Referat Bedah - BPH

8/18/2019 Referat Bedah - BPH

1/31

REFERAT

BENIGN PROSTAT HYPERPLASIA (BPH)

oleh :

Rino Setiady, S.ked

406148064

Pembimbing :

dr. Adi Purnomo, Sp.B

dr. Suryo Aji, Sp.B

KEPANITERAAN KINIK I!" BE#AH

R"!AH SAKIT BHA$AN%KARA SE!ARAN%

FAK"TAS KE#&KTERAN "NI'ERSITAS TAR"!ANA%ARA


2/31

#AFTAR ISI

DAFTAR ISI.............................................................................................................................i

DAFTAR GAMBAR................................................................................................................ii

BAB I PEDA!"#"A........................................................................................................$

BAB II TI%A"A P"STA&A..............................................................................................'

'.$ An()omi..............................................................................................................................'

'.' Fi*iologi..............................................................................................................................+

'.+ Deini*i...............................................................................................................................-

'.- E)iologi...............................................................................................................................-

'. P()ologi.............................................................................................................................../

'./ M(nie*)(*i 0lini0...............................................................................................................1'.1 Pemeri0*((n Fi*i0...............................................................................................................2

'.3 Pemeri0*((n Penunj(ng....................................................................................................$$

'.2 &ompli0(*i.......................................................................................................................$

'.$4 Pen()(l(0*(n((n..............................................................................................................$/

BAB III &ESIMP"#A........................................................................................................'/

BAB I5 DATAR P"STA&A666666666666666666666666..'1

i


3/31

#AFTAR %A!BAR Al() Reprodu0*i Pri(..................................................................................................................'

7on( &elenj(r Pro*)().................................................................................................................+

Benign Pro*)() !yperpl(*i(........................................................................................................-

Pemeri0*((n 8olo0 Dubur........................................................................................................$4

G(mb(r(n M(0ro*0opi* d(n Mi0ro*0opi* BP!.......................................................................$'

Si)o*0opi BP!..........................................................................................................................$+

Sonogr(i Pro*)() orm(l.........................................................................................................$+

Sonogr(i BP!.........................................................................................................................$-

Ele9(*i D(*(r Buli y(ng Mengindi0(*i0(n BP!......................................................................$-

Peni)r((n "SG norm(l d(n p(d( BP!....................................................................................$

#o0(*i Re*ep)or (;Adrenergi0..................................................................................................$2

Miro


4/31

BAB I

PEN#AH""AN

Pembe*(r(n pro*)() benign( ()(u lebih di0en(l *eb(g(i BP! *ering di)emu0(n p(d(

pri( y(ng mem(*u0i u*i( l(nju). I*)il(h BP! ()(u benign prostatic hyperplasia *eben(rny(

merup(0(n i*)il(h hi*)op()ologi*, y(i)u )erd(p() hiperpl(*i( *el;*el *)rom( d(n *el;*el epi)el

0elenj(r pro*)()

Su()u peneli)i(n menyebu)0(n b(hBP!?

y(ng bergej(l( p(d( pri( beru*i( -4@-2 )(hun men(p(i h(mpir $. Ang0( ini mening0()

deng(n ber)(mb(hny( u*i(, *ehingg( p(d( u*i( 4@2 )(hun pre9(len*iny( men(p(i h(mpir

4 d(n p(d( u*i( 34 )(hun men(p(i (ng0( *e0i)(r 34.

Me*0ipun j(r(ng meng(n(m jiB==?. =b*)ru0*i y(ng 0hu*u* di*eb(b0(n oleh pembe*(r(n

0elenj(r pro*)() di*ebu) *eb(g(i benign prostate obstruction >BP=?. =b*)ru0*i ini l(m(

0el(m((n d(p() menimbul0(n perub(h(n *)ru0)ur buli;buli m(upun ginj(l *ehingg(

menyeb(b0(n 0ompli0(*i p(d( *(lur(n 0emih ()(* m(upun b(non oper()i? *(mp(i )ind(0(n y(ng p(ling ber() y(i)u

pembed(h(n.

8olo0 dubur ()(u digital rectal examina-tion >DRE? merup(0(n pemeri0*((n y(ng

pen)ing p(d( p(*ien BP!, di*(mping pemeri0*((n i*i0 p(d( regio *upr(pubi0 un)u0 men(ri

0emung0in(n (d(ny( di*)en*i buli;buli. D(ri pemeri0*((n olo0 dubur ini d(p() diper0ir(0(n

(d(ny( pembe*(r(n pro*)(), 0on*i*)en*i pro*)(), d(n (d(ny( nodul y(ng merup(0(n *(l(h *()u

)(nd( d(ri 0eg(n(*(n pro*)(). &eurig((n *u()u 0eg(n(*(n p(d( pemeri0*((n olo0 dubur,

)erny()( h(ny( '/;+- y(ng po*i)i 0(n0er pro*)() p(d( pemeri0*((n biop*i. Sen*i)ii)(*

pemeri0*((n ini d(l(m menen)u0(n (d(ny( 0(r*inom( pro*)() *ebe*(r ++.

1


5/31

BAB II

PE!BAHASAN

I. ANAT&!I PR&STAT

&elenj(r pro*)() (d(l(h *(l(h *()u org(n geni)(li( pri( y(ng )erle)(0 di *ebel(h

inerior buli;buli d(n membung0u* ure)r( po*)erior. Pro*)() berben)u0 *eper)i pyr(mid

)erb(li0 d(n merup(0(n org(n 0elenj(r ibromu*0uler y(ng mengelilingi ure)r( p(r*

pro*)()i(. Bil( meng(l(mi pembe*(r(n org(n ini mene0(n ure)r( p(r* pro*)()i0( d(n

menyeb(b0(n )erh(mb()ny( (lir(n urin 0elu(r d(ri buli;buli. Pro*)() merup(0(n

0elenj(r (0*e*ori )erbe*(r p(d( pri( )eb(lny( C ' m d(n p(nj(ngny( C + m deng(n

leb(rny( C - m, d(n ber() '4 gr(m.

