Popular statements like “I got prostate,” or “I have prostate” are caused by the lack of information. It is not possible to get prostate because it is an organ already present in our body. There are three main diseases associated with the prostate gland which is a reproductive organ in men.

The size of the prostate enlarges with age. Due to the enlargement of the prostate, the urinary canal (urethra) gets pinched and urinary complaints occur.

The complaints of prostate diseases are grouped under two headings. The first one is related to the storage function of the bladder (urinary bladder). These complaints result from the decrease in the urine storage function of the urinary bladder, and usually appear as frequent urination, burning during urination, frequent waking up at night for urination, urgent need to urinate, and urinary incontinence before reaching the toilet.

The other group of complaints seen in prostate diseases is related to the discharge function of the urinary bladder. This group includes complaints such as difficulty in urinating, feeling of insufficient emptying, bifurcation of urination, dripping of urine, intermittent urination, inability to pass urine forward, thinning of where urine comes out, or not being able to urinate at all.

The first complaints are generally urinating during the night and frequent urinating.
These complaints are common in both prostate cancer and benign prostate enlargement. It is not possible to tell whether the prostate problem is benign or malign by just looking at the complaints.

Also, in prostate cancer, it should be noted that no complaints may show themselves depending on the region where cancer develops (far from the urinary tract, spread from other regions, etc.). For this reason, it is advised that men older than a certain age should be controlled regularly for prostate diseases.

In our country, we recommend that healthy men over 50 with no risks for or complaints of prostate diseases should have prostate control once a year. In countries like the USA, where prostate cancer is common (especially in Afro-American men), this age limit is much lower.

The most important risk factor of prostate cancer, which is known, is the presence of prostate cancer previously detected in the first-degree blood relatives of the person (father, brother, uncle, grandfather, etc.). These people should start having controls after they are 40 and the controls need to be repeated every six months. How are prostate diseases diagnosed?

For diagnosing prostate diseases, firstly, it is necessary to listen to the patients’ complaints and create a symptom (complaint) score. For this purpose, there is the International Prostate Symptom Score (IPSS). This score provides more objective information about the patients’ complaints.

Then, the patient must be examined with fingers through the rectum (anus). This examination provides valuable information about the size and stiffness of the prostate gland. The stiffness of the prostate gland is of much importance in distinguishing prostate cancer.

In addition, the amount of Prostate-Specific Antigen (PSA) in the blood must be measured. These two methods give us crucial tips for distinguishing prostate enlargement (BPH) and prostate cancer. If any suspicious condition is seen with these two diagnostic methods, the patient is guided to prostate biopsy.

Besides, in patients with difficulty in urinating, information about how fast the urine flows is gathered by measuring the urine flow rate with uroflowmetry. If the urine flow rate is low, this makes us think that the urinary tract is narrowed due to the enlargement of the prostate.

Moreover, it is possible to have information about the dimensions of the prostate through ultrasonography. The ultrasonography also gives us information regarding the condition of the kidneys. Also, measuring the remaining urine in the bladder (urinary bladder) after urination with ultrasonography provides important information for planning the treatment.

Sometimes, cystoscopy may be required to see whether the prostate really narrows down the urinary tract and investigate whether there is another disease in the urinary bladder. Cystoscopy is the visual examination of the urinary tract with a thin camera.

PSA is a protein, found in blood, that is secreted by only the prostate gland. Contrary to popular belief, high PSA mostly does not make people sick. However, high PSA shows us, the doctors, that there is an extraordinary situation in the patient’s prostate and that we need to examine it more closely. This extraordinary situation may result from infections or may be a symptom of malign diseases. The final diagnosis is only possible as a result of the pathological examination of the tissues taken from the prostate. In our daily practices, we benefit from PSA to diagnose as much prostate cancer as possible by performing as few prostate biopsies as possible.

