merely affects where it is applied thus no electrical current flows through the body. Even those with a pacemaker are not adversely affected by the bipolar technology.
  • Blood loss is less thus reducing operative time. Consequently, postoperative period is less annoying and hospital stay is shorted.
  • Tissue samples are obtained so that a pathologic assessment is possible. Greenlight technology vaporizes the tissue and no samples could be extracted for pathology.
  • In all these procedures special fluids are utilized throughout the operation. A severe complication named ‘water intoxication’-TUR Syndrome- may arise with a likelihood of 1-2 % when an excess quantity of them enters bloodstream. Plasma kinetic technology is exactly devoid of this adverse outcome because the fluid used here is ‘serum physiologic’.
  • If voiding complaints are disregarded, adverse effects as kidney failure may result

Important Notes On Prostate and Prostatic Enlargement (BPH)

  • Prostate is a male sexual organ; all healthy men are born with a prostate
  • Prostatic enlargement commences after 40 years of age and urine flow usually worsens
  • BPH (Benign Prostatic Enlargement) is not a cancer, it is a benign disorder
  • BPH is independent of prostate cancer, prostatic enlargement does not turn into a cancer of prostate
  • Prostatic enlargement often accompanies prostate cancer and relief of symptoms due to obstruction is possible with the surgical treatment of cancer
  • If voiding complaints are disregarded, adverse effects as kidney failure may result
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