%aa* 1. A+at Re*od-ki P*ia

&elenj(r pro*)() )erb(gi ()(* lobu* :

(. #obu* mediu*

b. #obu* l()er(li* >' lobu*?

. #obu* (n)erior d. #obu* po*)erior

P(d( 0elenj(r pro*)() jug( dib(gi d(l(m on( :

(. 7on( An)erior ()(u 5en)r(l .

Se*u(i deng(n lobu* (n)erior, )id(0 puny( 0elenj(r, )erdiri ()(* *)rom(

ibromu*0ul(r. 7on( ini melipu)i *eper)ig( 0elenj(r pro*)().

b. 7on( Perier

2


6/31

Se*u(i deng(n lobu* l()er(l d(n po*)erior, melipu)i 14 m(**( 0elenj(r pro*)().

7on( ini ren)(n )erh(d(p inl(m(*i d(n merup(0(n )emp() (*(l 0(r*inom(

)erb(ny(0.

. 7on( Sen)r(li*.

#o0(*i )erle)(0 (n)(r( 0edu( du0)u* ej(0ul()oriu*, *e*u(i deng(n lobu* )eng(h

melipu)i ' m(**( gl(ndul(r pro*)().7on( ini re*i*)en )erh(d(p inl(m(*i.

d. 7on( Tr(n*i*ion(l.

7on( ini ber*(m(;*(m( deng(n 0elenj(r periure)r( di*ebu) jug( *eb(g(i 0elenj(r

prepro*)()i0. Merup(0(n b(gi(n )er0eil d(ri pro*)(), y(i)u 0ur(ng lebih )e)(pi

d(p() meleb(r ber*(m( j(ring(n *)rom( ibromu*0ul(r (n)erior menj(di benign

pro*)()i hyperpi(*i( >BP!?.

e. &elenj(r;&elenj(r Periure)r(

B(gi(n ini )erdiri d(ri du0)u*;du0)u* 0eil d(n *u*un(n *el;*el (*in(r (bor)i

)er*eb(r *ep(nj(ng *egmen ure)r( pro0*im(l.

%aa* /. ona Ke+ena* P*otat

II. FISI&&%I PR&STAT

Se0re) 0elenj(r pro*)() (d(l(h (ir(n *eper)i *u*u y(ng ber*(m(;*(m( *e0re)

d(ri 9e*i0ul( *emin(li* merup(0(n 0omponen u)(m( d(ri (ir(n *emen. Semen beri*i

*ejuml(h (*(m *i)r() *ehingg( p! ny( (g(0 (*(m >/,?. Sel(in i)u d(p() di)emu0(n

enim y(ng be0erj( *eb(g(i ibrinoli*in y(ng 0u(), o*()(*e (*(m, enim;enim l(in

d(n lipid. Se0re) pro*)() di0elu(r0(n *el(m( ej(0ul(*i mel(lui 0on)r(0*i o)o) polo*.

0elenj(r pro*)() jug( mengh(*il0(n (ir(n d(n pl(*m( *emin(li*, deng(n perb(nding(n

(ir(n pro*)() $+;+' d(n (ir(n 9e*i0ul( *emin(li* -/;34 p(d(


7/31

&elenj(r pro*)() dib(+? In)er(0*i (n)(r( *el *)rom( d(n *el epi)el pro*)(), >-? Ber0ur(ngny(

0em()i(n *el >(pop)o*i*?, d(n >? Teori S)em *el.

(. Teori Dihidro)e*)o*)eron >D!T?

Dihidro)e*)o*)eron ()(u D!T (d(l(h me)(boli) (ndrogen y(ng *(ng() pen)ing

p(d( per)umbuh(n *el; *el 0elenj(r pro*)(). Diben)u0 d(ri )e*)o*)eron di d(l(m *el

pro*)() oleh enim ;redu0)(*e deng(n b(n)u(n 0oenim ADP!. D!T y(ng

)el(h )erben)u0 beri0()(n deng(n re*ep)or (ndrogen >RA? memben)u0 0omple0*

D!T;RA p(d( in)i d(n *el *el(nju)ny( )erj(di *in)e*i* pro)ein growth factor y(ngmen*)imul(*i per)umbuh(n *el pro*)().

4


8/31

P(d( berb(g(i peneli)i(n di0()(0(n b(h$21+? membu0)i0(n b(h growth factor ? )er)en)u. Se)el(h *el; *el *)rom( mend(p()0(n *)imul(*i

d(ri D!T d(n e*)r(diol, *el; *el *)rom( men*in)e*i* *u()u growth factor y(ng

*el(nju)ny( mempeng(ruhi *el; *el *)rom( i)u *endiri *e(r( in)r(0in d(n (u)o0rin,

*er)( mempeng(ruhi *el; *el epi)el *e(r( p(r(0rin. S)imul(*i i)u menyeb(b0(n

)erj(diny( prolier(*i *el; *el epi)el m(upun *)rom(.

d. Ber0ur(ngny( 0em()i(n *el pro*)() > Apoptosis?