The upper limit of normal PSA value is now accepted as “2.5 ng/ml”. Previously, this value was accepted as 4 ng/ml. However, some studies showed that if the values lower than 4 ng/ml are accepted as normal, a considerable number of prostate cancers will be overlooked. In fact, no value is totally innocent. Even with a PSA value below 1, there is a possibility of prostate cancer. However, as the percentage of these incidences is low and to make a diagnosis with these values, high numbers of normal people will need to have unnecessary biopsies, today, the limit is considered to be 2.5 ng/ml, which is a reasonable value.

With age, we raise the upper limit of PSA a little higher. For example, for a patient around 70-75 years of age, 4.0 ng/ml may not be a worrying value.

Even if the PSA is within the normal limits, extreme increases in the yearly follow-ups raise our suspicions. For this reason, we recommend yearly controls even when the results of examination and PSA values are normal.

What is important and concerns us is not the highness of the PSA, but why it gets high.

A variable course of PSA values with rising and falling usually makes us think of prostate or urinary tract infections rather than prostate cancer. However, there is still a need to be vigilant in terms of prostate cancer. The PSA’s tendency to rise continuously with high percentages worries us more in terms of prostate cancer.

Malign prostate enlargement is called prostate cancer. And now, we all know that cancer is an anarchic tissue enlargement working against the body. Prostate cancer that is not treated timely may spread throughout the body, especially to the lymph glands and bones. After a while, this may cost the patient’s life. The decision on how to treat prostate cancer should be made by considering cancer and the patient’s characteristics.

Benign prostate enlargement (BPH) occurs due to the enlargement of the glands and the connective tissues of the prostate. The enlargement causes difficulty in urinating and emptying the urinary bladder. And sometimes, the enlarged prostate presses down the urinary bladder leading to complaints of an urgent need to urinate, or urinary incontinence before reaching the toilet. Benign prostate diseases do not spread to the body. The most significant and feared effect of benign prostate enlargement is that, if it is left untreated for a long time and left to its own course, it may lead to kidney failure due to the constant urine remaining in the bladder which forces the kidneys.

There are some herbs in the medicinal form and used in the treatment of benign prostate enlargement. Uncertainties about the effectiveness and effect mechanisms of these herbs usually limit our chances of using and recommending these medicines. Besides, herbal substances may not be harmless all the time. Saw palmetto extract is the most popular herbal treatment alternative with proven effectiveness.

It is thought that many plants such as pumpkin seeds, black sesame (nigella sativa), nettle (urtica dioica), and broccoli may have a positive effect on prostate diseases.

There are also some foods recommended for general prostate health. Consuming foods like red wine, red grapes, pomegranate juice, cooked tomatoes or tomato paste, garlic, or olive oil will be beneficial for prostate health.

Some foodstuffs are thought to be associated with the development of benign prostate enlargement (BPH) and related symptoms. Increased energy intake, excess protein consumption, red meat, fat, cereals, bread, poultry, and starch increase the risk of clinical BPH development and BPH surgery. Data are showing that vegetables, fruits, polyunsaturated fatty acids, linoleic acid, and vitamin D reduce prostate enlargement and related complaints. It is also known that the amounts of vitamin E, lycopene, selenium, and carotene in body circulation are inversely proportional to the risk of BPH development.

Lycopene is a substance that is mainly found in tomatoes. Thanks to its strong antioxidant properties, it is thought to have preventing effects on many cancer types.

For prostate health, doing sports, eating mainly vegetables and fruits, avoiding fried foods, limiting red meat consumption, consuming fish at least two times a week (preferably oily cold sea fish in the form of boiled or grilled), using food supplements such as selenium, zinc, vitamin B and D are recommended. Such a diet and lifestyle also have positive impacts on sex life and heart health.

Moreover, there are data showing that consuming green tea or 1-2 glasses of red wine reduce the development of prostate cancer.

It is seen that the increase in body mass index and the fat in waist circumference go hand in hand with the increase in prostate size.

