What is benign prostatic hyperplasia? When does it require treatment?

What is benign prostatic hyperplasia? When does it require treatment?

Benign Prostatic Hyperplasia (BPH) is a common health issue among aging men. It affects approximately 50% of men over the age of 50. This condition occurs when the prostate gland enlarges and begins to press against the urethra. Although this growth is not cancerous, it can significantly affect quality of life.

What Are the Symptoms?

The most common symptoms of benign prostatic hyperplasia include:

  • Frequent urination
  • Waking up at night to urinate (nocturia)
  • Difficulty starting urination or intermittent stream
  • Sensation of incomplete bladder emptying
  • Weak urine flow
  • Sudden urge to urinate (urgency)

As these symptoms progress, they can reduce quality of life and lead to bladder problems or urinary tract infections.

What Causes It?

The exact cause of prostate enlargement is unknown, but age and hormonal changes are thought to play a role. In particular, changes in testosterone and dihydrotestosterone (DHT) levels can lead to the multiplication of prostate cells.

What are the treatment options?

The treatment plan is determined according to the patient’s age, severity of symptoms and general health status. The basic treatment methods are as follows:

1. Follow-up and Lifestyle Changes

In mild symptoms, only lifestyle recommendations such as follow-up and fluid intake regulation may be sufficient.

2. Drug Treatment

  • Alpha blockers: Reduce complaints by relaxing the urinary tract.
  • 5-alpha reductase inhibitors: Help shrink the prostate.

3. Surgical Treatments

In cases where symptoms are severe and medication does not provide sufficient benefit, surgical methods are used. At this point, one of the most effective and comfortable methods today is HoLEP.

HoLEP (Holmium Laser Enucleation Procedure)

It is an advanced laser technology used in the surgical treatment of benign prostatic hyperplasia. It offers successful results, especially in large prostates. Holep offers the following:

  • Low risk of bleeding.
  • It offers less pain and faster recovery compared to open surgery.
  • High long-term success rate.
  • Large prostate tissues can be removed in one go.
  • The risk of recurrence is quite low.

TURP (Transurethral Prostate Resection)

Prostate tissue is cut and removed with electric current by entering through the urinary tract. It is effective for medium-sized prostates and is the classic method that has been used for the longest time.

Open Prostatectomy

In very large prostates or in cases such as accompanying bladder stones, the prostate is completely removed with an incision made in the abdominal region. It is less preferred today, but it may be the most appropriate option for some patients.

GreenLight Laser (Laser Vaporization)

Prostate tissue is vaporized with a high-energy laser. It is especially advantageous for patients using blood thinners, as the risk of bleeding is low, but it may be limited for large prostates.

Rezum (Water Vapor Therapy):

Tissues are destroyed with controlled hot water vapor given into the prostate. It is a minimally invasive method, and is especially preferred in mild-moderate patients who do not want to use medication.

UroLift System

The urinary tract is opened by placing small implants that pull and fix the prostate lobes to the side. No surgical incision is required and is advantageous in terms of preserving sexual functions, but it is not suitable for large prostates.

Frequently Asked Questions About Benign Prostatic Hyperplasia (BPH)

  1. Is BPH cancer?
    No, benign prostatic hyperplasia is not cancer.
  2. Can BPH go away on its own?
    No. Symptoms may worsen over time, so monitoring is necessary.
  3. Is HoLEP dangerous?
    When performed by experienced physicians in appropriate centers, it is a safe procedure.
  4. Can the prostate grow back after HoLEP?
    The recurrence rate after HoLEP is quite low.
  5. Which is better: HoLEP or TURP?
    HoLEP is generally more effective and has less bleeding, especially in large prostates.
  6. How long is the hospital stay after HoLEP?
    Usually 1–2 days.
  7. How long does laser prostate surgery take?
    It varies between 45 minutes and 2 hours depending on prostate size.
  8. When is surgery necessary?
    Surgery is preferred in cases such as urinary retention, frequent infections, or bladder stones.
  9. Is HoLEP available in public hospitals?
    HoLEP is performed in some training and research hospitals, but it is more common in private hospitals.

10. How does prostate surgery affect sexual function?

In general, BPH surgeries have minimal effect on erectile function, and most patients maintain their ability to achieve erections. However, changes in ejaculation (retrograde ejaculation) may occur, which does not affect the sensation of orgasm. In newer and minimally invasive techniques, both erection and ejaculation are largely preserved.

Sources:

  1. Mayo Clinic
  2. Cleveland Clinic
  3. National Institute on Aging
  4. European Association of Urology
  5. American Urological Association
  6. Johns Hopkins Medicine
  7. NHS UK
  8. Urology Care Foundation
  9. MedlinePlus
  10. National Institutes of Health
  11. Harvard Health Publishing
  12. UpToDate
  13. PubMed
  14. WebMD
  15. EAU Guidelines 2024
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