WHAT IS PROSTATE?
Prostate is a gland in male reproduction system. Its main function is to produce the liquid part of semen which protects sperms and increases their quality.
WHAT IS PROSTATE HYPERPLASIA?
Regardless of its small size, prostate is one of organs that are most frequently getting sick in the body. Benign Prostate Hyperplasia, prostate cancer and prostatic inflammation are most frequently seen. The most common reason of presentation of the patients is the complaints secondary to prostate hyperplasia. Prostate starts to grow with age, especially around 45 years of age. Prostatic hyperplasia usually occurs as benign prostate hyperplasia. This growth continues with different paces until the end of life. Benign prostate hyperplasia develops in 50% of males over 50 years of age, 65% of the males in 60-70 years of age and 90% of the males over 80 years of age. Some of the prostate hyperplasias are malignant and they are defined as prostate cancer. Benign prostate hyperplasia and prostate cancer can be seen together however they are not secondary to each other and they are two completely different diseases.
The reason of benign prostate hyperplasia is generally the abnormal increase of cell count (hyperplasia). Number of glands around the urinary canal increases with aging. These increased glands push the prostate tissue outwards and flatten it. Prostate gland enlarges towards urinary tract, urinary bladder and rectum. It especially starts to compress urinary tract and prevents urine flow. This obstruction causes changes in canals which carry urine from kidneys to urinary bladder (ureter) and in kidneys. Due to the compression to the urinary tracts opening to the urinary bladder from kidney, caused by prostate, dilatation may occur in kidney and urinary tracts. Sometimes, in the future, this can cause clinical picture of renal failure which is indicated by elevated urea and creatinine levels in blood. While prostate hyperplasia is common, it is not a fact that every hyperplasia causes a problem and requires treatment. Prostate should be treated not only for growing, but also if it causes complaints or harms the body.
TREATMENT OPTIONS FOR PROSTATE
Choosing of the therapy to be performed depends of the severity of complaints, extra risk conditions due to the other problems of the patient, anesthesia risk, whether the blood thinners are used or not as well as the choices of patient and surgeon. Patients who have minimal complaints are carefully observed without performing therapy. Medication therapy can be preferred for the patients whose urinary problems are mild or moderate. At this point, the level of effect on life quality has importance in making choice of therapy. The size of prostate is not very important in choice of therapy. What important is the obstruction findings and the harm they cause. While sometimes surgery is decided for a prostate 30 g in volume, sometimes a 120 g prostate may be asymptomatic. Moreover, a therapy model recommended for a patient around 50 years of age may not be effective for a 80 years old male patient.
The group of patients requiring surgery consists of the patients for whom catheter must be placed anuria and this condition relapses, patients with relapsing infections secondary to prostate hyperplasia, calculus of urinary bladder, bleedings due to prostate hyperplasia, structural disorder of urinary bladder, disorders in renal functions. According to the data, 30% of males who are suffering from prostate hyperplasia undergo surgery.
Even if there are various minimal invasive treatment methods to increase patient’s quality of life (transurethral micro-wave thermotherapy, electro-vaporization, needle ablation with radiofrequency, transurethral incision, botulinum injections, prostatic stent), the most effective methods regarding long-term results and effectiveness are transurethral resection of prostate (TURP), transurethral plasmakinetic resection of prostate and lase prostatectomy interventions.TURP and plasmakinetic are closed surgery methods that are performed for many years and proved themselves with the obtained good results. It is based on the access made through urinary canal and dividing and removal of prostate with monopolar and bipolar electric power. In both of them, some of the most common postoperative complications (adverse effect) are bleeding, narrowing in urinary tract, dysuria (irritation) and redirection of semen during sexual intercourse. Due to the fact that the complication rates are relatively high, new techniques that cause less adverse effects are searched although the effectiveness is high.
ADVANTAGES OF LASER TECHNOLOGY
One of the energies that are used in minimally invasive treatment of enlarged prostatic tissue is laser energy. Surgeries performed by using laser are closed, in other words endoscopic surgeries and finer tools are used comparing to TURP method. For this, lasers with various wavelengths are used. Definitions of methods show differences according to the used laser energy type. The advantages are less bleeding and irritation, shorter recovery time, shorter catheter and hospitalization time due to this and ability to be performed for large prostates. This technology brings high success and low adverse effect together in benign prostate hyperplasia. However, urinary complaints can be seen in durations changing according to the wavelengths of the laser used for therapy. Burnt tissues are removed from the body in recovery period. It is wrong information among the patients that the prostate melts away following the laser vaporization. Here, the aim is to create a sufficient canal to make the patient urinate easily. There is always a rest prostate tissue and this patients should also attend annual control visits like every man, after the operation. Vaporization surgery does not eliminate the risk of a future prostate cancer.
ADVANTAGES OF DIODE (INFRARED LIGHT) LASER TECHNOLOGY
Diode (Infrared Light) laser technology, used in our clinic, is the most effective laser developed for now with 980 nm wavelength and 250 W energy power. The superiority of this technology on other lasers (Greenlight: 180W) is that even if it ensures strong tissue vaporization in a shorter time, its depth is less and tissue burning beneath the vaporized tissue is less. This ensures that the complaints of dysuria after the catheter is withdrawn are less comparing to others due to the les tissue rashes. Moreover, since depth is controlled, urinary incontinence and erectile dysfunctions are less common. Different from other lasers since it is applied by connecting the tissue, the procedure is faster and more tissue is removed. Hemostatic control is also better and surface of prostatic tissue is vaporized in a more proper way; thus it can be safely applied on enlarged prostates. Treatment can be performed for patients who use medications that prolong bleeding time. Also, due to the use of tools with small diameters, it decreases the risk of stenosis that might occur in urinary canal and is very problematic complication.
In treatment of prostate cancer, successful results are obtained with laparoscopic closed method which takes interest worldwide in recent years and performed only in several certain facilities in our country. In this method, the most important advantages are minimal blood loss during the surgery and very mild postoperative pain as well as fast recovery. While there is no difference between this method and open surgery in control of cancer, it also has a better preserving advantage since functional organs are seen 10 folds better than they are seen with eye.
With these advantages, laparoscopic therapy method is also used in treatment of kidney cancer.
In laparoscopic method, performed with two 1-cm and two ½ -cm holes, there are important advantages regarding pain, recovery and cosmetic since large surgical incisions are not made. Successful results are obtained in our clinic with laparoscopic method which has become the standard treatment of early stage renal tumor around the world and it is preferred by the patients.
The most important recent development in urology surgeries is “laparoscopic surgery” method which is now accepted as “gold standard” and a revolutionary development in surgical techniques. Laparoscopic surgery, colloquially known as blood-free or closed surgery, is the surgery technique which is performed with endoscopy by making access without conventional large incisions (image obtained with a camera connected to a camera) and with long and thin instruments. In addition to optic camera, frequently two canals, known as trocars are inserted from access points with different diameters (5-10 mm). While image is provided with optic camera, operation is completed from other canals with instruments specially developed for this technique.