It is proved that increased physical activity decreases the risk of benign prostate enlargement and prostate surgery. Along with increasing physical activity, keeping the body mass index low and reducing belly fat are important in preventing prostate diseases as well as sexual problems and reducing the risk of heart disease.

Among the prostate diseases, the only problem that can affect the sex life is chronic prostate infection (chronic prostatitis). Continuing urination complaints and a subsequent psychological impact can trigger sexual problems.

Sexual problems caused by other prostate diseases are not common. However, as patients in this group are mostly over middle age, they may have sexual problems accompanying the prostate complaints. Mostly, such complaints are not explained because of embarrassment. We must investigate the presence of such complaints without hurting the feelings of patients.

Some medications used in the treatment of prostate diseases, especially prostate cancer, may cause sexual problems.

Infertility cases caused by prostate diseases are not common.

Inflammation of the prostate, called chronic prostatitis, mostly affects younger people. Sometimes, environmental changes in the semen due to chronic prostatitis (by converting the alkaline environment to acid) that disrupt the living conditions of sperm cells may result in infertility.

Benign prostate enlargement does not cause infertility. However, some medical and surgical treatments for this disease may lead to problems by causing the semen to escape back into the bladder (retrograde ejaculation). At the time of ejaculation, the semen goes to the bladder instead of looking for a way outside. In such cases, it is possible to use sperm cells taken from the bladder for artificial insemination.

In prostate cancer surgeries, since the prostate and its adjacent glands and channel structures are completely removed, there will be no ejaculation even if there is a feeling of orgasm (dry orgasm). So, it is not possible for those patients to have a baby in natural ways.

Medications used in the treatment of BPH may provide regression up to 30% in the weight and volume of the prostate. However, this result can be achieved with the use of these treatments for six months. When the medication is discontinued, the prostate turns back to its normal size. Another issue to keep in mind is that the PSA values found in patients using this type of medication for six months or longer should be multiplied by two to find the normal PSA value of the patient. This is because these medications falsely lower the PSA values.

Hormone treatments for prostate cancer also lead to a decrease in prostate weight.

Urinating while sitting or standing has no importance on prostate enlargement, prostate cancer, or the occurrence or the increase of the related complaints.

Besides, it is worth saying that some rumors are completely groundless. Conditions such as extreme or less sexual intercourse, or masturbating or not, do not have any positive or negative effect on the prostate.

Prostatitis is a group of diseases that can be basically explained as the inflammation of the prostate. Almost 15% of adult males have complaints of prostatitis in a period of their lives. The most common complaints are burning while urinating, pain in the penis and testicles, and having difficulty urinating.

However, the definition of prostatitis covers many clinical conditions. Acute and febrile bacterial prostate infections can be seen, as well as chronic infections or non-bacterial inflammations.

Chronic prostatitis is a disease mostly seen in younger people with annoying symptoms about the urinary tract despite no apparent enlargement of the prostate.

Recently, there are serious concerns that chronic prostatitis may cause prostate cancer in later ages, therefore it is important to diagnose and treat patients in the right way.

Chronic prostatitis patients often seek medical advice with complaints such as burning when urinating, frequent urination, inability to relax after urination, feeling of need to urinate despite urination, inguinal pain, and pain that hits the anus from under the testicles. Generally, standard tests do not reveal any problems. If necessary, a urine test after a prostate massage could help make a diagnosis by detecting the increase of the inflammatory cells due to the mixing of prostatic secretions into the urine.

Inflammations of the prostate gland are generally named as prostatitis. Although they are not caused by bacteria all the time, antibiotic treatments are often used for a long time in the treatment of prostatitis. Also, some painkillers are used to regress the inflammation in that area and some prostate drugs are used to relax the urinary canals in the treatment of prostatitis.

Surgical methods are not used in the treatment of prostatitis.

Conditions explained as “getting prostate” in daily life are actually benign prostate enlargement.

