Benign prostatic hyperplasia is a condition associated with aging. Severe urinary complaints due to prostate enlargement, which severely impairs the quality of life of male patients, are seen in one third of men over 65 years of age. In patients with benign prostatic enlargement (BPH), a decrease in urine flow rate, an increase in the amount of urine remaining in the bladder, an enlarged prostate, and an increase in urinary excretion complaints are observed. Urinary retention may also be seen in some patients because they cannot urinate at all. We can identify patients in whom prostate disease may progress by looking at age, PSA test, prostate volume, deterioration in kidney function, degree of complaints and decreased urine flow rate. We first take a detailed history of the patients who apply with prostate complaints and evaluate their complaints.
Complaints such as frequent urination, burning in urination, intermittent urination, inability to relax after urination, weak urination, difficult urination, frequent getting up to urinate at night, difficult urination, urinary incontinence, bleeding in the urine are the complaints we encounter in prostate patients. Then, we distinguish benign prostate enlargement from prostate cancer with the PSA (prostate specific antigen) blood test. If there is a suspicion of prostate cancer in the patient, both by examination and PSA test, we perform further tests for this (see Prostate cancer). Not all PSA elevations indicate prostate cancer, and we know that factors such as infection, trauma, age, and prostate volume also cause PSA elevation. We evaluate kidney functions with urea and creatinine tests, and urinary tract infection or bleeding with urinalysis. We attach great importance to digital rectal examination in examination.
We can predict not only prostate size, but also any possible prostate inflammation or prostate cancer. Ultrasonography is the most frequently used radiological examination in the diagnosis of men with benign prostatic hyperplasia (BPH), and IVP (intravenous pyelography), CT and MRI can be performed when further examination is required. Uroflowmeter (voiding test) is an easy test by which we measure the urine flow rate. Cystoscopy is an endoscopic method in which we evaluate both the urethra and the prostate, as well as the bladder, and it can also be performed under local anesthesia. The urodynamic study, on the other hand, includes cystometry, which evaluates bladder function, and pressure flow study, which evaluates an obstruction or bladder dysfunction due to the prostate, and is an important daily examination lasting approximately 30 minutes. The treatment is completely determined according to the clinical picture of the patient. In addition to the patient’s physical condition, age, prostate volume, degree of complaints, prostate enlargement, stones or diverticulum in the bladder, whether the patient has a bleeding disorder, the preference of the doctor is also important. Only patients with mild lower urinary tract complaints can be followed up by making lifestyle changes.
So, what do we recommend to prostate patients? Simple but useful recommendations such as reducing fluid intake at certain parts of the day, avoiding caffeine and alcohol intake, which have diuretic effects, directing to double urination comfortably, bladder training… Drug treatments 5-alpha reductase inhibitors (Finasteride, dutasteride), alpha-blockers (terazosin, doxazosin) , alfuzosin, tamsulosin) or a combination of the two. We use the first group to reduce the volume of the prostate to eliminate mechanical obstruction, and the second group to eliminate dynamic obstruction. When necessary, we try to reach the target by giving both drug groups together. Herbal medicines are also widely used in both Europe and the United States today, although the exact mechanism of action is not known. Patients with recurrent prostate bleeding and infection who do not respond to drug therapy, patients with stones and diverticulum in the bladder, patients with a urethral foley (catheter) inserted because they cannot urinate, and patients whose kidney functions have deteriorated or have begun to deteriorate are candidates for surgical treatment. Both endoscopic (closed) and open surgery are among the surgical options and are performed completely according to the patient’s clinic and the doctor’s preference. Endoscopic surgeries such as transurethral prostate resection, laser (Greenlight, holmium, …) surgery, plasmakinetic surgery are the most frequently performed surgeries today. Complications after prostate surgery are now considerably reduced, and short-term and long-term complications such as urethral stenosis, urinary system infection, bleeding, bladder neck stenosis, urinary incontinence and retrograde ejaculation can be seen, although they are observed in small amounts.