Prostate Surgeries

Prostate Surgeries

Prostate Disease

The prostate is one of the organs that cause the most problems in the male body. Although prostate diseases are mostly seen from the age of 50, they can sometimes cause problems in young men too. In the Diagnosis and Treatment of Prostate Diseases, all prostate-related complaints and routine screenings are performed by our Urology specialists.

Complaints that may be related to prostate diseases are as follows:

  • Difficulty starting and stopping voiding
  • Weak or intermittent urine stream
  • Burning or pain on urination
  • Frequent need to urinate
  • Feeling of not fully emptying the bladder
  • Repeated urination at night
  • Sudden urinary urgency, difficulty keeping the urine
  • Continuing drips after urinating
  • Inability to urinate
  • Blood in the urine or semen
  • Painful ejaculation
  • Groin, hip, waist, back and/or leg pain

What is Prostate Enlargement?

Prostate enlargement often occurs as a benign development. This growth continues at a varying pace from the late 40s until the end of life. Although benign prostatic enlargement (BPE) is seen with aging, the exact cause is not completely clear. The enlarged prostate gland can prevent the flow of urine with the obstruction-constriction it creates in the urinary tract and bladder outlet. It can impair both the urine storage and urinary excretion function of the bladder. Although prostate enlargement is quite common, it may not cause the same level of problem in every man. Although it is detected as a natural part of aging in some, it may not require treatment. If an enlarged prostate causes bothersome symptoms, impairs urination, or becomes harmful to the body, it should be treated.

Prostate Enlargement Treatment

The main determining factors in the treatment are the degree of the patient’s complaints and the physical and functional problems caused by prostate enlargement. Although no serious complaints are reported in some of the patients, recurrent urinary tract infections, recurrent bloody urination, development of stones in the bladder, and kidney failure are conditions that require treatment.

Treatment approaches include:

  • Waiting with regular follow-up/observation
  • Medication (medical) treatment
  • Surgical treatment methods (Bipolar TUR-prostatectomy, Laser Greenlight prostatectomy, Prostate surgery with Holmium Laser Enucleation of the Prostate (HoLEP)

What is Prostatitis?

Prostatitis is inflammation of the prostate gland. Due to the inflammation that develops in this disease, the prostate gland swells and is painful. Although prostatitis is sometimes caused by a bacterial infection, often a microbial condition may not be found and the cause of prostatitis is not fully understood. In contrast to prostate enlargement or prostate cancers, which are usually the problems of older men, prostatitis can occur in adult men of all ages.

Prostatitis Treatment

Medicines are used in the treatment of prostatitis. These include painkillers (anti-inflammatory), alpha-blockers that relax the prostate and bladder neck, some antibiotics. In most men, the disease resolves within a few weeks to a few months, although in some people symptoms may last longer.

What is Prostate Cancer?

Cancer that develops in the prostate gland tissue is called “prostate cancer”. Prostate cancer is one of the most common cancers in western countries. The reasons for its formation have not been fully explained, but it is known that the probability of developing prostate cancer increases with age in men. Although it is usually detected in men over the age of 65, it can be said that the risk increases from the age of 50. If a close male relative (father, brother, uncle, etc.) has prostate cancer, the incidence of prostate cancer in that person is higher than normal. Treatment results of prostate cancer, especially detected in the early stages, are generally satisfactory. The feature that distinguishes prostate cancer from some other cancers is that it has a slow course and variable behavior.

Prostate Cancer Treatment

Treatment approaches may differ according to the stage and degree of the disease. Treatment methods can be applied alone, together, sequentially and alternatively, depending on the patient’s condition or disease level. In some patients, active surveillance without treatment may be offered as an option.

After the necessary diagnostic examinations, most patients are treated with one of the following methods:

  • Surgical treatment (da Vinci robotic radical prostatectomy, open radical prostatectomy)
  • Radiation therapy (radiotherapy, brachytherapy)
  • Focal therapy, (High-intensity focused ultrasound/HIFU, cryotherapy)
  • Medicine therapy (hormone therapy, chemotherapy).

PSA Test and Prostate Examination in the Diagnosis of Cancer

Prostate cancer can be detected early with the PSA (prostate specific antigen) test, which is examined with a blood sample. Early diagnosis of prostate cancer is important in terms of increasing treatment possibilities.

Reference for PSA Normal Values:

Hans-Joachim Luboldt, Joachim F. Schindler, Herbert Rubben .Age-Specific Reference Ranges for Prostate-Specific Antigen as a Marker for Prostate

Cancer.eau-ebu update series 5 (2007) 38–48.