The prostate gland enlarges with age due to the effects of testosterone. Prostate enlargement can affect in two ways. An obstruction may occur in the urinary tract due to prostate enlargement, causing difficulty when urinating or intermittent urination. And sometimes, the enlarged prostate presses down the urinary bladder, causing the constant stimulation of the bladder and thus leading to frequent urination or urinary incontinence.

The symptoms seen in prostate enlargement are not peculiar to this condition. Many diseases such as prostatitis, prostate cancer, and the narrowing of the urinary tract may show similar symptoms. It is important to make a diagnosis by evaluating these symptoms correctly.

The most common complaint is the weakening of the urine flow. Although this weakening is more apparent, especially in the morning, it can be seen at any time of the day. Other complaints include difficulty starting urination, a feeling of not being able to empty the bladder completely, frequent urination, intermittent urination, bifurcation while urinating, and prolonged dripping after urination. Sometimes there may be an inability to urinate at all, and in this case, it may be necessary to insert a catheter to empty the urine from the bladder.

Prostate enlargement may cause kidney failure due to the presence of so much urine remaining in the bladder and the kidneys’ functioning against constant high pressure.

For the treatment of prostate enlargement, medicinal or surgical treatments may be chosen depending on the intensity of complaints and the medical condition. While planning the treatment method, whether the prostate enlargement physically harms the patient (kidney failure, repeating bleeding) and the life quality of the patient must be considered.

For the treatment of patients with no physical harm caused by prostate enlargement, the primary method is to use medicinal treatment. Today, there are various medications used for this purpose. While some medications reduce the size of the prostate enlargement, some others relax the muscles at the outlet of the bladder and also the prostate gland, making it easier to urinate. The decision about which medication to use must be made according to the complaints and the general condition of the patient.

In cases where medical treatment is not sufficient, surgical treatment takes its place on the agenda. There are many surgical methods used today. Among these methods, the most appropriate one must be selected based on the general condition of the patient and the size of the prostate enlargement.

Today, the most popular and the gold standard method used all over the world is the transurethral resection of the prostate (TURP) also known as minimally invasive surgery of the prostate. In this surgery, the enlarged prostate tissues are cut out by entering through the urinary canal, with a minimally invasive method, and the urinary canal is widened which facilitates the urine flow. The removed tissues are examined by a pathologist. The advantage of this surgery is that the removed tissues can be examined, however, some problems may occur because the surgery lasts long, especially for large prostates, and due to the properties of the liquids used during the surgery.

Therefore, the use of this treatment method is limited for large prostates. Another surgical method, which has been developed using new technologies and cutting energies, and which has spread rapidly all over the world recently, is the surgical method called bipolar or plasma kinetic TUR-P. In this method, the prostate tissues are cut and removed by entering in a minimally invasive way and sent for pathological examination. The advantage of this method over classical TUR-P surgery is that it can be used to treat large prostates without time limitations and with lower amounts of bleeding. The patients stay catheterized for less time and are discharged from the hospital in the early period.

Some other methods that have gained popularity recently are the vaporization surgeries of the prostate using laser energy. The long-term efficacy and safety of these methods have not been fully proven yet. In the latest BPH guidelines published by the European Association of Urology and aiming to standardize the treatment approaches of urologists in Europe, prostate vaporization methods using lasers are only recommended as a primary treatment for people who use blood thinners and have bleeding problems. Also, as the prostate tissues are vaporized in these types of surgeries, no tissues can be taken out for examination by a urologist, causing the probable cancer cases to go unnoticed.

Open prostate surgery is a treatment alternative that can be used in patients with an extremely enlarged prostate and also with bladder stones. How to decide on the surgery to be applied in benign prostate enlargement?

After benign prostate enlargement surgeries, some problems with the ejaculation of the semen may occur. In such cases, called retrograde ejaculation, the semen cannot be ejaculated outside and goes into the urinary bladder. During the first urination, the semen will go out with urinary spillage. This situation does not affect having sexual pleasure and orgasm. The person feels himself as normally ejaculated, but the semen is not expelled.

