Urologist
The prostate is located just below the bladder, with the urethra passing through it. Its function is to secrete substances that facilitate the survival and mobility of sperm within the female reproductive system.
The prostate can be roughly divided into two parts: the outer part (peripheral zone) and the inner part surrounding the urethra (transition zone).
What is the location and function of the prostate?
How does the prostate affect urination?
After the age of 40, the inner part of the prostate begins to enlarge under the influence of hormonal, metabolic, and genetic factors. This growth is observed to some extent in all men.
In some men, this enlargement can narrow the urinary tract, leading to a decrease in urinary flow rate. This condition is known as benign prostatic hyperplasia (BPH).
What symptoms can prostate enlargement
cause?
It can cause symptoms such as a decrease in urinary flow rate, waiting before starting to urinate, interrupted urination, and an inability to fully empty the bladder. These symptoms occur with every urination but are most severe during the first morning urination. Other complaints may include sudden urgency to urinate, even leakage of a few drops before reaching the toilet, nighttime urination, and the sensation of residual urine remaining in the bladder after urination. The severity of symptoms can be assessed using the International Prostate Symptom Score (IPSS) questionnaire.
What examinations and tests are necessary to confirm the diagnosis in a patient with urinary complaints?
A prostate examination is performed rectally. Since the prostate is located just in front of the rectum's end, it can be examined manually through the rectum (digital rectal examination). Even small irregularities on the prostate surface can be easily detected during this examination. Because prostate cancer typically forms on the surface of the organ, firm areas suggestive of cancer can be felt through this method without causing significant pain. (Detailed information can be found in the prostate cancer section.) The absence of a detectable firmness during the examination does not rule out prostate cancer.
After the examination, an ultrasound may be performed to measure the exact size of the prostate and assess the condition of the bladder and kidneys. A urinalysis is conducted to detect the presence of blood or infection in the urinary tract. A blood test to measure creatinine levels is ordered to evaluate kidney function. To determine whether prostate enlargement is benign or malignant, a PSA test is requested. Urinary flow can be objectively measured using a uroflowmetry test to determine the extent of urination difficulties. (For more details on uroflowmetry, refer to the relevant section.)
What is PSA?
PSA stands for Prostate-Specific Antigen. It is an enzyme secreted by the prostate gland, and its function is to liquefy semen from a gel-like consistency to a more fluid state.
PSA is not specific to prostate cancer. A low PSA level does not definitively rule out prostate cancer, nor does a high PSA level necessarily indicate prostate cancer. PSA levels can also increase in conditions such as benign prostatic hyperplasia (BPH), prostate infections, or after the insertion of a urinary catheter. (For detailed information, refer to the prostate cancer section.)
PSA is an important test, especially when combined with a digital rectal examination, to assess the likelihood of prostate cancer.
What dietary changes should be made for patients with symptoms of benign prostatic hyperplasia (BPH)?
It is recommended to avoid excessive fluid intake, especially in the evening hours. Beverages with diuretic effects, such as coffee, tea, and cola, should not be consumed excessively. Avoiding spicy, hot, and sour foods may help prevent the worsening of symptoms.
How can urinary dysfunction caused by benign prostatic hyperplasia (BPH) be treated?
A decrease in urinary flow rate can be treated with medication or surgery.
Which medications are used in the treatment of prostate enlargement?
1. Medications that relax the muscles in the prostate to improve urinary flow (alpha-blockers).
2. Medications that shrink the prostate (5-alpha reductase inhibitors).
If the symptoms are not severe, these medications can lead to significant improvement. If the symptoms cannot be resolved with medications, surgery may be necessary.
Is it possible to treat prostate enlargement with herbal-based medications?
Herbal treatment can be applied to patients with mild symptoms. However, scientific evidence regarding their mechanisms of action is insufficient. Some studies have shown that they may have a combined effect similar to alpha-blockers and 5-alpha-reductase inhibitors. The most commonly used plants include Serenoa repens (Saw Palmetto), Pygeum africanum, and Hypoxis rooperi.
In which cases is surgery necessary?
1. If symptoms are severe and cannot be relieved with medication.
2. If bladder stones have formed.
3. If the prostate blocks the urinary tract and completely prevents urination.
4. If the kidneys cannot function properly due to incomplete bladder emptying.
5. If it causes recurrent urinary tract infections.
6. If it leads to blood in the urine that cannot be resolved with medication.
At this stage, the condition has progressed beyond the point where it can be treated with medication, and surgery becomes necessary.
How many types of prostate surgeries are there?
Surgery can be performed using either open or minimally invasive techniques.
Before the application of laser technology in prostate treatment, it was challenging to successfully treat prostates larger than 100cc using minimally invasive methods. Today, prostates of all sizes can be treated with various lasers (HOLEP, ThULEP). Using the HOLEP and ThULEP methods, the inner part of the prostate that narrows the urinary tract can be completely separated from the outer part and removed. (For detailed information, refer to the HoLEP section.)
Another minimally invasive method, the TURP (Transurethral Resection of the Prostate) technique, can also remove most of the part of the prostate narrowing the urinary tract, although it does not remove as much tissue as laser methods. TURP surgery can be performed using monopolar or the latest bipolar devices.
What are the advantages of bipolar (plasma kinetic) technology in TURP surgery?
If a traditional TUR-P (Transurethral Resection of the Prostate) surgery lasts too long, the absorption of the fluid used during the procedure by the body can lead to a dangerous condition called TUR syndrome, caused by a decrease in vital elements in the blood. For this reason, TUR-P with classic devices is not suitable for patients with large prostates. However, in Plasma Kinetic TUR-P, fluids containing elements similar to those in blood can be used, making it possible to perform TUR-P safely even for patients with large prostates.
In traditional TUR-P, the electric current flows through the body after reaching the prostate, which can be risky for patients with pacemakers. In the bipolar method, however, the electric current flows only through the prostate tissue being cut and returns directly through the device, making it safe for patients with pacemakers to undergo bipolar TUR-P.
Another advantage of the bipolar method over traditional TUR-P is reduced bleeding. The bipolar device performs coagulation simultaneously while cutting the prostate tissue, minimizing bleeding. As a result, less time is spent stopping bleeding, allowing more prostate tissue to be removed within the same timeframe.