The Use of Robotic Surgery in Benign Prostate Hyperplasia in Aging Men
It is well known that robotic surgery has shown good results in the treatment of prostate enlargement, a common issue that becomes a nightmare for men as they age. Robotic surgery is commonly used in the treatment of malignant prostate enlargement, while its use in benign prostate enlargement is considered a newer technique.
What is Prostate Cancer?
The prostate is a 15-20 gram organ located at the exit of the urinary bladder in men. It produces a hormone that facilitates the liquefaction of sperm and ensures the continuity of the urinary tract. The prostate starts to enlarge in the early 40s and continues to grow as men age. This growth can be either benign or malignant. Benign growth is called Benign Prostatic Hyperplasia (BPH), while malignant growth is known as prostate cancer.
Are the Diagnosis and Treatment of Benign and Malignant Growth the Same?
The diagnosis and treatment of these two types of growth are completely different. Their processes and follow-up procedures also vary. However, both types of growth often present with similar symptoms. Difficulty urinating, frequent urination, and nocturia (nighttime urination) are common symptoms in both benign and malignant growths. Patients presenting with symptoms of benign growth should be carefully evaluated to determine the nature of the enlargement. To differentiate between benign and malignant growth, patients undergo a hormone test called PSA (Prostate-Specific Antigen) and a digital rectal exam. If necessary, further differentiation can be achieved through MRI (Magnetic Resonance Imaging) of the prostate or, as a last resort, a prostate biopsy.
What Treatments Are Available for Benign Prostatic Hyperplasia (BPH)?
When treating benign prostatic hyperplasia, many factors must be considered. Initially, medication is the first step, but surgical treatment is preferred for patients who do not benefit from medication, have severe symptoms, experience impaired quality of life, have uncontrollable bleeding in the urine, or have additional issues like bladder stones. Surgical treatment for BPH includes several alternatives. The choice of treatment depends on the size of the prostate. According to the European Association of Urology (EAU) 2019 guidelines, a closed technique known as TUR (Transurethral Resection) is recommended for prostate volumes under 80 grams, while open surgery is advised for larger prostates. The challenge arises with prostates over 80 grams. Prostates ranging from 100 to 150 grams can still be treated with TUR in experienced clinical settings. For larger prostates, over 150 grams, careful consideration is required to choose the right treatment, as untreated patients will continue to experience symptoms.
Is Open Surgery Required for Large Prostates, or Can a Closed Technique Be Used?
For very large prostates, open surgery is often recommended. However, open surgery has some disadvantages, such as larger scars, longer hospital stays, increased bleeding, more pain, and a higher risk of complications. Even though not recommended for large prostates, TUR (a closed surgery technique) can still be performed. However, complications related to the long duration of the procedure, such as urinary tract strictures and TUR syndrome (water intoxication), are more common. This is where robotic surgery comes in, combining the benefits of both open and closed techniques by completely removing the prostate while using a minimally invasive approach.
The Use of Robots in Urology
The use of robotics in urology began in the 2000s and has become more widespread in Turkey in the last 4-5 years. However, the number of clinics utilizing robotic surgery remains limited. This technique is minimally invasive, where the patient’s abdominal cavity is inflated with gas, and the robotic arms are inserted through small incisions of approximately 8 mm. With three-dimensional and detailed imaging inside the body, the surgeon performs the surgery. It is important to note that the surgeon controls the robot, and the robot simply replicates the surgeon’s movements. In essence, the robot’s arm is an extension of the surgeon’s hand.
In Which Types of Prostate Enlargement Is Robotic Surgery Used? Are There Any Advantages?
In our country, robotic surgery is commonly used for prostate cancer (malignant prostate enlargement). This is also the case worldwide. However, the use of robotic surgery for the treatment of benign prostate enlargement is a newer technique. In our clinic, we have been using this method for the past two years with very successful results. For larger prostates, especially those over 15 grams, robotic surgery has fewer complications such as stricture development and recurrence when compared to other closed techniques like TUR, HOLEP, or Plasma Kinetic procedures. This is because robotic surgery simulates the highly effective open surgery previously used for large prostates but with a minimally invasive approach. With the increasing adoption of robotic surgery, I believe robotic techniques (robotic transvesical prostatectomy) will become more widely used for benign prostate enlargement in the future.
You Can Book an Online Appointment with Our Urology Department
You can contact us 24/7 by sending an email to info@koruhastanesi.com, calling our phone number 0543 514 02 04, or reaching our call center at 0312 911 77 77.