Apop)o*i* *el p(d( *el pro*)() (d(l(h me0(ni*me i*iologi0 homeo*)()i*

0elenj(r pro*)(). P(d( j(ring(n nom(l, )erd(p() 0e*eimb(ng(n (n)(r( l(ju

prolier(*i *el deng(n 0em()i(n *el. Ber0ur(ngny( juml(h *el;*el pro*)() y(ng

(pop)o*i* menyeb(b0(n juml(h *el;*el pro*)() *e(r( 0e*eluruh(n m(0in

mening0() *ehingg( meng(0ib()0(n per)(mb(h(n m(**( pro*)(). Didug( hormon

(ndrogen berper(n d(l(m mengh(mb() pro*e* 0em()i(n *el 0(ren( *e)el(h

dil(0u0(n 0(*)r(*i, )erj(di pening0()(n (0)i9i)(* 0em()i(n *el 0elenj(r pro*)().

e. Teori *)em ell

5


9/31

I*(( d(n 8oey meng(ju0(n )eori ini berd(*(r0(n (*um*i b(h


10/31

• P(n(r(n mi0*i lem(h

• In)ermi)en*i

• Mi0*i )id(0 pu(*

• Di*)en*i (bdomen

• Termin(l dribbling >mene)e*?

• 5olume urine menurun

• Mengej(n *(() ber0emih

• o0)uri

• "rgen*i

• Di*uri(

"rgen*i d(n di*uri( j(r(ng )erj(di,

ji0( (d( di*eb(b0(n oleh

0e)id(0*)(bil(n de)ru*or *ehingg(

)erj(di 0on)r(0*i in9olun)er.

Tae+ 1. Gej(l( =b*)ru0*i d(n Iri)(*i Benign( Pro*)() !iperpl(*i(

M(nie*)(*i 0lini* berup( ob*)ru0*i p(d( penderi)( hipepl(*i( pro*)() m(*ih

)erg(n)ung )ig( (0)or, y(i)u:

• 5olume 0elenj(r periure)r(l

• El(*)i*i)(* leher 9e*i0(, o)o) polo* pro*)() d(n 0(p*ul pro*)()

• &e0u()(n 0on)r(0*i o)o) de)ru*or

Timbulny( gej(l( #"TS merup(0(n m(nie*)(*i 0ompen*(*i o)o) buli;buli un)u0

mengelu(r0(n urine. P(d( *u()u *((), o)o) buli;buli meng(l(mi 0ep(y(h(n >()igue?

*ehingg( j()uh 0e d(l(m (*e de0ompen*(*i y(ng diu(( dingin, 0on*um*i ob();ob()(n y(ng

meng(ndung diure)i0um, minum )er)(lu b(ny(0?

'? M(**( pro*)() )ib(;)ib( membe*(r >*e)el(h mel(0u0(n (0)i9i)(* *e0*u(l ine0*i

pro*)()?

+? Se)el(h meng0on*um*i ob();ob() y(ng d(p() menurun0(n 0on)r(0*i o)o) de)ru*or

>golong(n (n)i0olinergi0 ()(u (drenergi;?

"n)u0 menen)u0(n der(j() ber()ny( peny(0i) y(ng berhubung(n deng(n penen)u(n

jeni* pengob()(n BP! d(n un)u0 menil(i 0eberh(*il(n pengob()(n BP!, dibu()l(h

*u()u *0oring y(ng valid d(n reliable. Terd(p() beber(p( *i*)em *0oring, di (n)(r(ny(

*0or #nternational $rostate !koring !ystem >IPSS? y(ng di(mbil berd(*(r0(n *0or

7


11/31

American Urological Association >A"A?. S0or A"A )erdiri d(ri 1 per)(ny((n. P(*ien

dimin)( un)u0 menil(i *endiri der(j() 0eluh(n ob*)ru0*i d(n iri)()i mere0( deng(n *0(l(

4;. To)(l *0or d(p() ber0i*(r (n)(r( 4;+. S0or 4;1 ring(n, 3;$2 *ed(ng, d(n '4;+

ber().

. %ea+a ada a+-*an kei3 aian ata

Merup(0(n penyuli) d(ri hiperpl(*i pro*)(), berup( gej(l( ob*)ru0*i (n)(r( l(in nyeri

pingg(ng, benjol(n di pingg(ng >hidronero*i*?, dem(m >ine0*i uro*ep*i*?.

7. %ea+a di +-a* a+-*an kei3

&eluh(n p(d( peny(0i) herni( hemoroid *ering mengi0u)i peny(0i)

hiper)ropi pro*)(). Timbulny( 0edu( peny(0i) ini 0(ren( *ering mengej(n p(d(

*(() mi0*i *ehingg( meng(0ib()0(n pening0()(n )e0(n(n in)r( (bdomin(l.

8


12/31

Gej(l( gener(li*()( jug( mung0in )(mp(0, )erm(*u0 0ele)ih(n, (nore0*i(,

mu(l d(n mun)(h, d(n r(*( )id(0 ny(m(n p(d( epig(*)ri0 >Brunner Sudd(r)h,

'44$?. Se(r( 0lini0 der(j() ber(), dib(gi menj(di - gr(di(*i, y(i)u:

• Der(j() $ : Ap(bil( di)emu0(n 0eluh(n pro*)()i*mu*, p(d( DRE >olo0

dubur? di)emu0(n penonjol(n pro*)() d(n *i*( urine 0ur(ng d(ri 4 ml.

• Der(j() ' : Di)emu0(n )(nd( d(n gej(l( *eper)i p(d( der(j() $, pro*)() lebih

menonjol, b()(* ()(* m(*ih )er(b( d(n *i*( urine lebih d(ri 4 ml )e)(pi

0ur(ng d(ri $44 ml.

• Der(j() + : Seper)i der(j() ', h(ny( b()(* ()(* pro*)() )id(0 )er(b( l(gi d(n

*i*( urin lebih d(ri $44 ml.

• Der(j() - : Ap(bil( *ud(h )erj(di re)en*i )o)(l.

'II. PE!ERIKSAAN FISIK

Buli;buli y(ng )eri*i penuh d(n )er(b( m(**( 0i*)u* di d(er(h *upr( *imi*i* (0ib()

re)en*i urine. &(d(ng;0(d(ng did(p()0(n urine y(ng *el(lu mene)e* y(ng merup(0(n

per)(nd( d(ri in0on)inen*i( p(r(do0*(.

