Enlarged Prostate Treatment in Turkey

Enlarged prostate, also known as benign prostatic hyperplasia (BPH), is a common condition in older men where the prostate gland increases in size. 

This enlargement can cause urinary symptoms such as difficulty in starting urination, a weak urine stream, the need to urinate frequently or urgently, and waking up several times at night to urinate. 

Enlarged prostate is not the same as prostate cancer and doesn’t increase the risk of cancer, but its symptoms can significantly affect quality of life. 

The exact cause of Enlarged prostate is not well understood but is thought to be related to hormonal changes as men age. 

Enlarged prostate Treatment options vary depending on the severity of symptoms and can range from lifestyle changes and medications to various surgical procedures. 

Regular medical checkups are important for managing BPH, especially since its symptoms can mimic those of other more serious conditions like prostate cancer.

Enlarged prostate is a common issue among older men, but there are numerous Enlarged prostate treatment options available, ranging from lifestyle modifications and medications to surgical interventions. 

In this comprehensive article, we will delve deeper into the topic of enlarged prostate, and what are the Enlarged prostate treatment options available to manage this common condition affecting older men.

Enlarged Prostate Treatment

The choice of Enlarged prostate treatment will depend on the severity of your symptoms and the extent to which they affect you. Your healthcare provider will also consider any other medical conditions you might have.

Available Enlarged prostate treatment methods range from “watchful waiting” and lifestyle adjustments to medication and surgical interventions.

Men over the age of 60 are more prone to experiencing symptoms. However, it’s common for men with an enlarged prostate to experience only mild symptoms. In many cases, simple self-care measures can significantly alleviate discomfort.

If diagnosed with Enlarged prostate (Benign Prostatic Hyperplasia), it’s recommended to undergo an annual evaluation to track your symptoms and determine if there’s a need to modify your Enlarged prostate treatment plan.

Lifestyle Change in Enlarged Prostate:

If you have an enlarged prostate that isn’t causing significant issues, you might choose to monitor your symptoms before seeking Enlarged prostate treatment. 

Since an enlarged prostate typically develops gradually, your symptoms may not worsen.

There are several lifestyle adjustments you can make to alleviate your symptoms:

1. Reduce Intake of Certain Beverages: Limit alcohol, caffeine, artificial sweeteners, and carbonated drinks as they can irritate the bladder and exacerbate urinary problems.
2. Moderate Evening Fluid Intake: Decrease fluid consumption in the late afternoon and evening to reduce nighttime urination. However, ensure adequate hydration during the day, aiming for 1.5 to 2 liters (3 to 4 pints).
3. Plan Bathroom Visits: Use the bathroom before leaving home, especially for long trips, and familiarize yourself with public restroom locations.
4. Double Voiding: After urinating, wait a few minutes and try to urinate again to more completely empty the bladder. Avoid straining.
5. Review Medications: Discuss with your doctor if any of your current medications, like antidepressants or decongestants, might be worsening your urinary symptoms.
6. Increase Fiber and Fruit Intake: Eating more fiber and fruits can prevent constipation, which can pressure the bladder and worsen urinary symptoms.
7. Maintain a Healthy Weight: Being overweight can aggravate symptoms. If concerned about your weight, consult your doctor for healthy weight loss strategies.
8. Regular Exercise: Regular physical activity may improve symptoms. If you’re not active currently, talk to your doctor about starting a safe exercise regimen.
9. Bladder Retraining: This technique helps increase bladder control. For detailed guidance, consult your doctor or a specialist nurse.
10. Urethral Massage: Also known as urethral milking, this technique helps remove residual urine in the urethra to prevent dribbling. After urination, gently press upwards behind the scrotum and move your fingers forward along the base of the penis. Seek further instructions from your healthcare provider.
11. Use of Absorbent Pads or Urinary Sheaths: Absorbent pads or pants can be worn to absorb leaks. Urinary sheaths, similar to condoms with a drainage tube, can be worn to collect urine discreetly. Consult your doctor or nurse for more information on these options.

Each of these strategies can contribute to managing the symptoms associated with an enlarged prostate. 

It’s important to consult with your healthcare provider for personalized advice and Enlarged prostate treatment.

Medicines

Medication is a commonly used approach for managing mild to moderate symptoms of an enlarged prostate. The Enlarged prostate treatment options include:

Alpha Blockers: 

These medications help ease urination by relaxing the muscles in the bladder neck and prostate. 

Common alpha blockers include alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax), silodosin (Rapaflo), and terazosin. 

They are particularly effective for those with relatively smaller prostates and can work quickly. 

Possible side effects include dizziness and retrograde ejaculation, a benign condition where semen enters the bladder instead of exiting the penis.

5-Alpha Reductase Inhibitors: 

These drugs aim to reduce prostate size by blocking hormonal changes that cause its growth. 

Finasteride (Proscar) and dutasteride (Avodart) are examples. They may take about six months to show effectiveness and can have sexual side effects.

Combination Therapy: 

In cases where a single medication isn’t sufficiently effective, your healthcare provider may recommend a combination of an alpha-blocker and a 5-alpha reductase inhibitor.

