Bedah Benign Prostatic Hyperplasia

8/17/2019 Bedah Benign Prostatic Hyperplasia

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BENIGN PROSTATIC

HYPERPLASIA (BPH)

Dr. Nurul Akbar, Sp. U


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INCIDENCE most common benign tumor in men

its incidence is age-related

symptoms of prostatic obstruction are also

age-related (decrease in the force andcaliber of their urinary stream).


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EPIDEMIOLOGY isk factors for the de!elopment of "#$ are

poorly understood

Some studies ha!e suggested a genetic

predisposition, and some ha!e noted racialdifferences.

Appro%imately &' of men under the age of '

*ho undergo surgery for "#$ may ha!e a

heritable form of the disease.

+his form is most likely an autosomal dominant

trait, and first-degree male relati!es of such

patients carry an increased relati!e risk of

appro%imately -fold.


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ETIOLOGY

not completely understood

multifactorial and endocrine controlled

prostate is composed of both stromal and

epithelial elements "#$ is under endocrine control


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PATHOLOGY

"#$ de!elops in the transition one

t is truly a hyperplastic process resulting from an increase in

cell number

/icroscopic e!aluation re!eals a nodular gro*th pattern that

is composed of !arying amounts of stroma and epithelium. Stroma is composed of !arying amounts of collagen and

smooth muscle

alpha-blocker therapy may result in e%cellent responses in

patients *ith "#$ that has a significant component of

smooth muscle, "#$ predominantly composed of epithelium might respond

better to &-reductase inhibitors

#atients *ith significant components of collagen in the

stroma may not respond to either form of medical therapy


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PATHOPHYSIOLOGY mechanical obstruction 0 intrusion into the

urethral lumen or bladder neck, leading to a

higher bladder outlet resistance

Dynamic obstruction 0+he prostatic stroma,composed of smooth muscle and collagen, is

rich in adrenergic ner!e supply. +he le!el of

autonomic stimulation thus sets a tone to the

prostatic urethra. Use of alpha-blockertherapy decreases this tone, resulting in a

decrease in outlet resistance.


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+he irritati!e !oiding complaints 0 result

from the secondary response of the bladder

to the increased outlet resistance

"ladder outlet obstruction leads to detrusormuscle hypertrophy and hyperplasia as *ell

as collagen deposition (seen as trabeculation

on cystoscopic e%amination)

f left unchecked, mucosal herniationbet*een detrusor muscle bundles ensues,

causing di!erticula formation


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SYMPTOMS 1bstructi!e 0 hesitancy, decreased force and

caliber of stream, sensation of incomplete

bladder emptying, double !oiding (urinating

a second time *ithin 2 h of the pre!ious!oid), straining to urinate, and post-!oid

dribbling.

rritati!e 0 urgency (difficult to postpone

urination), fre3uency (4 times per day),and nocturia (nocturnal fre3uency 42 times)


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IPSS '56 0 mild 7U+S

859: 0 moderate 7U+S

2'5;& 0 se!ere 7U+S


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SIGNS

D, transrectal ultrasound, andbiopsy).


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LABORATORY FINDINGS urinalysis 0 e%clude infection or hematuria

serum creatinine 0 to assess renal function

Serum #SA


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IMAGING intra!enous pyelogram or renal ultrasound

recommended only in the presence of

concomitant urinary tract disease or

complications from "#$ (eg, hematuria,urinary tract infection, renal insufficiency,

history of stone disease).


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ADDITIONAL TESTS /easurement of flo* rate

post-!oid residual urine

urodynamic profiles 0 reser!ed for patients

*ith suspected neurologic disease or those*ho ha!e failed prostate surgery


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DIFFERENTIAL DIAGNOSIS urethral stricture

bladder neck contracture

bladder stone

?a# urinary tract infection

neurogenic bladder


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TREATMENT *atchful *aiting

/edical +herapy (alpha blocker and & A)

surgical (recurrent urinary tract infection,

hematuria, bladder stones, renalinsufficiency or large bladder di!erticula)


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CONVENTIONAL SRGICAL

THERAPY +ransurethral esection of the #rostate

(+U#)

+ransurethral ncision of the #rostate

1pen Simple #rostatectomy


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MINIMALLY INVASIVE THERAPY 7aser +herapy

+ransurethral


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Smiths Beneral Urology

+hank you

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Bedah Benign Prostatic Hyperplasia