1) Pee*ikaan 7o+ok d--* diita+ *e7ta+ e9aination ( #RE )

Merup(0(n pemeri0*((n y(ng *(ng() pen)ing, DRE d(p() memberi0(ng(mb(r(n

)onu* *ing)er (ni, mu0o*( re0)um, (d(ny( 0el(in(n l(in *eper)ibenjol(n di d(l(m

re0)um d(n )en)u *(j( mer(b( pro*)(). P(d( per(b((n pro*)() h(ru* diperh()i0(n :

− &on*i*)en*i p(d( pembe*(r(n pro*)() 0eny(l

− Ad(0(h (*ime)ri

− Ad(0(h nodul p(d( pro*)()

− Ap(0(h b()(* ()(* d(p() dir(b( d(n (p(bil( b()(* ()(* m(*ih d(p() dir(b(

bi(*(ny( be*(r pro*)() diper0ir(0(n H/4 gr.

9


13/31

%aa* 4. Pee*ikaan :o+ok #--*

P(d( BP! (0(n di)emu0(n pro*)() y(ng lebih be*(r d(ri norm(l, permu0((n

liin d(n 0on*i*)en*i 0eny(l. Pemeri0*((n i*i0 (p(bil( *ud(h )erj(di 0el(in(n p(d(

)r(0)u* urin(ri( b(gi(n ()(* 0(d(ng;0(d(ng ginj(l d(p() )er(b( d(n (p(bil( *ud(h

)erj(di pnieloneri)i* (0(n di*er)(i *(0i) pingg(ng d(n nyeri 0e)o0 p(d( pingg(ng.

5e*i( urin(ri( d(p() )er(b( (p(bil( *ud(h )erj(di re)en*i )o)(l, buli;buli penuh

>di)emu0(n m(**( *upr( pubi*? y(ng nyeri d(n pe0(0 p(d( per0u*i. D(er(h inguin(l

h(ru* mul(i diperh()i0(n un)u0 menge)(hui (d(ny( herni(. Geni)(li( e0*)ern( h(ru*

pul( diperi0*( un)u0 melih() (d(ny( 0emung0in(n *eb(b y(ng l(in y(ng d(p()

menyeb(b0(n g(nggu(n mi0*i *eper)i b()u di o**( n(9i0ul(ri* ()(u ure)r( (n)erior,

ibro*i* d(er(h ure)r(, imo*i*, ondilom( di d(er(h me()u*.

/) #e*aat e*at ot*-ki

10


14/31

Der(j() ber() ob*)ru0*i d(p() diu0ur deng(n menen)u0(n juml(h *i*( urin

*e)el(h mi0*i *pon)(n. Si*( urin di)en)u0(n deng(n mengu0ur urin y(ng m(*ih d(p()

0elu(r deng(n 0()e)eri*(*i. Si*( urin d(p() pul( di0e)(hui deng(n mel(0u0(n

ul)r(*onogr(i 0(ndung 0emih *e)el(h mi0*i. Si*( urin lebih d(ri $44 bi(*(ny(

di(ngg(p *eb(g(i b()(* un)u0 indi0(*i mel(0u0(n in)er9en*i p(d( hiper)roi

pro*)().Der(j() ber() ob*)ru0*i d(p() pul( diu0ur deng(n mengu0ur p(n(r(n urin

p(d(


15/31

%aa* . %aa*an !ak*okoi dan !ik*okoi Benina P*otat Hie*+aia

+. Peni)r((n p(d( Benign( Pro*)() !iperpl(*i(:(. Fo)o polo*

Bergun( un)u0 men(ri (d(ny( b()u op(0 di *(lur(n 0emih, (d(ny(

b()u0(l0ulo*( pro*)() d(n 0(d(ng0(l( menunju0(n b(y(ng(n buli;buli y(ng

penuh )eri*i urine, y(ng merup(0(n )(nd( *u()u re)en*i urine

b. Pemeri0*((n ul)r(*onogr(i )r(n*re0)(l >TR"S?

Ad(l(h )e* "SG mel(lui re)um. D(l(m pro*edur ini, probe dim(*u00(n 0e

d(l(m re0)um meng(r(h0(n gelomb(ng *u(r( di pro*)(). Gem( pol( gelomb(ng

*u(r( merup(0(n g(mb(r d(ri 0elenj(r pro*)() p(d( l(y(r )(mpil(n. "n)u0

menen)u0(n (p(0(h *u()u d(er(h y(ng (bnorm(l )(mp(0 mem(ng )umor,

digun(0(n probe d(n g(mb(r "SG un)u0 mem(ndu j(rum biop*i un)u0 )umor

y(ng diurig(i. %(rum mengumpul0(n beber(p( po)ong j(ring(n pro*)() un)u0

pemeri0*((n deng(n mi0ro*0op. Biop*y )eru)(m( dil(0u0(n un)u0 p(*ien y(ng

diurig(i memili0i 0eg(n(*(n pro*)().

Tr(n*re0)(l ul)r(*onogr(i >TR"S? *e0(r(ng jug( digun(0(n un)u0 pengu0ur

9olume pro*)(), (r(ny( (n)(r( l(in :

• Me)ode *)ep pl(nime)ryJ. K(ng menghi)ung 9olume r()(;r()( (re(

horion)(l diu0ur d(ri d(*(r *(mp(i pun(0.

• Me)ode di(me)er. K(ng mengg(bung0(n pengu0ur(n )inggi >!heigh)? ,leb(r

>L#leng)h? deng(n rumu* : >! N L N #?