Tadalafil (Cialis): 

Commonly known for treating erectile dysfunction, tadalafil has also shown potential in treating symptoms of an enlarged prostate.

Surgery

Surgery is considered when lifestyle modifications or medications fail to improve symptoms of an enlarged prostate, or if the symptoms are severe.

Several surgical procedures are available for treating an enlarged prostate. The main types include:

• Transurethral Resection of the Prostate (TURP): A common and effective surgical method.
• Holmium Laser Enucleation of the Prostate (HoLEP): A laser-based procedure.
• Transurethral Water Vapour Therapy (Rezūm): Utilizes water vapor for treatment.
• GreenLight Laser Surgery: Another laser-based option.
• Prostatic Urethral Lift (UroLift): A minimally invasive procedure.

The availability of these surgeries might vary depending on different factors like the size of your prostate and any other existing health conditions. 

Our medical advisers will explain the pros and cons of each surgical option they provide, assisting you in making an informed decision.

For a detailed summary of the most common types of prostate surgeries and further guidance, you can consult us, or speak with a Specialist nearby.

Transurethral Resection of the Prostate (TURP):

Transurethral Resection of the Prostate (TURP) is a surgical procedure primarily used to treat an enlarged prostate. It’s the most frequently performed surgery for this condition.

The procedure involves the following steps:

• Insertion of a Thin Tube: The surgeon inserts a slender instrument through the penis into the urethra. This tube serves as a pathway for the surgical tools.
• Removal of Prostate Tissue: Through this tube, the surgeon introduces an electrically heated wire loop. This tool is then used to cut away small sections of the enlarged prostate tissue carefully.
• Relief of Urinary Symptoms: By removing the parts of the prostate that are pressing against the urethra, the surgery aims to alleviate urinary difficulties associated with an enlarged prostate.

This procedure is considered when other treatments, like medications or lifestyle changes, have not provided sufficient relief from the symptoms of an enlarged prostate. 

It’s important to discuss the potential risks and benefits of TURP with a healthcare provider to understand if it’s the right option for an individual’s specific condition.

Holmium Laser Enucleation of the Prostate (HoLEP)

(HoLEP) is a surgical technique for treating an enlarged prostate, similar in purpose to TURP but distinct in its method.

Key aspects of HoLEP include:

• Laser Technology: HoLEP utilizes a high-powered laser to precisely remove the parts of the prostate that are obstructing the urethra.
• Effectiveness and Side Effects: Research indicates that HoLEP is comparable to TURP in terms of improving symptoms associated with an enlarged prostate. The short-term side effects of both procedures are also similar.
• Benefits for Larger Prostates: HoLEP is particularly advantageous for men with significantly enlarged prostates.
• Reduced Likelihood of Repeat Surgery: There’s a lower chance of needing additional surgery after HoLEP compared to after undergoing TURP.
• Specialized Procedure: HoLEP requires specific equipment and expertise. Surgeons performing this procedure need specialized training.
• Availability: Due to its specialized nature, HoLEP is typically offered only in specialist centers.

This targeted approach with laser technology makes HoLEP a modern and effective option for certain patients, especially those with larger prostates or those seeking a potentially more durable solution. 

As always, discussing the best surgical option with a healthcare provider is crucial, as they can provide personalized advice based on an individual’s specific health situation.

Transurethral Water Vapor Therapy (Rezūm)

Transurethral water vapor treatment (Rezūm®) involves using steam to eliminate the prostate tissue obstructing the urethra. 

It’s an effective approach for men experiencing moderate to severe urinary symptoms due to a moderately enlarged prostate. 

Rezum is known for its minimal likelihood of inducing sexual dysfunction and has demonstrated significant enhancements in patients’ quality of life.

GreenLight laser surgery

GreenLight laser surgery involves utilizing a potent laser to warm and eliminate the prostate tissue obstructing the urethra. 

It’s also known as photo-selective vaporization of the prostate (PVP), GreenLight XPS, or laser prostatectomy.

This procedure may match the effectiveness of TURP in the initial two years post-surgery.

However, its long-term efficacy and potential side effects over an extended period remain uncertain.

prostatic urethral lift (UroLift)

The prostatic urethral lift (UroLift) is a procedure where small implants are inserted into the prostate. 

These implants are designed to retract the surplus prostate tissue from the urethra, facilitating easier urine flow. 

This technique aims to alleviate symptoms without necessitating the removal of any prostate tissue.

Availability of this procedure is limited to certain hospitals, as it requires surgeons who have undergone specialized training. 

UroLift has demonstrated effectiveness in symptom improvement for up to five years. 

However, information about its long-term side effects, especially beyond five years, is still not fully known.

Possible Side Effects of Surgery:

Surgery for treating an enlarged prostate, like most medical treatments, carries the risk of side effects. These may include:

• Increased frequency or urgency of urination.
• Urinary incontinence, especially during coughing, sneezing, laughing, or exercising.
• Presence of blood in your urine.
• Urinary tract infections.
• A diminished urine flow.
• Retrograde ejaculation.
• Difficulties in achieving or maintaining an erection.