After surgeries for benign prostate enlargement, erectile dysfunction rarely occurs. These surgeries are generally reliable and do not have an impact on sexual performance.

The point which needs attention here is that prostate cancer may occur without any symptoms. For this reason, men over 50 are advised to have yearly prostate controls even if they have no complaints.

The symptoms of prostate cancer are similar to those of benign prostate enlargement. General complaints seen in all prostate diseases include frequent urination, burning during urination, difficulty in urination, and being unable to empty the urinary bladder. It is not possible to understand whether a disease is benign or malign by just looking at the patient’s complaints. To make a distinction, some tests must be performed.

While prostate cancer is more common in the US and Northern Europe, the risk of prostate cancer decreases in far eastern countries like Japan. However, the fact that the risk in Japanese who immigrated to the US is closer to that in American men suggests that some environmental factors that have not been fully defined today play an important role in the development of prostate cancer. Excessive consumption of animal fats is the main factor accused.

Prostate cancer is the uncontrolled proliferation of the cells that make up the prostate, when unnecessary. It is one of the most common cancers seen in men. Although situations that pose a risk for the development of prostate cancer are not clearly known today, some situations that increase the risk have been defined. The most important one of them is genetics. If the father or a brother of the person experienced prostate cancer previously, the risk of developing prostate cancer for this person doubles. The cases of two or more prostate cancer in the first-degree blood relatives increase the risk of developing prostate cancer for the person five to 11 times more.

When we doubt that our patient may have prostate cancer, we apply the methods of multiparametric prostate MRI and prostate biopsy.

To diagnose prostate cancer, one needs to suspect about its presence first. Prostate examination and PSA (Prostate-Specific Antigen) levels in blood give us significant information about the situation. PSA is a protein produced only in the prostate cells in the body. Some amount of PSA is also found in blood and can be measured with blood tests. The PSA level in the blood increases in extraordinary situations such as cancer or infection in the prostate. Although increased PSA levels in the blood make us suspicious about the presence of prostate cancer, it is not enough to make a clear diagnosis. As well as the measurement of PSA, that the prostate is hard during examination by hand warns and causes us to suspect prostate cancer.

Prostate biopsy is not an open surgical intervention. It is the procedure of taking tissues from the prostate with a special needle, guided by imaging the prostate gland with ultrasonography. Although there are different applications performed in the clinics, the accepted practice in the world today is to take tissues from 12 different points of the prostate. Thus, the probability of detecting even the newly developed small tumors in the prostate increases.

Today, a prostate biopsy is a frequently used diagnostic procedure. Prostate biopsy is a procedure that can be applied under local anesthesia and also under general anesthesia if asked by the patient. After the biopsy procedure, the patient is discharged from the hospital on the same day. The material obtained with the biopsy procedure is examined in a pathology laboratory.

Our patients, who are diagnosed with the prostate cancer as a result of the pathological examination, undergo a series of radiological imaging to determine how widespread the disease is in the patient, and the treatment is planned according to the results of this staging process.

In the treatment of prostate cancer, one or a combination of surgical treatments (open or robot-assisted), radiation therapy, hormone therapy, or chemotherapy can be applied, considering how far the disease has progressed and the age of the patient.

Since prostate cancer is a type of cancer with very satisfactory results when diagnosed early, all men over 50 should undergo control by a urologist once a year, even if they have no complaints. For diagnosis, the measurement of the PSA level, which is a protein secreted by the prostate, and rectal prostate examination with fingers are of great importance.

Circumcision is one of the oldest surgical procedures that has been used in the history of humankind. There are many theories about the origin of the circumcision practice. However, it is certain that the circumcision practice started before written history and its origin got lost in the depths of history. The oldest available source on the origins of circumcision is ancient Egyptian hieroglyphs dated 2400 BCE. In Ancient Egypt, the male sexual organ was thought to be a symbol of abundance and power. A small piece of this organ was cut and given to the goddesses as a sign of devotion to the god.