. Si*)o*0opi

D(l(m pemeri0*((n ini, di*i*ip0(n *ebu(h )(bung 0eil mel(lui pembu0((n

ure)hr( di d(l(m peni*. Pro*edur ini dil(0u0(n *e)el(h *olu*i numb* b(gi(nd(l(m peni* *ehingg( *en*(*i *emu( hil(ng. T(bung, di*ebu) *ebu(h

y*)o*opeJ , beri*i len*( d(n *i*)em (h(y( y(ng memb(n)u do0)er melih()

b(gi(n d(l(m ure)r( d(n 0(ndung 0emih. Te* ini memung0in0(n do0)er un)u0

menen)u0(n u0ur(n 0elenj(r d(n mengiden)ii0(*i lo0(*i d(n der(j() ob*)ru0*i.

12


16/31

%aa* 6. %aa*an Sitokoi Benina P*otat Hie*+aia

d. "l)r(*onogr(i )r(n* (bdomin(l

• G(mb(r(n *onogr(i benign( hyperpl(*i( pro*)() menunju0(n pembe*(r(n

b(gi(n d(l(m gl(ndul(, y(ng rel()i hipoehoi dib(nding on( perier. 7on(

)r(n*i*i hipoe0oi0 enderung mene0(n on( en)r(l d(n perier. B()(* y(ng

memi*(h0(n hyperpl(*i( deng(n on( perier (d(l(h *urgi(l (p*uleJ.

• "SG )r(n*(bdomin(l m(mpu pul( mende)e0*i (d(ny( hidronero*i* ()(upun

0eru*(0(n ginj(l (0ib() ob*)ru0*i BP! y(ng l(m(.

%aa*


17/31

%aa* >.%aa*an E+e?ai #aa* B-+i yan !enindikaikan Benina P*otat

Hie*+aia

-. Pemeri0*((n l(in :

Pemeri0*((n der(j() ob*)ru0*i pro*)() d(p() diper0ir(0(n deng(n (r( mengu0ur:

• Re*idu(l urin :

%uml(h *i*( urin *e)el(h mi0*i, deng(n (r( mel(0u0(n 0()e)eri*(*i"SG

*e)el(h mi0*i

• P(n(r(n urinlo< r()e :

Deng(n menghi)ung juml(h urine dib(gi deng(n l(m(ny( mi0*i berl(ng*ung

>mlde)i0? ()(u deng(n (l() urolome)ri y(ng meny(ji0(n g(mb(r(n gr(i0

p(n(r(n urin. Alir(n y(ng ber0ur(ng *ering p(d( BP!. P(d( (lir(n urin y(ng

lem(h, (lir(n urinny( 0ur(ng d(ri $m#* d(n )erd(p() pening0()(n re*idu urin.

Post-void residual mengu0ur juml(h (ir *eni y(ng )er)ingg(l di d(l(m

0(ndung 0emih *e)el(h bu(ng (ir 0eil. PR5 0ur(ng d(ri 4 m# umum

menunju00(n pengo*ong(n 0(ndung 0emih y(ng mem(d(i d(n pengu0ur(n $44

*(mp(i '44 ml ()(u lebih *ering menunju00(n *umb()(n. P(*ien dimin)( un)u0

bu(ng (ir 0eil *eger( *ebelum )e* d(n *i*( urin di)en)u0(n oleh "SG ()(u

0()e)eri*(*i.

%aa* 10. %aa*an Pan7a*an "*in No*a+ dan ada BPH

&e)er(ng(n :

14


18/31

%aa*an a+i*an -*in ata @ de5aa -da yan aitoatik, a+i*an -*in +ei3

da*i 1, -*in *eid- > ada -+t*aono*a=i.

G(mb(r(n (lir(n urin b(


19/31

. PENATAAKSANAAN

Tid(0 *emu( p(*ien hiperpl(*i( pro*)() perlu menj(l(mi )ind(0(n medi0. &(d(ng;

0(d(ng mere0( y(ng mengeluh #"TS ring(n d(p() *embuh *endiri )(np( mend(p()0(n)er(pi (p(pun ()(u h(ny( deng(n n(*eh() *(j(. (mun (d(pul( y(ng membu)uh0(n

)er(pi medi0(men)o*( ()(u )ind(0(n medi0 y(ng l(in 0(ren( 0eluh(nny( *em(0in p(r(h.

Tuju(n )er(pi hyperpl(*i( pro*)() (d(l(h >$? memperb(i0i 0eluh(n mi0*i, >'?

mening0()0(n 0u(li)(* hidup, >+? mengur(ngi ob*)ru0*i in)r(9e*i0(, >-? mengemb(li0(n

ung*i ginj(l ji0( )erj(di g(g(l ginj(l, >? mengur(ngi 9olume re*idu urine *e)el(h mi0*i

d(n >/? meneg(h progrei)(* peny(0i). !(l ini d(p() dieg(h deng(n medi0(men)o*(,

pembed(h(n ()(u )ind(0(n endourologi y(ng 0ur(ng in9(*i.

=b*er9(*i Medi0(men)o*( =per(*i In9(*i9e minim(l

L()hul


20/31

Baan /. Penata+akanaan Benina P*otat Hie*+aia

Pen()(l(0*(n((n il(i inde0* gej(l( BP! Ee0 *(mping

L()ull


21/31

Tae+ 4. Penata+akaan Be*daa*kan Ni+ai Indek %ea+a Benina P*otat Hie*+aia

(. L()hul '? 0ur(ngi 0on*um*i m(0(n(n ()(u minum(n y(ng mengiri)(*i buli;buli

>0opio0el()?, >+? b()(*i penggun((n ob();ob() inluen( y(ng meng(ndung

enilprop(nol(min, >-? 0ur(ngi m(0(n(n ped(*(d(n (*in, d(n >? j(ng(n men(h(n

0ening )erl(lu l(m(.

