BENIGN PROSTATIC HYPERPLASIA (BPH) - Urology
It is a walnut-sized gland found only in men. It is located at the base of urinary bladder and also completely surrounds urinary tract. Prostate continues to grow from the birth to age of 20 years and it reaches to its mature size at this age and does not grow anymore. It remains in this size until age of 45 years and it starts to grow again. Duty of prostate is to contribute to the production of the fluids in ejaculate (semen) which is responsible for transportation of sperms (menis germ cell).
What is Benign Prostatic Hyperplasia (BPH)?
BPH is the benign increase in size of the prostate. Its prevalence increases over age. Symptoms may occur in a man at age of 60 years at rate of 50 percent.
Why does my prostate enlarge?
Reasons of enlargement in the prostate are not clearly known yet but it is thought that it has a relation with testicles (interstitial gland) because prostate gland of a man who does not have testicles does not enlarge. Men have both male hormones and female hormones. While testosterone levels decrease over age, estrogen levels remain the same. According to a theory, it is thought that high levels of female hormone likely have a role in prostatic enlargement. In another theory, it is claimed that another androgen synthesized from testosterone, dihydrotestosterone is responsible for the prostatic growth. Familal history of BPH increases the possibility of the disease as well. Prevalence of BPH is higher in European men than Asian men. This shows that genetic factors and lifestyle have an effect.
What are the symptoms of enlarged prostate?
Prostate constricts the urinary tract as it enlarges since it completely surrounds the tract. As a result, urination-related problems can arise. Major complaints are decrease in urinary outflow, intermittency in urination, post-void dribbling, post-void need of urination, urgent need for urination, increase in frequency of urination, waking up with urination need during night and pain in urination (dysuria). These complaints can be individually or jointly occur.
Is there any relation between the complaints and the size of the prostate?
No. Those with severely enlarged prostate may have no complaints and on the contrary, those with mildly enlarged prostate may have severe complaints.
What can I do to prevent my prostate to enlarge?
There is no natural way to prevent enlargement of the prostate. Prostate enlargement is a natural course of aging.
What happens if I do not receive treatment despite enlarged prostate and complaints?
First of all, symptoms of BPH can significantly decrease the life quality. If prostate growth prevents urinary bladder to void, it becomes a serious threat for health. Negative effects such as recurrent urinary tract infections, bladder damage, urinary calculus, renal damage and urinary incontinence can be observed. Treatment may not be necessary if your complaints do not disturb you or threaten your health. However, any man over 40 should get examined by an urologist once a year even if he has no complaints.
Does BPH turn into cancer?
No. BPH and prostate cancer develop independently from each other.
Does prostate growth negatively affect my sexual life?
There is no relation known between prostate growth and sexual life.
Which tests would be required when I apply to a physician for my complaints?
Your doctor would ask you some questions to evaluate when your complaints started, their frequency, other medical problems of you, your medications and your family history. After that, he makes a rectal examination with his finger in order to evaluate the size and consistence of your prostate and be able to diagnose a possible prostate cancer early, and he requests urinary and blood tests from you for an elaborated evaluation. Your urine stream velocity can be measured and your urinary system can be evaluated in a detailed manner, if necessary.
What is PSA test and why is it important?
PSA is a hormone synthesized by your prostate normally. High measured PSA causes your doctor to make a cursory examination in terms of prostate cancer. High PSA does not necessarily mean cancer. However, very early diagnosis of prostate cancer is possible with this test and therefore definitive treatment of prostate cancer can be provided with an appropriate treatment.
What are the treatment options in BPH?
There are many methods in BPH treatment. Treatment can be collected under three basic titles. These are follow up, medication and surgical treatment.
Follow up is applied in the patients who do not have too many complaints and significant obstructions in the result of the examinations performed. Medication is applied in the patients who have complaints but do not require or certainly require surgical treatment. These drugs must be used for a lifetime. Surgical Treatment, many patients cannot recognize severity of the disease because the disease develops very slowly in BPH. However, BPH can lead to many complications such as urinary retention, blood in urine, repetitive urinary tract infections if it is not treated. In today, the most effective treatment method is surgical treatment. No medication treatment is succeeded as much as surgical treatment yet.
What are the surgical treatment options in BPH?
TURP (Transurethral Resection of the Prostate), constitutes more than 90% of the prostate surgery. In this surgery which is colloquially known as closed surgery, prostate is removed by being cut into pieces with the help of the tools entering through penis under anesthesia.
Laser prostatectomy, is based on the principle of vaporization of prostate by using laser energy. It has some advantages such as shorter hospitalization period, the operation being able to be performed without discontinuation of blood diluents or under local anesthesia in the patients who cannot have general anesthesia.
TUNA (Transurethral Needle Ablation), is based on the principle of meltdown of prostate with radiofrequency waves with the help of catheter placed under local anesthesia.
TUIP (Transurethral Incision of the Prostate), intends to increase urine stream by making incisions on the prostate under local anesthesia.
Transurethral Microwave Therapy is a treatment method which is similar to TUNA but in which microwaves are used.
Transvesical prostatectomy is colloquially known as open surgery. Its hospitalization period is longer and complication rates are higher than TURP and laser prostatectomy.