Dr.M.

Galuh Richata, SpU

 A fibromuscular (30-50%) and glandular (50-
70%) organ
 Weighs about 20 g; 2,5 cm in length
 Prostatic secretions: 1/3 of semen,
discharged at ejaculation
Prostate Lobes (Lowsley):
Anterior, Posterior, Median, Right Lateral,
Left Lateral.
Zonal Anatomy (3 Zones; McNeal, 1968)
- Peripheral zone (70% of the volume)
- Central zone (25%)
- Transition zone (5%)

McNeal, 1972  5 zones:

- Anterior segment (fibromuscular area)
- Preprostatic sphincteric zone
 Prostatitis  most found in peripheral zone

 Benign Prostate Hyperplasia (BPH) 

develop in transition zone

 Prostate Cancer  mostly originates in

peripheral zone (70%), 10-20% from
transition zone, 5-10% central zone.
 Most common urologic diagnosis in men
under 50 years of age.
 Probably results from ascending urethral
infection  intraprostatic reflux of urine? 
prostate anatomy?
 Microorganism: Aerobic Gram-negative
(80% E coli, 10-15% Pseudomonas, Serratia,
Klebsiella, Proteus)
Signs & Symptoms
- Rectal, low back, perineal pain
- Fever and chills
- Urinary urgency, frequency, dysuria
- Acute urinary retention  prostatic sweeling
- Malaise, arthralgia, myalgia
- Sometimes hematuria, cloudy urine
Physical Exams
DRE: prostate is tender, could be enlarged
(irregularly firm & warm)
Lab
Blood: Leucocytosis
Urine: pyuria, microscopic hematuria , bacteria
Urine culture  identify the organism
DRE:
Management
- Antibiotics (guided by resistance test)
- Antipyretics
- Analgesics
- Stool softeners
- Hydration
- Bed rest
 Most common benign tumor in men
 Incidence is age-related
 Risk factor & Etiology: ??? (multi factorial,
endocrine controlled)
 Its main concern is Bladder Outlet
Obstruction (BOO)
BPH  BOO 
complications:
- Urinary retention
- Urinary tract infection
- Bladder stone
- Hematuria
- Bladder diverticulae
- Renal impairment
Sign & Symptoms
BOO  LUTS (Lower Urinary Tract Symptoms)
Obstructive Symptoms:
Weak Stream, Straining, Hesitancy,
Intermittency, Incomplete Emptying,
Terminal Dribbling
Irritative Symptoms:
Frequency, Nocturia, Dysuria, Urgency

IPSS  International Prostate Symptoms Score

 General condition: state of pain, body
temperature, signs of renal impairment
 Suprapubic region: bladder: palpable?
tenderness?
 DRE: Prostate:
- Size: 20-40-60 g?
- Consistency: Firm/Hard?
- Symmetric/Asymmetric?
- Surface: Smooth/Nodules?
- Tender/nontender?
DRE:
 Lab
- General : blood, urine
- PSA (Prostate Specific Antigen)

 Imaging
- Ultrasound (transabdominal, transrectal)
- IVU
 Management
For General Practitioners:
- No complication  oral therapy
LUTS : Alpha Blockers, 5-Alpha Reductase
Inhibitors.
- Complications  refer to Urologist
Urinary Retention  catheterization  then
refer to urologist
Catheterization

Cystostomy/
Bladder Puncture
Management
Operative/Surgery
- Open
Prostatectomy
- Cystoscopy &
Trans Urethral
Resection of
Prostate (TURP)
Trans Urethral
Resection of
Prostate
(TURP)
TURP
Carcinoma of the Prostate (CaP)
 Most common cancer diagnosed
 2nd leading cause of cancer death in American
men
 Prevalence increase rapidly with age
 Risk Factor: still debatable
 70% from the peripheral zone
Pattern of Progression
- Local Extension
- Metastases (lymphogenous or
haematogenous) :
- Lymph Node (obturator, common illiac)
- Bone
- Visceral (lung, liver, adrenal)
General Practitioners  Screening!
Signs & Symptoms
- asymptomatic
- similar to BPH (LUTS, urinary retention,
hematuria, etc)
- hematospermia (local extension)
- bone pain (metastases)
DRE :
- Volume : can be small/large
- Consistency: hard, stony (induration)
- Surface: uneven, nodule
- Asymmetric

Lab:
PSA : > 4 ng/mL
Any male with LUTS  screening with DRE 
found anything suspicious  refer to
urologist