Se(r( periodi0 p(*ien dimin)( un)u0 d()(ng on)rol deng(n di)(ny( 0eluh(nny(

(p(0(h menj(di lebih b(i0 >*eb(i0ny( mem(0(i *0or y(ng b(0u?, di*(mping i)u

dil(0u0(n pemeri0*((n l(bor()orium, re*idu urin, ()(u urolome)ri. %i0( 0eluh(n mi0*i

ber)(mb(h jele0 d(rip(d( *ebelumny(, mung0in perlu dipi0ir0(n )er(pi y(ng l(in.

b. Medi0(men)o*(

Tuju(n )er(pi medi0(men)o*( (d(l(h beru*(h( un)u0 : >$? mengur(ngi re*i*)(n*i o)o)

polo* pro*)() *eb(g(i 0omponen din(mi0 penyeb(b ob*)ru0*i inr(9e*i0( deng(n ob();

ob()(n pengh(mb() (drenergi (l( >(drenergi (l( blo0er d(n >'? mengur(ngi 9olume

pro*)() *eb(g(i 0omponen *)()i deng(n (r( menurun0(n 0(d(r hormone

)e*)o*)eronedihidro)e*)o*)eron >D!T? mel(lui pengh(mb() ;redu0)(*e.

$? Pengh(mb() re*ep)or (drenergi0 .

Mengendur0(n o)o) polo* pro*)() d(n leher 0(ndung 0emih, y(ng memb(n)u

un)u0 mering(n0(n ob*)ru0*i 0emih di*eb(b0(n oleh pembe*(r(n pro*)() di BP!.

Ee0 *(mping d(p() )erm(*u0 *(0i) 0ep(l(, 0elel(h(n, ()(u ring(n.

"mumny( digun(0(n (lph( blo0er BP! )erm(*u0 ta-+oin >Flom(N?,

a+=-oin >"roN()r(l?, d(n ob();ob()(n y(ng lebih )u( *eper)i te*aoin >!y)rin?

()(u do9aoin >8(rdur(?. =b();ob()(n ini (0(n mening0()0(n p(n(r(n urin d(n

meng(0ib()0(n perb(i0(n gej(l( d(l(m beber(p( minggu d(n )id(0 berpeng(ruh

p(d( u0ur(n pro*)().

18

http://translate.googleusercontent.com/translate_c?hl=id&sl=en&u=http://www.medicinenet.com/script/main/art.asp%3Farticlekey%3D14862&prev=/search%3Fq%3Dbenign%2Bprostatic%2Bhyperplasia%26hl%3Did%26client%3Dfirefox-a%26hs%3DuAo%26rls%3Dorg.mozilla:en-US:official&rurl=translate.google.co.id&usg=ALkJrhhaR9Z9vm6QTPsOxC7-RQSJ6QQVxQhttp://translate.googleusercontent.com/translate_c?hl=id&sl=en&u=http://www.medicinenet.com/script/main/art.asp%3Farticlekey%3D39923&prev=/search%3Fq%3Dbenign%2Bprostatic%2Bhyperplasia%26hl%3Did%26client%3Dfirefox-a%26hs%3DuAo%26rls%3Dorg.mozilla:en-US:official&rurl=translate.google.co.id&usg=ALkJrhjB2WxgtfcCzKZIPtqXSxbal1bwOghttp://translate.googleusercontent.com/translate_c?hl=id&sl=en&u=http://www.medicinenet.com/script/main/art.asp%3Farticlekey%3D762&prev=/search%3Fq%3Dbenign%2Bprostatic%2Bhyperplasia%26hl%3Did%26client%3Dfirefox-a%26hs%3DuAo%26rls%3Dorg.mozilla:en-US:official&rurl=translate.google.co.id&usg=ALkJrhhS6M2DQ8Azmw82YGNc_hKAj7pgaQhttp://translate.googleusercontent.com/translate_c?hl=id&sl=en&u=http://www.medicinenet.com/script/main/art.asp%3Farticlekey%3D714&prev=/search%3Fq%3Dbenign%2Bprostatic%2Bhyperplasia%26hl%3Did%26client%3Dfirefox-a%26hs%3DuAo%26rls%3Dorg.mozilla:en-US:official&rurl=translate.google.co.id&usg=ALkJrhiimg--uLiX8geB6nDqRlaj2I77Pghttp://translate.googleusercontent.com/translate_c?hl=id&sl=en&u=http://www.medicinenet.com/script/main/art.asp%3Farticlekey%3D14862&prev=/search%3Fq%3Dbenign%2Bprostatic%2Bhyperplasia%26hl%3Did%26client%3Dfirefox-a%26hs%3DuAo%26rls%3Dorg.mozilla:en-US:official&rurl=translate.google.co.id&usg=ALkJrhhaR9Z9vm6QTPsOxC7-RQSJ6QQVxQhttp://translate.googleusercontent.com/translate_c?hl=id&sl=en&u=http://www.medicinenet.com/script/main/art.asp%3Farticlekey%3D39923&prev=/search%3Fq%3Dbenign%2Bprostatic%2Bhyperplasia%26hl%3Did%26client%3Dfirefox-a%26hs%3DuAo%26rls%3Dorg.mozilla:en-US:official&rurl=translate.google.co.id&usg=ALkJrhjB2WxgtfcCzKZIPtqXSxbal1bwOghttp://translate.googleusercontent.com/translate_c?hl=id&sl=en&u=http://www.medicinenet.com/script/main/art.asp%3Farticlekey%3D762&prev=/search%3Fq%3Dbenign%2Bprostatic%2Bhyperplasia%26hl%3Did%26client%3Dfirefox-a%26hs%3DuAo%26rls%3Dorg.mozilla:en-US:official&rurl=translate.google.co.id&usg=ALkJrhhS6M2DQ8Azmw82YGNc_hKAj7pgaQhttp://translate.googleusercontent.com/translate_c?hl=id&sl=en&u=http://www.medicinenet.com/script/main/art.asp%3Farticlekey%3D714&prev=/search%3Fq%3Dbenign%2Bprostatic%2Bhyperplasia%26hl%3Did%26client%3Dfirefox-a%26hs%3DuAo%26rls%3Dorg.mozilla:en-US:official&rurl=translate.google.co.id&usg=ALkJrhiimg--uLiX8geB6nDqRlaj2I77Pg


22/31

G(mb(r $-. #o0(*i Re*ep)or α$;Adrenergi0 >α$;AR*?

