Prostate

Prostate

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Both the urethra passes through the prostate and during ejaculation, semen empties into the urethra and comes out of the urethra.

Lateral Section of Male Urogenital System

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The prostate is an essential organ like our eyes and ears, being only in men, and is at the exit of the urinary bladder, just below the urinary bladder and in front of the rectum (last part of the large intestine). Its main function is related to reproduction and it is a gland of 18-20 grams about the size of a walnut. Both the urinary canal (urethra) and the semen excretory ducts pass through it. The semen passes through the prostate and is eliminated into the urethra.

The importance of the prostate is due to the fact that it secretes a large part of the liquid called semen and that there are some substances in this liquid that give activity and mobility to the sperm and protect the sperm. Approximately 5-10% of the semen that comes out with ejaculation is composed of sperm cells, the remainder is composed of fluids from other glands (Seminal gland, Prostate and Bulbourethral gland) and which keep the sperm alive in the female reproductive organs. If there is a problem in prostate secretion, sperm movements and vitality will be impaired, so there may be a problem in conceiving a child, it might cause infertility.

The prostate enlarges in most of the men with aging, generally outward growth and inward growth, i.e. condensation of the urethra, the larger the prostate, the more difficult it is to urinate. When the prostate rises above its normal size, it does not follow similar path in every man. In some men, there is an enlargement of the urethra passing through the prostate, however, in some men there is an enlargement into the bladder. In this type of enlargement, while the prostate appears slightly enlarged on ultrasound images, serious complaints might occur in the patient. In cases where the prostate enlarges outward, if the urethra is not condensated, the patient does not complain the same even though the prostate is very large. When evaluating the prostate in male patients, we do not only look at its enlargement in volume, but mainly at the level of condensation of the urinary tract and difficulty in urination. The patient might have an outwardly enlarged prostate, if he has no difficulty in urination, and if the urinary tests and cancer screening tests are normal, the patient is usually monitored at 6-month intervals. Complaints about Prostate Enlargement:

  • A frequent need to pee,
  • Straining to pee,
  • Needing to get up frequently in the night to pee,
  • Needing to pee urgently, leaking urine,
  • Having the weak flow of of urine,
  • Not being able to pee at all
  • Swelling of the bladder

Getting a Diagnose of Prostate Enlargement

The diagnosis of prostate enlargement is get by blood and urine tests, ultrasonography, urine flow test (uroflow) and tests that are not disturb the patient in any way.

If the patient has persistent higher PSA despite antibiotic and anti-inflammatory treatment, if a nodule is identified in the prostate during rectal examination or ultrasound examination, it is certained whether there is a possible prostate cancer by performing a Multi-Parametric Prostate MRI examination and, if necessary, a Prostate Needle Biopsy under the guidance of Transrectal Prostate Ultrasound.

Because the treatment of benign prostate enlargement (BPH: Benign Prostatic Hyperplasia) is different, the treatment of prostate enlargement is different due to prostate cancer.

Both BPH and prostate cancer might be carried on one patient. Treatment might be diffirent according to condensation of urethra or stage of the disease. It is recommended that every man over the age of 40, whether or not they have urinary problems, need to visit a Urologist at least once a year for a prostate examination and PSA test. These check-ups are important, especially in people having prostate cancer in their first-degree relatives (father, brother). Because men having relatives with prostate cancer the risk of developing prostate cancer is 2-6 times higher than other men.

Benign Prostatic Hyperplasia Treatment (BPH)

BPH treatment divided into two groups as medical treatment and surgical treatment

In BPH treatment first aproach of treatment need to be medical treatment. Other treatments need to applied when medical treatment fails.

Purpose of drugs treatment, is to relieve the flow of urine, the drug groups used for this purpose and briefly their mechanisms of strenghts are as follows:

1-    Alpha Blockers:

Drugs in this group increase the urine flow rate by relaxing the smooth muscles in the bladder outlet and prostatic urethra, i.e, they provide more comfortable urination. (Tamsulosin, Terazosin, Alfuzosin, Silodosin, Doxazosin)

Since these drugs also relax smooth abdominal muscles, they cause hypotension.

Most known side effects:

1- Orthostatic Hypotension (Sudden drop in the blood pressure and darkening when sudden standing up, therefore it is recommended to stand up slowly)

2- Retrograde ejaculation (the semen cannot be eliminated, one has an orgasm, but because the bladder outlet is loosened, the semen is empjeculated into the bladder and then excreted from the urine)

3-Drugs that cause a decrease in prostate volume act by inhibiting alpha reductase and preventing the transformation of testosterone to di-hydro testosterone. (Drugs with active ingredients are Finasderid, Dutasteride)

4- A plant extract, sabal extract, is also sometimes used in medical treatment.

5- If urinary infection is identified, appropriate antibiotic treatment is administered according to the results of the culture-antibiogram test.

Surgical treatment are administered when medical treatment is not enough.This methods are followed as briefly:

Open Prostatectomy

Transurethral resection (TUR) is done with bipolar energy, plasmokinetics energy or monopolar energy

Laser Enucleation applied transurethrally is done with HOLEP-Holmium Laser.

Transurethrally applied Laser Vaporization is done with Vaporization-KTP, Diode, Thulium Laser

The most recently administered treatment; Transperineal Prostate Laser Ablation Treatment. In this method, we administer laser directly into the prostate with fine needles, painlessly placing laser fiber tips into the prostate without any surgery. Since it is administered with local anesthesia, it is safely administered to elderly patients with severe disease. This practice has been started in our clinic.

It is also possible to treat prostate cancer with this method. Cancerous cells that are get early and have not metastasis beyond the prostate are treated much more easily by laser burning than other treatment methods.

In other treatment methods of prostate cancer, the entire prostate (neoplasm and cortex) is removed together with the seminal sacs. This procedure is called Radical Prostatectomy. The procedure is applied with one of the Open Surgery, Robotic Surgery, Laparoscopic Surgery methods. Depending on the pathology result, other treatments such as radiotherapy, hormonal therapy and chemotherapy are applied if necessary.

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Endoscopic View Of Enlargement Prostate

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TUR Prostatectomy Schematic View

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Laser Prostatik Vaporizasyon (Buharlaştırma) şematik görünüm

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Lazer Vaporizasyon sonrası prostatik üretranın endoskopik görünümü


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