Benign prostatic hyperplasia and prostate cancer are two completely different diseases. BPH never turns into prostate cancer even when untreated. However, the person may have both benign prostate enlargement and prostate cancer at the same time. Because these two diseases are age-related diseases.

Signs and Symptoms

When the prostate enlarges, it may constrict the flow of urine. Nerves within the prostate and bladder may also play a role in causing the following common symptoms:

• Urinary frequency
• Urinary urgency
• Needing to get up frequently at night to urinate (Nocturia)
• Hesitancy – Difficulty initiating the urinary stream; interrupted, weak stream
• Incomplete bladder emptying – The feeling of persistent residual urine, regardless of the frequency of urination
• Straining – The need strain or push (Valsalva maneuver) to initiate and maintain urination in order to more fully empty the bladder
• Decreased force of stream – The subjective loss of force of the urinary stream over time
• Dribbling – The loss of small amounts of urine due to a poor urinary stream as well as weak urinary stream.

Diagnosis

Digital rectal examination

Urinalysis

Urine culture

Prostate-specific antigen (PSA)

Electrolytes, blood urea nitrogen (BUN), and creatinine

Ultrasonography

Endoscopy of the lower urinary tract

IPSS/AUA-SI

Treatments

There are several effective treatments for prostate gland enlargement, including medications, minimally invasive therapies and surgery. It is necessary to consider your complaints, size of your prostate, other health conditions and preferences of you to determine the most appropriate treatment option.

Pharmacologic treatment

Agents used in the treatment of BPH include the following:

• Alpha-adrenergic receptor blockers
• 5-alpha reductase inhibitors
• Phosphodiesterase-5 enzyme inhibitors
• Anticholinergic agents

Surgery

• Transurethral resection of the prostate (TURP)
• Open prostatectomy

Minimally invasive treatment

• Transurethral incision of the prostate (TUIP)
• Laser treatment
• Transurethral microwave therapy (TUMT)
• Transurethral needle ablation of the prostate (TUNA)
• High-intensity ultrasonographic energy therapy
• Prostatic stents
• Laparoscopic prostatectomy
• Robotic prostatectomy

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Diabetes, hypertension, chronic glomerulonephritis and polycystic kidney disease are the main causes of end-stage renal disease.

Kidney transplantation is a surgical method applied to people with end stage renal failure. People with end-stage renal disease need to have waste removed from their bloodstream via a machine (dialysis) or a kidney transplant to stay alive. Renal transplantation can also be performed after some treatments such as hemodialysis, peritoneal dialysis or hemofiltration.

The person giving his/her kidney is called donor and the person receiving the kidney is called recipient. The kidney to be transplanted should not be rejected by the recipient’s immune system. The kidney to be transplanted is usually found from a family member or a person (cadaver) who has donated his/her kidney before he/she died. In the transplantation process, the left kidney of the donor is usually removed and attached to the right pelvic region of the recipient.

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The prostate is located at the base of the pelvic space in the body in other words in the most difficult area to reach. In order to reach the prostate from the incision made to the abdominal skin, it is necessary to go further below the location of the bladder. In classical robotic surgery, the connection between the bladder and the abdominal wall is cut and normal anatomy is changed to reach the prostate. Approximately 25 cm distance should be covered to reach the prostate from the skin. In Robotic Perineal Radical Prostatectomy method,  this distance is reduced to 5 cm since the perineal entry is made. In this method, the connection between the bladder and the abdominal wall ,the structure holding all the internal organs, which is called endopelvic fascia, are not cut, in other words the normal anatomical structure is not changed.

In Robotic Perineal Radical Prostatectomy method, the muscles passing through the prostate and the nerves that provide penile erection, the vessels feeding the prostate and the large vessels in the abdomen are protected better.The reason for better preservation of these nerves is that the prostate does not move much during the operation.

In classical robotic surgery performed with perforated holes from the abdomen, the main veins (dorsal vein complex) feeding the prostate are sutured to prevent bleeding.However, in the perineal radical prostatectomy , this suturing process is not required.
Furthermore, in the classical robotic surgery, there is a risk of damaging the large vessels in the abdominal wall and abdomen during the placement of arms of the robot. However, this risk is not found in the robotic radical perineal prostatectomy method.

“Robotic Perineal Radical Prostatectomy” ,which is referred to the world medical literature as “BakırköyTuğcu Technique”, is a preferred method especially for patients who have undergone abdominal surgery previously.

Perineal Radical Prostatectomy can also be performed by open surgery.However, open surgery is difficult if the prostate is larger than 60 gr, and in cases where the lymph nodes need to be removed, a separate incision should be made from the abdomen.Robotic Perineal Radical Prostatectomy has eliminated these disadvantages of the open method.

In this method, removal of lymph nodes with tumor involvement is possibleand can be successfully performed in prostates larger than 60 g. With this technique, the removal of lymph nodes have been performed for the first time in the world with “BakırköyTuğcu Technique” by Prof. Dr. VolkanTuğcu and has the largest series in the world about prostatectomy with Robotic Perineal Radical Prostatectomy.