'? Pengh(mb() redu0)(*e

=b() ini be0erj( deng(n (r( mengh(mb() pemben)u0(n dihidro)e*)o*)eron

>D!T? d(ri )e*)o*)erone y(ng di0()(li*i* oleh enim redu0)(*e di d(l(m *el

pro*)(). Menurunny( 0(d(r D!T menyeb(b0(n *in)e*i* pro)ein d(n repli0(*i

*el;*el pro*)() menurun. Pembe*(r(n pro*)() di BP! *e(r( l(ng*ung )erg(n)ung

p(d( D!T, *ehingg( ob() ini menyeb(b0(n pengur(ng(n ' per0ir((n u0ur(n

pro*)() lebih d(ri / *(mp(i $' bul(n.

. Ter(pi In9(*i Minim(l

Diperun)u0(n un)u0 p(*ien y(ng mempuny(i ri*i0o )inggi )erh(d(p pembed(h(n

$? Miro


23/31

G(mb(r $$. !i7*o5a?e T*an-*et3*a+

'? Tr(n*ure)hr(l j(rum (bl(*i. %ug( p(d( )(hun $22/, FDA menye)ujui )r(n*ure)hr(l

j(rum (bl(*i in9(*i minim(l >T"A? *i*)em un)u0 pengob()(n BP!. Si*)em

T"A memberi0(n energy r(diore0uen*i )ing0() rend(h mel(lui j(rum 0emb(r

un)u0 region pro*)() y(ng membe*(r. Shield* melindungi ure)r( d(ri 0eru*(0(n

(0ib() p(n(*. Si*)em T"A mening0()0(n (lir(n urin d(n mengur(ngi gej(l(

deng(n ee0 *(mping y(ng lebih *edi0i) ji0( dib(nding0(n deng(n re*e0*i

)r(n*ure)hr(l d(ri pro*)() >T"RP?.

%aa* 1/. T*an-*et3*a+ ;a*- A+ai In?ai= !inia+

+? T3e*ot3e*ay denan ai*. Ter(pi ini menggun(0(n (ir p(n(* un)u0

mengh(nur0(n j(ring(n 0elebih(n d(l(m pro*)(). Sebu(h 0()e)er meng(ndung

beber(p( lub(ng dipo*i*i0(n d(l(m ure)r( *ehingg( b(lon pengob()(n )erle)(0 di

20


24/31

)eng(h pro*)(). Sebu(h 0ompu)er mengon)rol *uhu (ir, y(ng meng(lir 0e b(lon

d(n mem(n(*0(n j(ring(n pro*)() *e0i)(rny(. Si*)em ini memo0u*0(n p(n(* di

T"RP? digun(0(n

un)u0 24 per*en d(ri *emu( oper(*i pro*)() dil(0u0(n un)u0 BP!. Deng(n

T"RP, (l() y(ng di*ebu) re*e)o*ope dim(*u00(n mel(lui peni*. The

re*e)o*ope, y(i)u p(nj(ng *e0i)(r $' ini d(n di(me)er $ ' ini, beri*i l(mpu,

0()up un)u0 mengend(li0(n (ir(n irig(*i, d(n loop li*)ri0 y(ng memo)ong

j(ring(n d(n *egel pembuluh d(r(h.

8(ir(n irig(n y(ng dip(0(i (d(l(h (u(de* . 0erugi(n d(ri (u(de* (d(l(h

*i()ny( y(ng hipo)oni* *ehingg( d(p() m(*u0 mel(lui *ir0ul(*i *i*)emi0 d(n

menyeb(b0(n hipo)ermi( rel()i9e ()(u gej(l( in)o0*i0(*i (ir y(ng di0en(l

deng(n *indrom T"RP. Di)(nd(i deng(n p(*ien y(ng mul(i geli*(h, *omnolen

d(n )e0(n(n d(r(h mening0() d(n )erd(p() br(di0(rdi. %i0( )id(0 *eger( di()(*i,

p(*ien (0(n meng(l(mi edem( o)(0 d(n j()uh 0e d(l(m 0om(. "n)u0

mengur(ngi ri*i0o )imbulny( *indrom( T"RP oper()or h(ru* memb()(*i diri

un)u0 )id(0 mel(0u0(n re*e0*i lebih d(ri $ j(m d(n b(ru mem(*(ng *i*)o*)omi

)erlebih d(uhlu *ebelum re*e0*i dih(r(p0(n d(p() mengur(ngi penyer(p(n (ir 0e

*i*)emi0.

21


25/31

Sel(m( oper(*i 24;meni), (hli bed(h menggun(0(n loop 0(


26/31

%aa* 14. (a) a+at T"RP, () 7a*a e+ak-kan T"RP, (7) -*et*a *otatika a7a T"RP

Pro*edur bed(h y(ng di*ebu) in*i*i )r(n*ure)hr(l d(ri pro*)() >T"IP?, pro*edur ini

meleb(r ure)hr( deng(n membu() beber(p( po)ong(n 0eil di leher 0(ndung 0emih, di

m(n( )erd(p() 0elenj(r pro*)(). Pro*edur ini digun(0(n p(d( hiperpl(*i pro*)() y(ng

)id(0 )(r)(lu be*(r, )(np( (d( pembe*(r(n lobu* mediu* d(n p(d( p(*en y(ng umurny(

m(*ih mud(.

