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B P H

( Benign Prostatic Hyperplasia )

dr.Ainun Aschorijanto SpU


Sub Divisi Urologi, Lab/SMF Ilmu Bedah
FK Unsrat – RSU Prof R.D Kandou
Manado
Definisi :
BPH :Pembesaran jinak pada kelenjar Prostat

Prevalensi :
BPH vs Usia pria
Otopsi
60 tahun : 50 %
80 tahun : 90 %

Klinis
50 -60 tahun : 21 %
80 tahun : 53 %

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Anatomi kelenjar prostat
Prostat terletak di rongga pelvis.
Anterior  cavum Retzii
Posterior  Ampulla recti.
Dasar prostat berhubungan dengan bladder neck.
Apex terletak pada diaprahma urogenital.
Ukuran prostat : 3 x 4 x 2 cm.
Berat prostat : ± 20 gram.

Mc Neal membagi prostat menjadi 3 zona :


1. Zona Perifer  70% vol prostat.
60% – 70% asal Ca prostat.

2. Zona centralis  25% vol prostat.


5% - 10% asal Ca prostat.

3. Zona Transisional  5% vol prostat.


10% – 20% asal Ca prostat.
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Anatomi kelenjar prostat

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Pembagian zona prostat menurut Mc Neal

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TEORI TERJADINYA BPH
Theory Cause Effect

Dihydrotestosteron  5- reductase and Epithelial and


Hypothesis stromalhyperplasia
androgen receptors
Estrogen-testosteron  Estrogens
imbalance Stromal hyperplasia
 Testosteron
Stromal-epithelial
Interaction  Epidermal growth Epithelial and stromal
factor/fibroblastgrowth hyperplasia
factor
 Transforming growth
factor  Longevity of stroma
Reduced cell death
and epithelium cells
Stem cell theory
Estrogens
Proliferation of
 Stem cells transitcells

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Gejala BPH

LUTS
Lower Urinary Tract Symptoms

Obtruktif : Irritatif :
Hesitansi  Urgensi
Rasa tak puas  Frekwensi
Double voiding  Nokturia
Mengejan saat kencing
Dribbling

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IPS S
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Gejala BPH
International Prostate Symptom Score
( I - PSS )
Dalam 1 bulan terakhir:
• 1. Terasa sisa kencing 0 1 2 3 4 5
• 2. Sering kencing 0 1 2 3 4 5
• 3. Terputus-putus 0 1 2 3 4 5
• 4. Tidak bisa menunda 0 1 2 3 4 5
• 5. Pancaran lemah 0 1 2 3 4 5
• 6. Mengejan 0 1 2 3 4 5
• 7. Kencing malam 0 1 2 3 4 5
Total …….
Total IPSS score: 0-7: ringan, 8-18 : sedang, 19-35 : berat

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Pemeriksaan fisik :
 Colok dubur ( DRE / RT )
 TSA / BCR
 Ukuran
 konsistensi
 Mobilitas
 Nodul
 Nyeri

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Pemeriksaan fisik :
Uroflowmetri
Max.flow Interpretati
rate on
(ml/sec)

> 15 ml/sec Normal

10 - 15 Mild
ml/sec obstructed

< 10 ml/sec Obstructed

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 Cystometrogram
 Urodynamic
 Pressure flow study
 Cystoscopy

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Pemeriksaan Laboratorium
 Urinalisis : exclude inf / hematuri
 Serum Cr : Menilai fungsi ginjal
 PSA : Menyingkirkan Ca prostat

PSA value Interpretation


0.5 - 4 ng/ml Normal
4 - 10 ng/ml 20% chance of Ca
> 10 ng/ml 50% chance of Ca

rise of > 20%/year Refer for biopsy

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Pemeriksaan Imaging
Urinary tract imaging
IVP Bila ada riwayat / kecurigaan :
 Hematuri
USG Ginjal  UTI
 Renal Insufficiency
 BSK

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Transrectal Ultrasonography ( TRUS )

Accurate measurement of the prostate


Hypoechoic focus
Prostatic biopsy (if indicated)

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Perubahan buli buli pada BPH

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Diagnosa banding
 Striktur uretra
 Bladder neck contracture
 Batu buli buli
 Ca prostat
 Neurogenic bladder

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Penatalaksanaan :
1. Watchful waiting
 Penderita BPH ringan
 IPSS : 0 – 7 ; Qmax : > 15 ml/dt
 Evaluasi : Tiap 3 bulan
IPSS (subyektif)
Uroflowmetri (obyektif)

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2. Medikamentosa
Alpha blocker
Prazosin
Doxazosin ( Hytrin )
Terazosin ( Cardura )
Tamsulosin ( Harnal )
 Supresi Androgen
5 alfa-reduktase inhibitor
(finasteride)

Fitoterapi
Saw palmetto berry
Pygeum africanum
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Echinacea purpurea
Kontra indikasi Tx medikamentosa
 Retensi urin (akut atau kronik)
 Insufisiensi renal
 Dilatasi traktus atas
 Hematuria berulang
 ISK berulang
 Batu buli-buli / divertikel

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3. Pembedahan
 Retensio Urin
 Retensio Urine > 100 cc
 BPH dan penyakit :
 Batu saluran kemih

 Hernia / hemorhoid

 Tx medikamentosa gagal
 Flowmetri = Obstruktif

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 Operasi terbuka :
 Retro pubic open prostatectomy ( Millin‘ s )
 Transvesical open prostatectomy ( Frayer’s )
 Perineal open prostatectomy

 Endoscopic
Transurethral resection of the prostate ( TURP )
Transurethral incision of the prostate ( TUIP )

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 Terapi minimal invasif
 Laser
 Transurethral electrovaporization of the prostate
 Transurethral needle ablation of the prostate
 Hypertermia
 High intensity focused ultrasound
 Intraurethral stents
 Transurethral balloon dilation of the prostate

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