The likelihood of experiencing each of these side effects varies based on several factors, including the specific type of surgical procedure chosen. 

For detailed information and guidance tailored to your situation, it’s advisable to consult with your doctor or our medical advisers.

Procedure and pre-surgery preparations 

The type of prostate surgery you undergo will shape your experience and what to expect. 

For minimally invasive procedures, local anesthesia is often used, meaning you’ll stay awake but the specific area being operated on will be numbed. 

In contrast, other surgeries require general anesthesia, where you’ll be completely asleep.

If you’re scheduled for surgery under general anesthesia, you’ll need to prepare in the following ways:

• Fasting: Cease eating and drinking from midnight the night before your surgery.
• Smoking Cessation: If you’re a smoker, it’s advised to quit smoking four weeks prior to the surgery.
• Alcohol Restriction: Avoid consuming alcohol for 48 hours before the operation.

Additionally, it’s crucial to review all your medications, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements, with your surgeon. Follow their guidance on temporarily stopping any of these as necessary.

Post Surgery Experience 

After undergoing surgery for an enlarged prostate, it’s common to initially experience an increase in symptoms such as:

• More frequent urination.
• A heightened sense of urgency to urinate.
• The presence of some blood in your urine.

These symptoms are typically normal and should resolve within a few days following the surgery. 

However, if these symptoms worsen or persist beyond a week, it’s important to consult with our team.

Associated Complications

Many surgical treatments for an enlarged prostate can result in retrograde ejaculation, where semen flows backward into the bladder instead of exiting through the penis during orgasm, or anejaculation, which is the absence of ejaculation during orgasm. 

While these conditions are not harmful to health, they can lead to male infertility.

If you are considering fathering a child in the future or are planning a pregnancy with a partner, it’s crucial to discuss these potential risks with your urologist prior to undergoing the surgery. 

This will help you make an informed decision about the procedure and understand its implications on fertility.

Recovery After Enlarged Prostate Surgery

The duration of your recovery after prostate surgery is contingent on the specific type of procedure you undergo. 

Post-surgery, you’ll be moved to a recovery room where you’ll stay for approximately one to two hours. 

Most of these surgeries are outpatient procedures, allowing you to return home on the same day. Nonetheless, depending on your overall health and the nature of the surgery, your surgeon might suggest an overnight hospital stay.

Once you’re home or at a hotel, it’s important to rest for at least one to two days before gradually resuming everyday activities.

For less invasive surgeries, such as:

• GreenLight laser prostatectomy,
• TUIP (transurethral incision of the prostate),
• TUMT (transurethral microwave therapy), and
• UroLift,

You should avoid heavy lifting and strenuous activities for one to two weeks.

On the other hand, more invasive surgeries require a lengthier recovery period. After procedures like:

• HoLEP (holmium laser enucleation of the prostate),
• Simple prostatectomy, and
• TURP (transurethral resection of the prostate),

It’s advisable to refrain from heavy lifting and intense physical activities for three to six weeks.

Adhering to these guidelines is crucial for a smooth and successful recovery.

Enlarged Prostate Surgery Alternatives

If surgery isn’t feasible—due to health reasons, personal preferences, or if lifestyle changes and medications have been ineffective—your doctor or nurse may recommend using a catheter. 

This device is a slender, flexible tube designed to drain urine from your bladder and can be either permanent or temporary.

Permanent Catheter:

• • Insertion: It’s inserted through the penis or via a small incision in the abdomen.
  • Maintenance: Attached to a drainage bag concealed under clothing, it typically requires changing by a healthcare professional every 12 weeks.

Temporary Catheter (Self-Catheterization):

• • Usage: You insert the catheter yourself as needed for urination.
  • Frequency: While some men may only need it once daily to ensure complete bladder emptying, others might need to use it multiple times a day.

Risks and Management of Urinary Infections:

• Catheter usage can increase the risk of urinary infections. Indicators of an infection include dark or cloudy urine with a strong odor, fever, a burning sensation during urination, and general malaise.
• Treatment: If you experience these symptoms, contact your doctor or nurse. Antibiotics are commonly prescribed to treat such infections.

Preventive Measures:

• Hygiene: Always wash your hands with warm, soapy water before and after handling your catheter or drainage bag.
• Cleaning: Wash the catheter and surrounding area at least twice daily with warm water and unscented soap, using a separate washcloth from the one used for your body. Wipe downwards along the catheter, away from your body, and dry it thoroughly.
• Hydration: Consume plenty of fluids (1.5 to 2 liters, or 3 to 4 pints, daily).
• Diet: Eat fiber-rich foods like fruits, vegetables, and wholemeal bread to prevent constipation, which can impede catheter drainage.

These guidelines are essential for reducing infection risks and ensuring comfortable and effective catheter use.

Takeaway

When considering prostate surgery, choosing a proficient surgeon, especially one with significant experience in conducting numerous such procedures, is crucial. 

For instance, at a reputable center like Istanbul Urology Clinic, surgeons who have performed many of similar surgeries are typically available. 

The high level of expertise tends to reduce the risk of complications such as u

rinary incontinence and sexual side effects, including erectile dysfunction, which can arise from nerve damage.