/) =pen *urgery.

D(l(m beber(p( 0(*u* 0e)i0( *ebu(h pro*edur )r(n*ure)hr(l )id(0 d(p()

digun(0(n, oper(*i )erbu0(, y(ng memerlu0(n in*i*i e0*)ern(l, d(p() digun(0(n.

=pen *urgery *ering dil(0u0(n 0e)i0( 0elenj(r *(ng() membe*(r >O$44 gr(m?,

0e)i0( (d( 0ompli0(*i, ()(u 0e)i0( 0(ndung 0emih )el(h ru*(0 d(n perlu

diperb(i0i. Pro*)()e0*omi )erbu0( dil(0u0(n mel(lui pende0()(n *upr(rubi0

)r(n*9e*i0(l >Freyer? ()(u re)ropubi0 inr(9e*i0(l >Millin?. Penyuli) y(ng d(p()

)erj(di (d(l(h in0on)inen*i( uirn >+?, impo)en*i( >;$4?, ej(0ul(*i re)rogr(de

>/4;34? d(n 0on)r(0)ur leher buli;buli >+4?. Perb(i0(n gej(l( 0lini* 3;

$44.

2) =per(*i l(*er

23


27/31

&elenj(r pro*)() p(d( *uhu /4;/o8 (0(n meng(l(mi 0o(gul(*i d(n p(d(

*uhu y(ng lebih d(ri $44o8 meng(l(mi 9(por(*i. Te0ni0 l(*er menimbul0(n

lebih *edi0i) 0ompli0(*i *(y(ngny( )er(pi ini membu)uh0(n )er(pi ul(ng '

*e)i(p )(hun. &e0ur(ng(nny( (d(l(h : )id(0 d(p() diperoleh j(ring(n un)u0

pemeri0*((n p()ologi >0eu(li p((d !o:KAG o(gul()ion?, *ering b(ny(0

menimbul0(n di*uri p(*( bed(h y(ng d(p() berl(ng*ung *(mp(i ' bul(n, )id(0

l(ng*ung d(p() mi0*i *pon)(n *e)el(h oper(*i d(n pe(0 lo< r()e lebih rend(h

d(rip(d( p(*( T"RP. Ser() l(*er mel(lui ure)r( 0e d(l(m pro*)() menggun(0(n

y*)o*ope d(n 0emudi(n memberi0(n beber(p( *embur(n energi y(ng

berl(ng*ung +4 *(mp(i /4 de)i0. Energi l(*er mengh(nur0(n j(ring(n pro*)()

d(n menyeb(b0(n penyu*u)(n.

%aa* 16. &e*ai ae* ada P*otat

a) In)er*)i)i(l l(*er o(gul()ion. Tid(0 *eper)i pro*edur l(*er l(in, 0o(gul(*i

l(*er in)er*)i*i(l )emp() ujung probe *er() op)i0 l(ng*ung 0e j(ring(n pro*)()

un)u0 mengh(nur0(nny(.

%aa* 1P5P?.

P5T (;energi l(*er )inggi un)u0 mengh(nur0(n j(ring(n pro*)(). 8(r( *(m(

deng(n T"RP, h(ny( *(j( )e0ni0 ini mem(0(i roller b(ll y(ng *pe*ii0

deng(n me*in di()ermi y(ng u0up 0u(), *ehingg( m(mpu membu()

9(por(*i 0elenj(r pro*)(). Te0ni0 ini u0up (m(n )id(0 menimbul0(n

24


28/31

perd(r(h(n p(d( *(() oper(*i. (mun )e0ni0 ini h(ny( diperun)u0(n p(d(

pro*)() y(ng )id(0 )erl(lu be*(r >H4 gr(m? d(n membu)uh0(n


29/31

BAB III

KESI!P"AN

!iperpl(*i( 0elenj(r pro*)() mempuny(i (ng0( morbidi)(* y(ng berm(0n( p(d(

popul(*i pri( l(nju) u*i(. Deng(n ber)(mb(h u*i(, u0ur(n 0elenj(r d(p() ber)(mb(h 0(ren(

)erj(di hiperpl(*i( j(ring(n ibromu*0uler d(n *)ru0)ur epi)el 0elenj(r >j(ring(n d(l(m

0elenj(r pro*)()?. Gej(l( d(ri pembe*(r(n pro*)() ini )erdiri d(ri gej(l( ob*)ru0*id(n gej(l(

iri)()i.

Pen()(l(0*(n((n BP! berup(


30/31

)id(0 d(p() dipredi0*i p(d( )i(p indi9idu


31/31

. R(h(rdjo, %. $22/. Pro*)() !iper)ropi. D(l(m : %umpulan #lmu )edah. Bin(rup(

(0*(r(, %(0(r)( $/$;14+.

/. R(mon P, Se)iono, Ron(, Bu0u Ilmu Bed(h, F(0ul)(* &edo0)er(n"ni9er*i)(*

P(dj(j(r(n '44': '4+;1.

1. S(bi*)on, D(9id. S(bi*)on : Bu0u Aj(r Bed(h. Alih b(h(*( : Pe)ru*. Tim(n. EG8.

$22-.

3. Sj(ei, M. $22. Di(gno*i* Pembe*(r(n Pro*)() %in(0. D(l(m : $embesaran $rostat

&inak. K(y(*(n Penerbi) IDI, %(0(r)( /;$1

2. Sj(m*uhid(j() R, De %ong L. $221. Tumor Pro*)(). D(l(m: )uku a*ar #lmu )edah,

EG8, %(0(r)(, $221 $43;/-.

$4. "mb(*, R. $22. $atofisiologi dan $atogenesis $embesaran $rostat &inak . K(y(*(n

penerbi) IDI, %(0(r)( $;'.

Referat Bedah - BPH

Documents