Benign prostatic hypertrophy (BPH)
BPH or Benign Prostatic Hypertrophy (BPH) is the growth of prostate gland with increasing age in men that causes some complaints. BPH is a very common disease. There are complaints of prostate enlargement in about 1/4 of men at the age of about 50, and about half of men around 80 years of age.
What are BPH complaint?
The most common symptoms of prostate enlargement are:
Frequent urination (especially at night)
Sudden need of urinating (urgency)
Difficulty in starting to urinate
Urinary pain or burning
Feeling that the bladder is not fully emptied
Urine dropping or incontinence
Poor urine flow during urination
How is the diagnosis made?
The diagnosis of BPH can easily be made by some examinations and tests performed in patients with the above complaints. The most common of these are rectal digital examination, PSA blood test, transrectal ultrasound and urine flow. With these methods, the diagnosis of BPH is confirmed, the degree of BPH is determined and other diseases of the prostate can be excluded.
What treatment options are available?
The most commonly used methods in BPH are drug therapy and surgery. In the beginning, mostly drug therapy is tried. However, in a significant proportion of patients, symptoms may increase over time and surgery may be necessary. The most common procedure in BPH is the TURP procedure (transurethral resection of the prostate). In this process, the prostate is accessed by entering with a thin tube from the urethra (urine channel) and the middle part of the prostate that narrows the canal is taken out by shaving. Following TURP surgery, the patient can go home after a few days in hospital. TURP is a very successful method of relieving prostate complaints, but has some side effects. Of these, retrograde ejaculation is the most common. Retrograde ejaculation is the flow back of semen into the bladder during orgasm. The semen accumulated in the bladder is excreted in the urine during the next voiding. Another common side effect after TURP is bleeding. Bleeding may continue for several weeks, although it decreases gradually after the procedure.
Following TURP, besides these two common side effects, the following problems may develop although more rarely:
Impotence: In some patients, a decrease in erectile function may occur after TURP. This is more common in patients who had erection problems before the procedure.
Urinary incontinence: Urinary retention problems may occur after TURP due to ongoing bladder problems or damage to the sphincter muscles during operation.
Urethral strictures: After TURP, the scar tissue formed in the urethra may contract later and the patient may have difficulty in urinating. In this case, it may be necessary to expand the strictures via the urethra by special methods.
Infertility: If retrograde ejaculation occurs, pregnancy is not possible in the normal way because the semen does not come out during sexual intercourse.
TURP surgery can sometimes be done with laser. In this method, the tissue is not cut, but instead it is burned. Because bleeding is less, it is preferred especially for those who use blood thinners, but the same complications may develop in this method.
If the prostate is overgrown, ie above 75-80 g, TURP is usually not sufficient. The recommended method in such patients is "open prostatectomy". In this surgery, an incision is usually made from the lower part of the abdomen and a large portion of the prostate is removed. In open prostatectomy, complaints related to prostate enlargement may be eliminated, but side effects such as infection, bleeding, impotence, and urinary incontinence are even more common than TURP. Therefore, the application of nonsurgical treatments is of greater importance, especially in patients with large prostates.
What is embolization Treatment?
Embolization is the intentional occlusion of the arteries of a tissue or organ by angiography. The organ does not die and lose its function but it shrinks significantly. The method of embolization is a method that has been successfully used in medicine for many years in stopping bleeding, reducing or killing the cancerous tissue, and in the non-surgical treatment of uterine fibroids. The use of embolization in prostate enlargement is more recent. It was first implemented in 2011 by Portuguese and Brazilian interventional radiologists and achieved successful results. Since then, prostate embolization has been applied in many countries around the world at many centers including ours.
Interventional oncology in cancer management
Prof Saim Yilmaz, MD