Benign Prostate

Hyperplasia

Pendahuluan
Hiperplasia prostat adalah kondisi yang terjadi
pada laki-laki dimana terjadi pembesaran kelenjar
prostat, yang dapat mendesak saluran
perkemihan.
Dapat juga disebut BPH.
Anatomi Prostat

Etiologi
Belum diketahui secara pasti
Tetapi hingga saat ini dianggap berhubungan
dengan proses penuaan yang mengakibatkan
penurunan kadar hormon pria, terutama
testosteron.
Pada saat penuaan terjadi penurunan testosteron
dimana hormon estrogen akan jauh mendominasi,
itu adalah kemungkinan salah satu triger
terjadinya pertumbuhan sel prostat

Faktor Resiko
Stress
Dalam keadaan stres, tubuh memproduksi lebih banyak
steroid stres (karsitol) yang dapat menggeser produksi
DHEA (dehidroepianandrosteron). DHEA berfungsi
mempertahankan kadar hormon seks yang normal,
termasuk testosteron.

Kolesterol tinggi juga dapat mengganggu

keseimbangan hormonal dan menyebabkan
terjadinya pembesaran prostat.
Nikotin dan konitin
meningkatkan aktifitas enzim perusak androgen, sehingga
menyebabkan penurunan kadar testosteron.

Manifestasi Klinik
Saluran kemih bagian
bawah

Saluran kemih bagian

atas

Obstruksi

Nyeri pinggang
Demam (infeksi)
Hidronefrosis

Hesistensi
Pancaran miksi lemah
Intermitten (miksi terputus)
Miksi tidak puas
Distensi Abdomen
Volume urin menurun dan
harus mengejan saat
berkemih

Iritasi
Frekuensi sering, nokturia,
disuria.

Di luar saluran kemih

Keletihan
Anoreksia
Mual dan muntah
Rasa tidak nyaman pada
epigastrik

Klasifikasi berdasarkan klinik

Derajat I
Apabila ditemukan keluhan
prostatismus
Pada DRE (digital rectal
examination) atau colok dubur
ditemukan penonjolan prostat
Sisa urine kurang dari 50 ml.

Derajat II
Ditemukan tanda dan gejala
seperti pada derajat I
Prostat lebih menonjol, batas atas
masih teraba
Sisa urine lebih dari 50 ml tetapi
kurang dari 100 ml.

Derajat III
Seperti derajat II, hanya
batas atas prostat tidak
teraba lagi
Sisa urin lebih dari 100 ml.

Derajat IV
Apabila sudah terjadi
retensi total

Diagnosis
A personal and family medical history
o What symptoms are present
o When the symptoms began and how often they occur
o Whether he has a history of recurrent UTIs
o How much liquid he typically drinks each day
o Whether he counsumes caffeine and alcohol
o About his general medical history, including any significant
illnesses or surgeries.

A physical exam
o Examines a patiens body
o Taps on specific areas of the patients body
o Performs a digital rectal exam

Medical tests

Medical Tests
Urinalysis
Urine sample
Visit or sends it to a
lab for analysis.
Technician places a
strip of chemically
treated paper, called a
dipstick, into the urine.
Patches on the dipstick
change color to
indicate signs of
infection in urine

A PSA Blood Test

Prostate cells create a
proteinii called PSA.
Prostate cancer, BPH,
prostate infections,
inflammation, aging,
and normal
fluctuations can cause
high PSA levels

Medical Test
Urodynamic Test
Look at how well the
bladder and urethra
store and release
urine.
Uroflowmetry
Postvoid residual
measurement
Reduced urine flow or
residual urine in the
bladder

Cystocopy

Uses cystocope to look

inside the urethra and
bladder through the
opening at the penis
and into the lower
urinary tract

Medical Test
Transrectal
Ultrasound
Use tranducer.
The technician inserts
a tranducer into the
mans rectum, next to
the prostate.
The ultrasound image
shows the size of the
prostate and any
abnormalities, such as
tumors.

Biopsy
Taking a small piece of
prostate tissue.
A pathologist examines
the prostate tissue in
lab.
This test can show
whether prostate
cancer is present

Tatalaksana
Non Farmakologi
Perubahan gaya hidup
Surgery

Farmakologi

Alpha blockers
Phosphodiesterase-5 inhibitors
5-aloha reductase inhibitors
Combination medication

Non-farmakologi : Perubahan
gaya hidup
Mengurangi konsumsi cairan, khususya sebelum
tidur.
Mencegah atau mengurangi konsumsi kafein dan
alcohol
Mencegah atau mengontrol penggunaan obatobatan seperti dekongestan, antihistamin,
antidepresan, dan diuretic.
Excersing pelvic floor muscle
Mencegah atau pengobatan konstipasi.

Farmakologi
Alpha blockers
Relax the smooth
muscles of the
prostate and bladder
to improve urine flow
and reduce bladder
blockage
Terazosin, doxazosin,
tamsulosin, alfusozin,
silodosin.

Phosphodiesterase-5
inhibitors

For erectile
dysfunction.
Can reduce lower
urinary tract
symptoms by relaxing
smooth muscles in the
lower urinary tract.
Tadalafil

Farmakologi
5-Alpha reductase
inhibitors
Block the production of
DHT
Finasteride dan
dutaseride
Can prevent
progression of
prosotate growth

Combination
MTOPS
study, have
shown the combining
two classes of
medications, instead of
using just one, can
more effectively.
Finastride and
doxazosin
Dutaseride and
tamsulosin
Alpha blockers and
antimuscarinic

Surgery
TURP

Inserts a resectoscope
through the urethra
and cuts pieces of
enlarged prostate
tissue with a wire loop

Laser Surgery

Uses a high energy

laser to destroy
prostate tissue with a
cystocope.

Surgery
Open prostatectomy
Making an incisinion,
or cut, through the
skin to reach the
prostate.
Prostate greatly
enlarge, complications
occurr, or the bladder
is damaged and needs
repair,