Circumcision has been widely practiced as a ritual for transition from childhood to adulthood in African communities.

In the Torah, the holy book of the Jews, circumcision is obligatory for the descendants of Prophet Abraham. It is even rumored that Prophet Abraham was circumcised at the age of 80 after this revelation.

Also in the Christian belief, born among the Jews, circumcision was a subject of discussion, but it did not become a religious necessity as it was seen as unnecessary by some apostles. However, some Christian groups in Africa, such as the Coptic community in Egypt, consider both male and female circumcision to be religiously necessary, while some Protestant denominations in the United States and Catholics in the Philippines consider male circumcision to be religiously necessary.

Circumcision is accepted as the symbol of Islam although there is no verse about it in the Qur’an. The words of the Prophet Muhammad praising and recommending circumcision have been transferred to the present day.

Today, the vast majority of circumcisions are performed for cultural and religious reasons. Almost all Muslims and Jews all over the world are circumcised. Also, circumcision is a widely practiced procedure in the United States of America for cultural and health reasons.

However, there are also medical conditions in which circumcision should be applied as a treatment method. The most important one of them is phimosis. This is when the foreskin cannot be stripped enough to expose the glans penis. While this is a normal situation in newborns and small babies, it can become a problem with the advancing of age. Sometimes it may develop later due to infections, and the primary method in the treatment of this condition is circumcision.

The strangulation of the glans penis and the inability to restore the foreskin after the foreskin is forcibly stripped is called paraphimosis and may need to be treated by performing emergency circumcision.

Circumcision is also a necessary procedure if the child has recurrent urinary tract infections or recurrent infections on the foreskin and tip of the penis.

Circumcision is required in some children with congenital urinary system anomalies (such as congenital hydronephrosis, and vesicoureteral reflux). Moreover, circumcision may be necessary for some penile traumas (such as the foreskin being stuck in the zipper).

The foreskin is an area where nerves are highly populated, and circumcision can be a very painful procedure if appropriate pain relief methods are not applied. Since pain is considered a natural part of the circumcision ritual, circumcision has been practiced for centuries without any measures against pain. However, from a medical point of view, pain is a problem that needs to be cared for and solved. It is also known that severe pain experienced during circumcision may have negative effects on the child’s life in the future.

Circumcision, which is the most frequently performed surgical procedure in boys, should be performed under the best possible conditions, considering the well-being of the child. Today, modern medicine offers us many alternatives to perform the circumcision operation painlessly. In the circumcision procedure, which can be performed comfortably with local anesthesia techniques in infancy, general anesthesia methods are preferred, which allow a safer circumcision in older ages. It is important that the method to be used here is determined by the joint decision of the family, child, and physician.

The circumcision performed within the first month after the birth is called newborn circumcision. Widely practiced in Jews and in the United States, newborn circumcision has been practiced more and more frequently in our country recently. The advantages of this procedure can be listed as the fact that it can be applied with local anesthesia, it does not leave any negative psychological scars on the child, and it heals quickly.

The World Health Organization has stated that circumcision can be applied to babies over 2.500 gr, and 12 hours later after birth.

Before the newborn circumcision, the baby must be examined by a pediatrician. Afterward, the physician who will perform the circumcision should evaluate whether there is a condition in the penis and testicles that may prevent circumcision. It should be noted that circumcision is not a mandatory procedure, a very careful evaluation should be made, and possible complications should be minimized.

Consequently;

Although circumcision is an operation that has been widely performed for centuries since the time of primitive societies, complications seen today are gradually decreasing as the possibilities of modern medicine are used more and more in this operation.

Although circumcision is a small and simple procedure, it should be kept in mind that this procedure is a surgical intervention. The procedure should be performed under sterile conditions, if possible, in operating room conditions, and without causing the child to experience pain. It should also be noted that sexual or functional problems that the child may experience in the future will be minimized if the circumcision is performed by an experienced physician.

