Prostate Surgery In Turkey

Prostate Surgery Procedures

Prostate surgery is the treatment method used in cases where drug treatment is not sufficient or fails in the treatment of Benign Prostatic Hyperplasia (BPH). Prostate enlargement causes many negative conditions that will negatively affect the daily lives of people, such as frequent urination, difficulty urinating, urination, urination and pain. In treatment, drugs are tried first, but surgical treatments, i.e. prostate surgeries, are considered for patients who cannot recover with the drug or who do not want to use drugs due to side effects or other ailments that repeat the disorders despite benefiting before the drug. In addition, surgical treatments should be applied in patients with stone development in the bladder, frequent urinary tract inflammation, frequent bleeding in the urine and never emptying of their urine.

The basic logic of prostate surgeries is based on removing and removing the prostate, but there are different methods that can be used to do this. In general, there are two types of prostate surgeries: “Open Prostate Surgery” and “Closed Prostate Surgery”. There are different techniques also used in closed surgery or endoscopic surgeries. We will consider these in detail, but I would like to underline that any of the techniques applied do not have the advantage of another. When performed by an experienced and competent surgeon, the result is the same regardless of which technique prostate surgery was performed. More patients’ preferences stand out here. And I think that our patients who are in favor of preferring the techniques that stand out in certain periods that we can call fashion should be well informed about this issue. Our patients who choose the appropriate method together with their doctor, not the method that is on the agenda, can achieve easier recovery by minimizing the problems that may occur after prostate surgery.

TUR-P (Transurethral Resection of the Prostate)

Laparoscopic prostate surgeries, known as TUR, are surgical operations in which the prostate is removed from the urinary tract by entering it with a special endoscope called a resectionscope and removing the prostate into small pieces with the help of the energy used. In the classic TUR-P method, monopolar electric current is used. In this method, since electric current passed through the patient’s body, its application could have negative effects, especially in patients with pacemakers. There are also disadvantages such as the high amount of bleeding and the development of liquid-induced TUR syndrome, which is used for imaging with an endoscope. The new technology method we use in TUR prostate surgeries is bipolar TUR surgery, which we call “Plasma Kinetic TUR”. In this method, high frequency electric current is used to cut the prostate into pieces. It is a safely applicable method even in patients with pacemakers because there is no electric current passing through the body. The amount of bleeding is less, the duration of surgery and the hospital stay after surgery are shorter. In addition, TUR Syndrome is unlikely to occur as serum is used physiologically for imaging. TUR Syndrome is a condition in which the amount of sodium in the body decreases by passing the liquid used to provide appearance during the operation into the body. Even if the serum used in plasma kinetic TUR application passes into the physiological body, it is not possible to cause any problems. With all these advantages, it is not wrong to say that Plasma Kinetic TUR is the gold standard method that combines the effectiveness of classical TURP in tissue extraction and the superiority of laser prostatectomy in bleeding control.

Who is the TUR Procedure Suitable for?

The TUR method is suitable for patients with moderate or severe complaints with benign prostatic enlargement and prostate volume in the range of 30-100 milliliters.

How is TUR Prostate Surgery Operated?

TUR Prostatectomy can be performed under general anesthesia or local anesthesia. The patient is put to sleep with general anesthesia or spinal or epidural anesthesia is applied from the waist. The operation is started by evaluating the prostate, urinary tract and bladder by entering the urinary tract with a camera system called “cystoscope”. With a tool called a resectionscope, prostate tissue is broken into small pieces, and the cut parts are pushed into the bladder (urine bag). At the end of the resectionscope is a semicircular wire, and thanks to the electric current transmitted through this wire to the prostate tissue, nearly all of the enlarged prostate tissue inside the prostate capsule can be cleaned. In addition, if a significant hemorrhage is observed during the procedure, the bleeding can be controlled through this wire called loop. When the inside of the prostate capsule is cleaned, the cut parts are taken out and sent to the pathology for examination. At the end of the operation, catheters is inserted into the bladder to ensure the flow of urine, and with the help of this catheter, the urethra and bladder are washed with a sterile liquid, ending the process. Thus, the formation of clots is prevented. The catheter is removed after the blood urine color begins to improve. This process takes an average of 1-2 days.

Prostate Surgery with Laser

After the use of lasers became widespread in medicine and urology, various methods used by laser were applied in prostate surgeries from the past to the present. Laser prostate surgeries, some of which have already been performed and some of which are still performed, are;

Greenlight Laser, PVP (Photocellective Prostatic Vaporizing), PVDL(Prostate Vaporizing with Diode Laser), PEDL (Prostate Eneculation with Diode Laser), WTL (With Thulium Laser) Prostate Enuclement, PRTL (Prostate Resection with Thulium Laser), PRHL (Prostate Resection with Holmium Laser) and PEHL (Prostate Enuclement with Holmium Laser).

Laser prostate surgeries are very popular in every period and methods continue to develop with changing technology. Since it is unnecessary to go into the detail of each of these methods, we will focus on holep, which is currently the most up-to-date method.

HOLEP Laser Prostate Surgery

Holep (Prostate Enuclement with Holmium Laser) technique is to be used by laser instead of electric current used in TUR method. The biggest reason for laser prostate surgeries was the lack of chance of bleeding and the biggest disadvantage was the lack of tissue samples. Previously used laser techniques, prostate tissue evaporated, so tissue samples could not be taken for pathological examination, which led to possible cancer cases being overlooked. Thanks to the HOLEP method, it is now possible to take samples for biopsy. As a result, Prostate Surgeries with Holmium Laser are preferred and applied as often as Plasma Kinetic TUR Surgeries. HOLEP, which has many advantages such as no burning sensation (disordate) when urinating after removal after the operation, similar low complication risks, faster recovery and low relapse rate, is a method that can be applied to every patient regardless of the volume of the prostate. 

How to Operate HOLEP Prostate Surgery?

The preparation stage before prostate surgery with HOLEP Laser and the way the operation is performed are very similar to TUR. TUR operation is based on the principle of “burning with electrical energy”, and HOLEP is based on the principle of “separating prostate tissue with laser”. By entering the urinary tract, prostate tissue is separated from the prostate capsule by laser and pushed into the bladder first, when all the tissue is cleaned, the parts are removed from the bladder and the catheter is inserted and the process is terminated. When it comes to laser surgery, patients have concerns about erectile dysfunction, but this concern is unwarranted. The nerves that regulate sexual functions pass around the prostate capsule. The cleaned tissue is inside the prostate capsule. The effect of the laser on healthy tissue is less than 0.4 mm and is unlikely to damage the nerves passing around the prostate capsule.