• Introduction

Benign prostatic hyperplasia (BPH) or the so called “prostate enlargement” is a common condition of men of middle and advanced age. It is remarkable that the whole process of prostate enlargement is found in the male population from the age between 30 and 40 years. But finally at an age of 80 approximately 90% of elderly men suffer from prostate enlargement. Therefore it has been observed that this abnormal condition increases with age resulting in a gradual progression and often leading to a reduction in the flow of urine (force of urination).

• Symptoms

The BPH develops gradually with age leading to a worsening of symptoms. The symptoms include:
⇒  Reduction of the flow of urine during urination is one of the most common symptoms of prostatic hyperplasia. Typically the victim observes that the urine flows near to the body of the patients and urination frequently results in wetting the shoes. It is particularly troublesome because many men with advanced prostatic hyperplasia are forced to urinate sitting down in the basin in an attempt to avoid wetting themselves.
⇒ The emergence of so-called teardrop bladder is usually a result of reduction of the flow of urine. The young man when finished urinating stop the flow of urine without any loss that remains dry. On the contrary, in the case of prostatic hyperplasia, urination may continue for a few seconds forming drops of urine despite the will of the person to stop urination.
⇒ Prostatic hyperplasia is characterised by frequent urination. It is one of the most important symptoms of the disease and ultimately what bothers most of the patients. When frequent urination occurs at night is called nocturia.
⇒ Many people complain that they have an urgent desire to urinate that can not be held. They describe that on the way to the toilet they may lose some urine and feel that they are not able to hold urine. This phenomenon is described by urgent urination.
⇒ Many patients describe struggling over the toilet to initiate urination, and urination comes only after long wait. Other patients are forced to open the tap in order to relax more and urinate. Others complain of pain when urinating and sometimes see a little blood in their urine. Many people feel that after urination their bladder is not empty and there is residual urine in it. These are all symptoms of prostatic hyperplasia. There are other individual symptoms which are not as annoying and do not have such a negative impact on quality of life of patients.
⇒ The dramatic conclusion of hyperplasia and the most dangerous symptom is the so called acute urinary retention. The patient feels great discomfort and pain in the lower abdomen and feels that he is going to “explode”. He cannot urinate. It is very painful and requires immediate treatment by a medical specialist with catheter placement into the bladder. The relief is immediate and urine comes out through the catheter.

• Possible complications of BPH

Apart from the symptoms that bother the male population there are significant risks that are not visible, but can seriously jeopardize the health of unsuspecting men. We must emphasize that the disease is not dangerous at its early stages. Nevertheless, its final evolution includes serious risks. It all starts with the obstruction caused by prostatic hyperplasia which prevents urine to find a natural way out and there is always an amount of urine into the bladder. The quantity of urine that constantly remains in the bladder is the source of many problems such as the formation of stones in the bladder. Moreover, serious complications such as hydronephrosis, pyelonephritis, and eventually renal failure are also possible. The term hydronephrosis describes the dilatation of the kidney caused by its inability to expel urine. The kidney is trying to overcome the obstruction and “swells”. This creates a vicious circle resulting in renal failure. The stagnant urine in the urinary tract becomes infected and ultimately causes a systemic infection called pyelonephritis. Eventually, kidney failure is the most unfortunate but rare condition of the benign prostatic hyperplasia. Thus, the prostatic hyperplasia should be timely addressed. Close collaboration with a urologist is necessary in order to early diagnose and treat prostatic hyperplasia while avoiding the above complications.

• Treatment

BPH can be treated either conservatively or surgically. In most patients the initial treatment proceeds conservatively with administration of medicine. Surgical treatment follows when the conservative treatment fails. Certainly, it is likely to require surgical treatment during the first diagnosis. Only the urologist is able to set the “indications” for surgery. In summary, surgical treatment is proposed after failure of medical treatment and when the blockage of urine flow causes serious problems.
The surgery is called prostatectomy and it includes the excision ,or rather, the removal of the prostate adenoma, the portion of the prostate that has enlarged. Our department has the ability to offer 3 different methods of surgical access for the same purpose, which is the removal of the obstructive portion and restoration of comfortable urination for the patient. These accesses are called transurethral prostatectomy, Photoselective Vaporization of the Prostate (PVP) with Greenlight laser and laparoscopic simple prostatectomy.

• Transurethral prostatectomy

The transurethral prostatectomy is performed by the use of a special tool called a , resectoscope. This tool is inserted through the urethra and thus does not require surgical incision.

Since there is no surgical incision, it is easily understandable that the procedure is less painful and practical, it also means that the patient can be dismissed early from the hospital and return home after approximately 4 days. This method is a basic of the surgical treatment of BPH and allows the patient to mobilize quickly and soon return to work.

• Photoselective Vaporization of Prostate (PVP) with Green light laser

The Photoselective Vaporization of Prostate is an advanced method of prostatectomy for BPH introduced in recent years. The method requires no incisions and the introduction of the tool is done through the urethra. An important advantage of this method is the increased potential for intraoperative hemostasis which is especially useful in patients receiving anticoagulant therapy and are at increased risk for bleeding. In addition, the catheter inserted postoperatively is removed on the first day after surgery.

• Laparoscopic simple prostatectomy (adenomectomy)

Laparoscopic simple prostatectomy is an advanced approach substituting open prostatectomy surgery, which represented for decades the basis for the surgical treatment of BPH. In the case of laparoscopic simple prostatectomy, the surgical incision in the lower part of the abdomen of the patient (unlike open prostatectomy) is avoided. Surgery involves entering the abdomen with a small hole in the abdominal wall. A small incision in the limit of the bladder and the prostate is performed for the removal of the adenoma of the prostate. After surgery, a catheter placed in the bladder and the patient remains in hospital for about 5 days. The catheter is removed after about 5 days and the patient returns back home. The method has significant advantages compared to the open prostatectomy in terms of blood loss, post-operative pain and mobilization of the patient. It should be noted that a method is indicated to patients with very large prostates who would be difficult to deal with above described methods.

• Possible complications

As for any surgical procedure, there is a possibility of adverse situations after prostatectomy. In some cases, especially if specific precautions are not met, sudden bleeding may appear. In this case, it is important to drink plenty of water and contact the treating doctor immediately. Nevertheless, the patient should avoid panic. All complications are managed with close cooperation with the treating urologist. Another complication is infection of the urinary tract. The latter complication is understood why urination may be painful or sometimes the testicles are swollen and fever may be present. In this case you should contact the treating urologist to provide the appropriate treatment.

• Sexual activity after prostatectomy for BPH

Of crucial importance is the question about sexual potency after prostatectomy for BPH because it affects a vital human function and pleasure in sex. The answer is that it does not affect the ability of man to make sexual contacts. Nevertheless, it should be emphasized that the possibility of not seeing the sperm after sex. This is associated with the release of the sperm in the bladder where it is mixed with the urine. In short, the sperm comes out when we go to urinate. This situation is called “retrograde ejaculation” and there is no reason to believe that the operation has not succeeded.