Kuliah Prostat (2)
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Transcript of Kuliah Prostat (2)
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Disorders of the Prostate
Dr.M.Galuh Richata, SpU
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Prostate Gland
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
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Prostate Gland
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BPH
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
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Prostate Gland
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Prostate Gland
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Disorders of the Prostate
Prostatitis most found inperipheralzone
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.
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Prostatitis
Most common urologic diagnosis in menunder 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)
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Prostatitis
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
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Prostatitis
Physical ExamsDRE: prostate is tender, could be enlarged
(irregularly firm & warm)
LabBlood: Leucocytosis
Urine: pyuria, microscopic hematuria ,
bacteria
Urine culture identify the organism
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Prostatitis
DRE:
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Prostatitis
Management
- Antibiotics (guided by resistance test)
- Antipyretics- Analgesics
- Stool softeners
- Hydration- Bed rest
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Benign Prostate Hyperplasia
(BPH) 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)
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BPH
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BPH
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BPH
BPH BOO
complications:
- Urinary retention
- Urinary tractinfection
- Bladder stone
- Hematuria- Bladder diverticulae
- Renal impairment
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BPH
Sign & SymptomsBOO LUTS (Lower Urinary Tract Symptoms)
Obstructive Symptoms:
Weak Stream, Straining, Hesitancy,
Intermittency, Incomplete Emptying, TerminalDribbling
Irritative Symptoms:
Frequency, Nocturia, Dysuria, Urgency
IPSS International Prostate Symptoms Score
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BPH
General condition: state of pain, bodytemperature, 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?
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BPH
DRE:
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BPH
Lab
- General : blood, urine
- PSA (Prostate Specific Antigen)
Imaging
- Ultrasound (transabdominal, transrectal)- IVU
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BPH
ManagementFor General Pract i t ioners:
- No complication oral therapy
LUTS :Alpha Blockers, 5-Alpha
Reductase Inhibitors.
- Complications refer to Urologist
Urinary Retention catheterization
then refer to urologist
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BPH
Catheterization
Cystostomy/
BladderPuncture
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BPH
Management
Operative/Surgery
- Open
Prostatectomy
- Cystoscopy &
Trans Urethral
Resection ofProstate (TURP)
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BPH
Trans UrethralResection of
Prostate
(TURP)
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BPH
TURP
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Prostate Cancer
Carcinoma of the Prostate (CaP)
Most common cancer diagnosed
2nd
leading cause of cancer death inAmerican men
Prevalence increase rapidly with age
Risk Factor: still debatable 70% from the peripheral zone
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Prostate Cancer
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Prostate Cancer
Pattern of Progression- Local Extension
- Metastases (lymphogenous or
haematogenous) :- Lymph Node (obturator, common illiac)
- Bone
- Visceral (lung, liver, adrenal)
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Prostate Cancer
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Prostate Cancer
General Practitioners
Screening!Signs & Symptoms
- asymptomatic
- similar to BPH (LUTS, urinary retention,hematuria, etc)
- hematospermia (local extension)
- bone pain (metastases)
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Prostate Cancer
DRE :- Volume : can be small/large
- Consistency: hard, stony (indurat ion)
- Surface: uneven, nodule
- Asymmetric
Lab:
PSA : > 4 ng/mL
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Prostate Cancer
Any male with LUTS screening with DRE
found anything suspicious refer to
urologist