0 – 2.5 ng/ml for 40-49 years old

50-59 0 – 3.5 ng/ml for age

0 – 4.5 ng/ml for 60 – 69 years old

0 – 6.5 ng/ml for 70 years and older

Apart from cancer, PSA may also be elevated after benign prostatic hyperplasia – BPH, inflammation of the prostate (prostatitis), after sexual intercourse, after biopsy, after prostate rectal examination, urinary tract infection, urinary tract interventions (catheter insertion) and surgeries. For this reason, high PSA does not mean that there is cancer, and a low level is insufficient to rule out cancer. Prostate cancer is detected in 1 out of every 5 patients with a PSA value within the normal range. For this reason, digital prostate examination comes to the fore together with the PSA value in the diagnosis of prostate cancer. With this examination, it is possible to have an idea about the presence of prostate cancer regardless of the PSA value.

Prostate Surgeries

In prostate enlargement (BPH), patients who do not respond to drug treatment, who initially respond to drug treatment, but whose drug becomes insufficient over time and cannot use drugs due to side effects; can be treated with prostate surgery. In addition, depending on prostate enlargement; Prostate surgery should also be planned for patients with stones in their bladder, recurrent bleeding from the urinary tract, frequent urinary tract infections, and those who cannot empty their urine at all.

How is Prostate Surgery Performed?

In the transurethral resection of the prostate (TUR-P) operation, the prostate tissue is burned from the inside with the help of electrical energy and removed in small pieces. Since the risk of bleeding is high in this surgery, the blood thinners (antiaggregant-coagulant) drugs that the patient has to use, if any, are discontinued 1 week in advance and can be restarted at the earliest 1 week after the surgery. After the procedure, the patient should stay with the catheter for at least 3-4 days. It has been reported in many studies that TUR-P syndrome, urethral stricture, infection, urinary incontinence, difficulty in urination, retrograde ejaculation and need for reoperation were observed after this method.

Open Prostatectomy:

Prostate size 100 gr. and above, open prostate surgery can be applied. In this surgery, the bladder is opened along with the skin and subcutaneous tissues of the patient and the prostate is removed with the help of fingers. Since the bleeding rates are quite high during this surgery, blood support may be required frequently. After the procedure, the patient should stay with the catheter for at least 1 week. In addition, the hospital stay is longer than other methods.

Laser in Prostate Surgery:

With the use of laser in urology, surgical operations have started to be performed by using laser in prostate surgery. These methods are; Greenlight laser, photoselective vaporization of the prostate (PVP); Thulium Laser Enucleation of Prostate (ThuLEP), Thulium Laser Resection of Prostate (TmLRP), Diode Laser Enucleation of the Prostate (DiLEP), Diode Laser Vaporization of the Prostate (DiLVP), Holmium Laser Resection of the Prostate (HoLRP), and Holmium Laser Enucleation of the Prostate (HoLEP).

What is HoLEP?

HoLEP is a prostate surgery method that is entered through the urinary canal and performed using a holmium laser. Although this method is performed closed, the entire prostate is removed with a method similar to open prostate surgery. Spinal anesthesia is sufficient during the operation.

Which patients are suitable for HoLEP surgery?

All patients who are being considered for surgical treatment of prostate disease can be considered suitable candidates for HoLEP. This method is independent of prostate size, so it can be applied to all prostate sizes.

What are the features of HoLEP surgery?

Since it is done with the principle of “separation with laser” instead of “burning with electrical energy”, the patient whose catheter is removed does not experience a burning sensation (dysuria) while urinating. With features such as low bleeding risk, short hospitalization period and fast recovery period, patients can get rid of their catheters in as little as 24 hours and return to their normal lives quickly. Since its effect on healthy tissue is less than 0.4 mm, it does not damage the nerves that pass around the prostate capsule and regulate sexual functions.

For this reason, post-operative erection problems are not expected in patients. Since it does not cause a burning defect in the surgically removed tissues, the tissue can be examined more easily by pathologists and the possibility of possible malignant formations (malignancy) to be overlooked is reduced. Since the prostate tissue is completely removed, the risk of recurrence of the disease is very low.

I’ve started working as a doctor since I attended Uludağ University Faculty of Medicine. I stopped working in the hospitals in 2020 with the thought of opening my own medical clinic. At the beginning of 2022, I opened my office in Karşıyaka Mavişehir Park Yaşam Ofisleri. In our urology clinic, I deal with my patients along with my team.


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