Kidney stones may be formed for many reasons. When the concentrations of crystal-forming substances such as calcium, oxalate, and uric acid increase in the urine, these substances form precipitation and these precipitated minerals combine to form stones, just as in nature.

Some stones may contain several chemical structures at the same time.

The type of kidney stone and the risk of a person for developing stones can be determined. With a metabolic evaluation and the analysis of the stone, removed by surgery or dropped naturally, it is possible to determine the risk. The formation of the stones can be reduced by regulating eating habits and, if necessary, by drug supplementation.

As in the case of all other cancers, it is hard to give an exact reason for bladder cancer. However, it is proven that some factors increase the risk of developing bladder cancer.

In history, bladder cancer is known as “chimney sweeps’ disease”. Inhaling chemicals in the chimneys has increased the occurrence of the bladder cancer.

The most important factor causing bladder cancer is smoking cigarettes and other tobacco products. This includes hookah, which is frequently smoked in our country.

Also, various chemicals such as some chemical substances used in paint and chemical industries, some painkillers, and artificial sweeteners are blamed for causing bladder cancer.

Of course, people who do not smoke or are not exposed to any unfavorable substances may also develop bladder cancer. However, the risk is quite lower for these people compared to those who were exposed to the agents mentioned above.

In some types of bladder tumors, the irritating effects of chronic infections and bladder stones may play a role.

Although the reason is not known clearly, bladder cancer is more common in men.

Bladder cancers are seen in three female patients versus five male patients. That men smoke more or are exposed to chemicals may be the underlying reason for this difference. But, this is only an assumption. The reason of this difference is not clearly known.

The most common and important complaint of patients is blood in the urine. This complaint is observed in more than 90% of the patients. The most typical symptom of bladder cancer is intermittent and painless blood in the urine, containing clots.

Other possible complaints are burning during urination, need for urinating frequently, blood clots in the urine, and sometimes getting unable to urinate due to the accumulation of the clots in the bladder as a result of excessive bleeding.

In advanced and spread tumors, there may be complaints such as malaise, fatigue, loss of appetite, nausea, and vomiting.

It is very important to listen to the patients’ complaints and evaluate them well.

During the physical examination of the patient, sometimes no symptom appears. In some patients, especially in cases where the tumor is on the anterior surface of the bladder and is large, the tumor may be palpable on the examination. Again, if the bladder is full of blood clots and the patient is unable to urinate, the tumor becomes palpable on the examination.

Some patients should be examined with both hands under anesthesia and the extent of the tumor in the bladder should be determined. While one hand examines the abdomen, the other tries to reach the tumor through the anus.
Apart from physical examination, laboratory or imaging methods are used for diagnosis.

In the urine analysis, blood is seen. Although seen less, some patients may not have visible bleeding. With the aim of both examining these patients and evaluating the colored urine, urine analysis is required.

The tumors can be seen in the ultrasonography. Imaging methods such as intravenous urography, computerized tomography (CT), and magnetic resonance (MR) can also be used as required.

However, the most significant diagnostic method is looking into the bladder with eyes. This procedure is called “cystoscopy”. With this procedure, we see whether there is a tumor in the bladder, and if there is, we evaluate its size, number, and relationship with the structure of the bladder wall.

All these reasons make cystoscopy the most important diagnostic method for bladder cancer.

Testicles are a pair of reproductive organs located in a pouch of skin called the scrotum. And, varicocele is the name given to the enlargement of the veins of the testicles. Varicocele is similar to the varicose veins seen in legs.

It is one of the common reasons for low sperm production, poor sperm quality, and male infertility. Varicocele may also disrupt the development of the testicle and lead to testicular shrinkage. However, there is no rule that every varicocele will affect sperm production.

The incidences of varicocele increase with age: Fortunately, varicocele is an easily diagnosed disease and not all varicoceles require treatment. If required, the most common treatment method for varicocele is a surgical operation.