In which patient groups does the robotic perineal prostatectomy method apply?

Patients who have undergone surgery for colon cancer

Patients who have undergone surgery previously for colon cancer have serious anatomic abnormalities and abdominal adhesions due to abdominal operations.This situation makes almost impossible to perform abdominal surgical procedures again.Such patients are well-suited for the Robotic Perineal Prostatectomy performed by entering the region between the rectum and the testicles.

Patients with kidney transplantation

It is difficult to reach the prostate by entering into the abdomen in patients who have undergone renal transplantation before.These patients are also suitable for robotic perineal radical prostatectomy. In classical robotic surgery to be performed from the abdomen, there is a possibility that the transplanted kidney may be damaged due to the change in the anatomy of the urinary tract and bladder.

Patients with artificial bladder

The Robotic Perineal Radical Prostatectomy method is a comfortable method

for patients who have undergone bladder removal surgery before due to the bladder cancer and who has artificial bladder from the intestine.

In classical robotic surgery, there is a risk of damage to the artificial bladderbecause the bladder structure is intervened to reach the prostate at the entrance of the abdomen.

This risk is eliminated in the Perineal Radical Prostatectomy.

Patients receiving radiation therapy to their abdomen

Patients who have previously received radiation therapy in the abdominal region are not eligible for classical robotic surgery. This is because structural changes adhesions and deterioration of abdominal organs and tissues occur due to radiation therapy. Prostate cancer is also successfully treated in these patients by robotic surgery from the perineal region.

Patients with Penile Implants

Some types of penile implants are made with abdominal implanted devices, so abdominal surgical intervention is generally not preferred. Prostate cancer surgery in patients with penile implant can be performed safely from the perineal region.

The comfort and privileges of the robotic perineal radical prostatectomy method are as follows;

There is no abdominal pain in the postoperative period because no action is performed in the abdomen that contains the intestines.

Generally, there are no difficulties such as gas extraction and bowel movements.

The patient is discharged on average a few days after surgery and can continue his daily life a week later.

Since the operation is performed in a small incision in the area between the anus and testicles, the scar does not appear after a while.

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According to the type of surgery to be performed in robotic and laparoscopic surgery, 3-5 holes are opened on the abdominal skin with a size of about 1 cm.The abdomen is inflated with gas. Surgery is performed through cameras and special instruments are sent into the abdomen through these holes.

Because of the very small operation incision in robotic and laparoscopic surgery, the pain is less in the postoperative period, the duration of hospitalization is shortened and the recovery period is faster, so it is faster to return to daily life.Robotic operations can be performed from a single incision of 2 cm from the belly button instead of three-four holes used in robotic surgery. This process is called single port surgery.

The main advantage of single port robotic surgery is to give better results in terms of cosmetic apperance due to the incision made into the belly. In this process there is almost no scar in the abdomen and the incision made in the abdomen is also masked by belly.

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Ureteropelvic junction (UPJ) obstruction is the obstruction of the ureter where the ureter enters the kidney.Obstruction may be congenital or may be gained later.Generally, it stems from the pressure of the vessel located in that area.This prevents the urine produced in the kidneys from passing into the urethra and passing into the bladder.As a result, the fluid pressure inside the kidney increases and after a while, renal function deterioration occurs.

The treatment of UPJ obstruction is surgery. Surgery is performed by open, laparoscopic or robotic methods.Robotic UPJobstruction surgery is performed with robotic arms which are sentinto 3-4 small incisions made to the abdominal wall. The surgeon sits in a place called the console and performs the operation using the arms of the robot.The robot arms have the ability to make maneuvers which cannot be done by human hands and to enter easily into narrow areas.Because of the small operation incision, recovery after surgery and return to normal daily life is faster.The pain felt in the postoperative period is less.

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Superficial bladder cancer is the more common and lighter form.In these patients the treatment called TUR-bladder surgery method is applied.TUR-urinary bladder surgery is a closed surgical procedure performed by entering a special instrument from the tip of the penis.The tumor tissue removed during surgery is sent to the pathological assay.According to the pathology results, it may be necessary to administer a number of drugs (TB microbe, BCG, chemotherapy drugs) into the bladder at specific intervals.

The bladder is completely removed in the treatment of the bladder cancer which only involves the bladder muscle and does not spread to other parts of body. This process is called radical cystectomy.In the radical cystectomy operation, all of the bladder, prostate, semen canals and the end of the semen canals are removed in men and also bladder, uterus, overies and a part of the vagina wall are removed in women.After the bladder is removed, a new bladder is made from the intestine, or a small intestine section where the urinary canals are connected is also connected to the abdominal wall as a mouth. In these patients, urine is collected in a urine bag (urostomy bag) adhered to the abdominal wall.In the case of bladder made from intestine, urine accumulates in newly constructedintestine bladder and expelledthrough the penis byurination.The patient does not need to use bags.

