Benign prostatic hyperplasia (BPH), which typically occurs in older men, is one of the significant issues that can affect the quality of life. Urology Specialist Assoc. Prof. İlter Alkan stated that advancements in laser technologies have led to significant changes in urological surgery, bringing important conveniences for both patients and physicians, particularly in recent years. He highlighted that one of the most current technological developments in this field is the Thulium Fiber Laser. The treatment can be applied to prostates of any size and patients of any age, significantly reducing potential side effects during and after the operation, thus improving post-operative quality of life.
Assoc. Prof. İlter Alkan from Yeditepe University Kozyatağı Hospital stated that benign prostatic hyperplasia is one of the most common urological diseases. He provided information about the current treatment method 'Thulium Fiber Laser (ThuFLEP)'. Assoc. Prof. Alkan emphasized that benign prostatic hyperplasia should not be confused with prostate cancer. "According to the literature, 50% of men over the age of 50 have prostate enlargement. This percentage increases with age, reaching 70-80% in the 60-70 age range. Therefore, it is a frequently encountered problem," he said.

ThuFLEP Treatment Does Not Harm Surrounding Organs

Assoc. Prof. Alkan explained that it is possible to remove all of the benign enlarging prostate tissue (adenoma) in a closed method surgery, thus providing significant benefits to the patient. "One of the most important features of the treatment is the very low depth of field," said Assoc. Prof. Alkan. "This ensures that when the tissue is cut, there is no harm to surrounding organs. Additionally, because the vessels are closed during the cut, there is no risk of bleeding." He noted that because the entire enlarging tissue is removed during the surgery, the likelihood of the disease recurring is very low. "Prostate can grow again by 10% in ten years. This is not due to the remaining tissue but because of the formation of new tissue. However, a 10% chance in ten years is quite a low figure," he stated.

Surgery Can Be Planned If Complaints Increase Over the Years in Benign Prostatic Hyperplasia

Assoc. Prof. Alkan provided information on when surgery is necessary in the treatment of benign prostatic hyperplasia, emphasizing that not every prostate enlargement requires surgery. "If the patient has mild complaints, if the urine test does not show significant blockage, and if it does not significantly affect daily life, we can only apply drug therapy. However, sometimes complaints can increase over the years despite medication. In such cases, we can plan surgery. If the patient wakes up 3-4 times at night to urinate, has intermittent and difficult urination, and these complaints start to reduce the quality of life, we consider surgery. If the urination test also reveals a blockage, we decide on surgery," he explained.

Short Hospital Stay and Catheterization Period with ThuFLEP Treatment

Assoc. Prof. Alkan stated that after the surgery, the patient stays in the hospital with a catheter for one night and is discharged the next day after the catheter is removed and the patient urinates comfortably, making the transition to daily life very short.

ThuFLEP Surgery is Effective in Large Prostates

Assoc. Prof. Alkan noted, "In the past, we used to perform open surgeries for large prostates, for example, benign prostatic hyperplasia over 80-100 grams. However, with other laser methods, this size issue has been eliminated for a long time. Even prostates of 150-200 grams can be operated on with the ThuFLEP method. Therefore, open surgery is no longer necessary for large prostates due to benign prostatic hyperplasia. Another feature of the procedure is that it is bloodless. The low risk of bleeding is a significant advantage, especially for patients who need to use blood-thinning medications.

“Age Is Not a Factor If the General Condition is Good in ThuFLEP Surgery"

Assoc. Prof. Alkan stated that there is no age limit for the surgery. "If the patient's general condition is good and there are no problems with anesthesia, surgery can be performed. We have patients who have undergone surgery at the age of 90 and have been discharged with their urinary complaints resolved in a healthy manner," he said.

“Men Should See a Doctor for Prostate Enlargement After Age 50, Even If There Are No Complaints"

Assoc. Prof. Alkan emphasized that men should have their prostate checked after the age of 50, even if they have no complaints. "If there is a family history of prostate cancer, they should be checked earlier, otherwise, it is necessary to see a doctor from the age of 50 onwards, even without complaints. Patients come to us with prostatism complaints such as difficulty and intermittent urination, waking up at night to urinate, feeling of incomplete emptying after urination, and urgency in advanced stages, which may affect the bladder. We determine whether surgery is necessary based on the test results. Sometimes, patients may come with complications such as complete inability to urinate. In such cases, we need to operate," he explained. Assoc. Prof. Alkan continued to talk about the situations that can arise if the disease is neglected: "In advanced stages, some of our patients neglect it for many years, leading to the accumulation of a large amount of urine in the bladder without being aware of it. This condition can extend to the kidneys and cause damage. The kidneys enlarge on both sides, and the patient's urea level rises. This is a very advanced stage, which we see less frequently. When we insert the catheter, the patient's kidneys recover immediately. Usually, these patients go to surgery.”

“ThuFLEP Surgery Does Not Affect Patients' Sexual Lives”

Assoc. Prof. Alkan clarified that the ThuFLEP method used in the treatment of prostate enlargement does not affect the patient's sexual life, addressing a common concern.

"Today, we perform prostate enlargement surgery endoscopically. We do not see any problems that would affect the patients' sexual lives. There are no issues with erectile function. The patient's pre-surgery condition in terms of sexual life and erectile function continues as it was. The risk is higher after prostate cancer surgery. Therefore, it is important not to confuse prostate cancer surgery with benign prostatic hyperplasia surgery. Erectile dysfunction and erection problems are not seen after benign prostatic hyperplasia surgeries. However, the condition of not ejaculating after sexual intercourse can occur after these surgeries. We can see this condition in 70% of cases unless special techniques are applied. Removing all the tissue is a very effective method, but it can lead to dry ejaculation. This side effect may not be very important for our patients in their 60s-70s, but it can be significant for younger patients. Prostate enlargement can also be seen at a rate of 8% in men in their 40s. In this age group, especially if the patient has a desire to have children, this situation is important. By applying special techniques in these cases, we can reduce this rate. To preserve ejaculation function, we can reduce this side effect rate from 70% to 10%," he explained.