Varicocele generally does not show any symptoms. But, it may sometimes cause pain in the testicle.

The intensity of the varicocele pain increases with physical exercises and standing for long times. It tends to increase later in the day and decreases when you lie down and rest. Varicocele progresses and becomes evident in the scrotum over time.

As the varicocele may adversely affect the sperm quality and the count, especially in young men, it is treated with surgery.

Although there is no clearly defined reason for varicocele, it is thought to be caused by the malfunction of the valves in the veins of the testicle. As a result of the malfunction of these valves, the veins enlarge, and the venous blood accumulates in and around the testicle, which may lead to poor sperm quality or count.

Due to the position of the left testicle vein, varicocele is generally seen on the left side. However, it is known that unilateral varicocele may disrupt sperm production in both testicles.

For now, there is no clearly defined factor that increases the development of varicocele. However, in some studies, it has been revealed that varicocele is seen less in overweight and more in taller people.

The most important method for diagnosing varicocele is physical examination. Your doctor examines your testicles while you are standing and try to feel the enlarged veins. Your doctor may ask you to strain while holding your breath or to cough. Therefore, the enlarged veins that cannot be felt otherwise can be felt.

Color Doppler ultrasonography is the most significant imaging method to diagnose varicocele. In this method, both vessel diameters and the direction of blood flow in the veins can be determined. In this way, it is determined whether there is a backward flow of venous blood.

Varicocele is not a condition that always needs to be treated.

In couples who are married and have difficulties in having children; varicocele should be treated if there is a clinically detectable varicocele, and the female factor has been investigated and no problem found, or if there is deterioration in any of the parameters in the spermiogram test.

Unmarried adult men with deterioration in the sperm parameters should get treatment.

For young adults, if the sperm parameters are normal, the situation may be followed up with yearly spermiogram tests, and no treatment may be required.

In adolescence, if the size of the affected testicle is smaller than the other testicle and if there is growth retardation in it, treatment is required. Otherwise, close follow-up is sufficient.

Varicocele cannot be treated with medication. So, the treatment options consists of invasive methods. These methods are open surgery, laparoscopic surgery, and angioembolization.

Open surgery has changed with advanced technology today. With the start of using microscopes during operations, the surgeons’ visual ability and thus the success of the operations have significantly increased. Varicocele surgeries performed under microscopes are called microscopic varicocelectomy.

Laparoscopic varicocele surgery is performed with the help of cameras through the three holes opened in the abdomen. It is not frequently preferred for the treatment of varicocele due to reasons like it certainly requires general anesthesia, bears the risk of injury to the abdominal organs, and the size of the skin incision is larger than that of open surgeries.

Angioembolization is a procedure in which a radiologist reaches the enlarged testicular veins through the veins of the groin or neck, and occludes the testicular veins from inside. It is rarely used today.

There is no herbal treatment with scientifically proven efficacy today for the treatment of varicocele. Varicocele is the enlargement of the veins, causing the venous blood flow back. And for now, there is no medicational treatment with proven efficacy that could turn this enlargement back. Microsurgery has proved its efficacy and reliability in the treatment of varicocele.

Varicocele surgeries performed under microscopes are called microscopic varicocelectomy.

Today, varicocele surgeries performed using the microsurgical method are accepted as the gold standard method for treating varicocele. The surgery is carried out through a two-centimeter incision in the inguinal region. All enlarged veins of the testicle are ligated under the microscope. The advantage of using a microscope is that it allows seeing all veins and protecting the arteries thanks to the increased visibility. With the microsurgical varicocelectomy operation performed with experienced hands, the possibility of varicocele recurrence is reduced, and the risks associated with the operation are minimized.

Although varicocele operations are very rare, there are risks such as the formation of fluid around the testicle (hydrocele), recurrence of varicocele, injury to the arteries, or testicular atrophy.

Although these risks are observed at different rates according to the surgical method used, they are seen less in microsurgical varicocelectomy.