Radical cystectomy and neo bladder making operations can be performed open, laparoscopic and robotic surgeries. In bladder cancer operations performed by robotic method, incisions of 1 cm are opened in the lower part of the abdomen of the patient. The surgeon performs the operation by means of robotic arms sent from these incisions.The most important advantage of robotic surgery is that robotic arms can perform better maneuvers by entering very narrow areas where the human hand cannot enter.Thus, both the surrounding tissues will be less damaged and the damage to the veins and nerves that cause the penis to erect is prevented. In addition, very small incisions in robotic surgery allow the patients to recover more quickly, to experience less pain and to return to their daily life more quickly.

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When the disease is diagnosed, if it has not spread to other parts of the body, the kidney is surgically removed. This process is called radical nephrectomy.

Depending on the size and location of the tumor, the surgical method is changed.ifthe kidney is taken completely with the adipose tissues around it, then this method is called radical nephrectomy. Ifonly the tumor portion of the kidney is removed, and the rest of the kidney is left, then this process is called partial nephrectomy.

The nephrectomy can be performed by open, laparoscopic or robotic methods.In robotic nephrectomy, the surgeon performs surgery with robotic arms, which are inserted into the abdomen from small incisions, each of which is about 1 cm and which are opened on the abdominal wall.Robotic arms, which are capable of performing maneuvers which cannot be done by human hand, can reach to narrow areas which human hand can not reach. And also the hand tremor problem which is encountered during the open surgical procedure is not seen in robotic surgery.

Very small incision, less pain in the postoperative period and faster return to daily life are the main advantages of robotic surgery.

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Prostate is a chestnut-sized organ found in men. It produces a substance that causes fluidity of the semen.Prostate cancer is the uncontrolled proliferation of some cells in the prostate. Approximately half of men over the age of 70 have prostate cancer.The likelihood of a man getting prostate cancer throughout his life is approximately 15-17%.

Treatment of prostate cancer varies depending on the stage of the disease.Surgical treatment, in other words radical prostatectomy, is the most effective and most preferred treatment method in patients with cancer limited to prostate.In this operation, the prostate is completely removed and after the removal, the bladder neck and urinary canal end are sutured.

Radical prostatectomy can be performed by three different methods: open, laparoscopic and robotic.In open radical prostatectomy, the incision site is larger, so the wound site healing duration is longer, the hospitalization of patient is longer and the risk of wound site infection is higher.In robotic radical prostatectomy, the incisions are very small and the patients recover more quickly.

In robotic radical prostatectomy, the patient’s abdominal cavity is first inflated with carbon dioxide gas.Then 3 or 4 small incisions are made on the abdominal skin, each approximately 1 cm in size, and the operation is performed with camera and robot arms placed inside the abdomen.The surgeon performs the operation in the operating room, sitting on the place called the console by checking the arms of the robot which has the feature of rotating 540 degreesand having the ability to make maneuvers that cannot be done by human hand in very narrow areas.

The main advantages of robotic radical prostatectomy; the absence of a large surgical wound in the patient’s abdomen, shorter postoperative recovery, faster and easier return to daily life, better cancer control, less pain in the postoperative period and faster urine control.

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The technology applied in robotic surgery has important advantages for both the doctor and the patient.Firstly, when compared to open surgery, less blood loss is observed in robotic surgery. Intra-abdominal is inflated with gas during the robotic surgery and the gas pressure prevents bleeding by pressing on the veins.When the operation is completed, this gas is evacuated, thenbleeding vesselscan be more easily detected and sealed by the help of the special cameras which has three-dimensional, high image quality and the ability to enlarge the field ten times.

Patients who underwent robotic surgery are less hospitalized than other patients and are discharged earlier.This is due to the smaller surgical incisions in robotic surgery, less blood loss and less pain after surgery. The catheter of patient who underwent radical prostatectomy with robotic surgery isremoved earlier. So the duration of catheterizationis shorter. The reason for this is that the urinary bladder and external urinary tract, called urethra, can be sutured in a better and waterproof manner in robotic prostatectomy operation. The duration of catheterization is usually 5 days.

Patients who underwent robotic surgery have less pain in the postoperative period and need less pain medication.Because wound incisions are smaller than open surgery and therefore they feel less pain.
Cancer control is better in robotic surgery.The cancerous tissue is more clearly seen and removed during surgery with three-dimensional and high-resolution image-capable cameras and robotic arms capable of moving at 7 degrees.

After prostate surgery performed by robotic surgery, urine control is often quicker and better. Better image capability, less bleeding, better sutured bladder and urinary canal provide rapid urine control during the postoperative period.

After prostate cancer surgery with robotic surgery, the return to sexual life is seen earlier.In a medically suitable patient, preservation of the nerve and vascular bundle around the prostate, which enables the erection, is more possible with robotic surgery. Therefore, return to sexual life in the postoperative period is earlier in these patients.

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