Prostate enlargement (bph)

PRELIMINARY INFORMATION

The prostate is present in all mammals. Of course, they differ anatomically, biochemically and pathologically. The dormant stem cells in the prostate rarely divide, but when they divide, they cause the disease of prostatic enlargement, which is called Benign prostatic hyperplasia (BPH).

A decrease in cell death occurs due to undetected defects in the aging process. Benign prostate enlargement has an increasing importance in terms of public health. It is known that men over the age of 60 have approximately 30% of the disease causing complaints. BPH and prostate cancer are two different diseases that are seen in the same organ, in the same age group, in the same sex, and their possible association is mentioned. Although they have common points, it is useful to know that there is no causal relationship between BPH and prostate cancer today. Benign prostate enlargement negatively affects the quality of life of patients. The aim of treatment in these patients is to improve the quality of life.

DIAGNOSIS

Patients most frequently apply to the doctor because of decreased urinary flow rates, frequent urination and difficulty in urination. The physician questions the patient’s complaint in detail. He then proceeds to a physical examination to make a diagnosis.

The size, shape, consistency, symmetry and presence of a mass (nodule) of the prostate are evaluated.

Basic diagnostic procedures For the diagnosis of prostate enlargement, first of all, a finger examination is performed from the rectum. Then it moves on to other processes. Routine biochemical evaluation including prostate specific antigen (PSA) and kidney function is performed. Urination is evaluated with a questionnaire called the International Prostate Symptom Score and a test called Uroflowmetry that measures the voiding flow rate. The size of the prostate can be determined by ultrasonography.
It is also evaluated in the kidneys.

TREATMENT

According to the International Prostate Symptom Score survey data, the classification of patients and treatment planning are essential in clinical practice. Medication, endoscopic surgery and open techniques are used in the treatment of BPH, and open surgical technique is less preferred today due to the developing technology. The clinical condition of the patient and the size of the prostate determine the treatment. It should be known that not every patient can be treated with medication. Apart from these, patients who do not benefit from medical treatment or do not want to use drugs for a long time are also candidates for surgical treatment.

medical treatment

They are drugs commonly used in the treatment of BPH. It causes an increase in the urinary flow rate of the patients. They may cause orthostatic hypotension, fatigue, headache, asthenia, nasal congestion and retrograde ejaculation. It is known that 5 alpha-reductase inhibitors provide 20-30% reduction in prostate size and moderate improvement in urine flow rate. It has also been found to reduce the risk of surgery. Treatment with the combination of both drug groups constitutes the current treatment.

Surgical treatment

Endoscopic entry through the urinary tract and removal of the prostate with the help of electrocauteries, that is, transurethral electroresection (TURP: closed surgery) or open surgery, is the method accepted as the gold standard in the surgical treatment of BPH. With the technological developments, many studies have been carried out on alternative methods to TURP. Alternative methods using different energy sources have been developed. Prostate surgery with laser energy is a method that has been tried in different ways for a while in benign prostate enlargement, it has been accepted that it may have a place in well-selected patients (patients at risk of bleeding, large prostates), and it has been determined that it is by no means the gold standard. Evaporation (evaporation) with greenlight laser is a method with a very short history, very limited number of short-term results have been reported in the literature, and its long-term success is uncertain.

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