You are on page 1of 35

BENIGN PROSTATIC HYPERPLASIA

Revi Dinayanti, S.Ked
Supervisor:
Dr. Marta Hendry, SpU
Benign Prostatic Hyperplasia

1

Background
Anatomy

Benign Prostatic Hyperplasia

2

Zones of the prostate

Benign Prostatic Hyperplasia

Peripheral Zone
70% of the young
adult
Central Zone
25%
Transition Zone
5%
BPH uniformly
originates in the
transition zone

3

The Prevalence Benign Prostatic Hyperplasia 4 .

Benign Prostatic Hyperplasia 5 .

heart and circulatory disease.Risk Factors 40 years and older 40 years and older medical conditions such medical conditions such as obesity. heart and as obesity. and type 2 diabetes type 2 diabetes family history of benign family history of benign prostatic hyperplasia prostatic hyperplasia lack of physical exercise lack of physical exercise Benign Prostatic Hyperplasia 6 . and circulatory disease.

Benign Prostatic Hyperplasia 7 .

Benign Prostatic Hyperplasia 8 .

Benign Prostatic Hyperplasia 9 .

Benign Prostatic Hyperplasia 10 .

Benign Prostatic Hyperplasia 11 .

Approach to a patient with BPH History History: :LUTS LUTS use useIPSS IPSS Physical PhysicalExamination Examination  DRE DRE TRUS TRUS Serum SerumPSA PSA Benign Prostatic Hyperplasia 12 .

Benign Prostatic Hyperplasia 13 • Surgical approaches • Surgical approaches • Medical management • Medical management • Watchful waiting • Watchful waiting Treatment .

R • Sex : Male • Age : 57 years old • Address : Prabumulih • Admission : 2014 • Register Number : RI 14022109 • Occupation : Pensioner Benign Prostatic Hyperplasia 14 .Identification • Name : Mr.

Anamnesis Chief Complain t Unable to urinate Benign Prostatic Hyperplasia 15 .

Clinical Presentation difficult difficult to to urinate urinate had to hadto to push push begin to begin urinate urinate slow slow urine urine stream stream dribbling dribbling Since Since 1 1 years years ago ago stopped stopped and and started started again again when when urinate urinate sensatio sensatio n of n of incomplit incomplit e e bladder bladder emptyin emptyin g g Benign Prostatic Hyperplasia 16 .

More More severe severe pain pain while while urinatin urinatin gg 3 months ago Dificult Dificult to tohold hold urinatio urinatio nn >8x/day >8x/day ss Urinate Urinate at atnight night Benign Prostatic Hyperplasia 17 .

2 2 month month s ago s ago Difficult to Difficult urinate to urinate Diagnosed as BPH administer edadminister to RSUD ed to RSUD Prabumulih Prabumulih catheterize d Benign Prostatic Hyperplasia administer edadminister to RSMH ed to RSMH Surgical manageme nt 18 .

DM and CVD (-) Benign Prostatic Hyperplasia 19 .History of Past Illnes Stone found while urinating (-) Hematuria (-) Normal defecation Catheterized 2 monts ago Trauma (-).

Physical Examination General Examination Sensorium : Compos Mentis BP : 140/90 mmHg PR : 81 x/minute RR : 20 x/minute Temp : 36.4oC Benign Prostatic Hyperplasia 20 .

feces feces (+). good. (+).Local Examination CVA CVA Region Region Inspection Inspection :: Bulging Bulging (-) (-) Palpation Palpation :: Both Both ballotement ballotement (-) (-) Percussion: Percussion: Both Both CVA CVA pain pain (-) (-) External External Genitalia Genitalia Inspection Inspection :: there there is is no no urethra urethra bloody bloody discharge discharge and and had had been been circumcised. There There is is aa urethra urethra catheter catheter No No 16F. circumcised. 16F. blood blood (-). mucosa mucosa good. Suprapubic Suprapubic Region Region Inspection Inspection :: Bulging Bulging (-) (-) Palpation Palpation :: Pain Pain (-) (-) Rectal Rectal Toucher Toucher Examination Examination TSA TSA good good Prostate Prostate enlargement enlargement (+) (+) (the (the prostate’s prostate’s surface surface is is flat flat and and its its consistence consistence is is rubbery). (-). rubbery). Benign Prostatic Hyperplasia 21 .

Additional Examination Benign Prostatic Hyperplasia 22 .

3 14.Laboratory Examination Examination Normal Range Result Hb(g/dl) 13.2 1.7-1.6 4 Benign Prostatic Hyperplasia 23 .6-5.5 28 Creatinine (mg/dl) 0.31 Na (mEq/L) 135-155 145 K (mEq/L) 3.6-48.9 Ht (%) 43-49 41 Leucocytes (mm3) 4.2-17.5-11 x 103 7 x 103 BSS (mg/dl) < 200 99 Ureum (mg/dl) 16.

22 cm) and the other organ(Ren. lien/pancreas) were normal Benign Prostatic Hyperplasia 24 . Liver.55 x 3. gallbladder.USG of Abdomen Abdomen examination of this patient showed enlargement of the prostate (3.59 x 4.

Diagnosis Benign Prostatic Hyperplasia Benign Prostatic Hyperplasia 25 .

Treatment  Pro TURP Benign Prostatic Hyperplasia 26 .

Prognosis   Fungsionam : Dubia Vitam : Dubia ad Bonam Benign Prostatic Hyperplasia 27 .

THANK YOU Thank You Benign Prostatic Hyperplasia 28 .

I P S S Benign Prostatic Hyperplasia 29 .

Rectal Exam Danger Signs on RE  Firm to hard nodules  Irregularities. unequal lobes  Induration  Stony hard prostate  Any palpable nodular abnormality suggests cancer Benign Prostatic Hyperplasia 30 .

“watchful waiting” Minimal Minimal symptom symptom s s Avoiding Avoiding fluid at fluid night at night Watchfu Watchfu l l waiting waiting Fu once once aFu year a year Avoid Avoid caffeine caffeine and and alcohol alcohol Benign Prostatic Hyperplasia 31 .

Medication 5α reductas e inhibitor α1 adrener gic blockers • blocks the conversion of testosterone to dihydrotestosteron • Relax the smooth muscle of prostate Benign Prostatic Hyperplasia 32 .

TURP (Transurethral Resection Of The Prostate) “Gold Standard” of care for BPH n n n Uses an electrical “knife” to surgically cut and remove excess prostate tissue Effective in relieving symptoms and restoring urine flow Benign Prostatic Hyperplasia 33 .

TRUS Benign Prostatic Hyperplasia 34 .

5-4 0.5-4 ng/ml ng/ml Benign Prostatic Hyperplasia 35 .PSA >10 >10ng/ml ng/ml • 50% chance of Ca • 20% chance of Ca 4-10 4-10 ng/ml ng/ml • Normal 0.