BPH Post TURP in Columbia Asia Pulomas Hospital: Laporan Kasus

May Velyn Dina, Gracia, Fariza, Fildza

Child Health Department

Pendahuluan
Sindrom TURP adalah komplikasi dari tindakan TURP yang berkaitan dengan penggunaan
cairan irigasi yang terjadi akibat diabsorpsinya cairan irigasi secara berlebihan sehingga dapat
menyebabkan hiponatremia, hipervolemia, hemolisis, dan gagal ginjal akut. Insiden sindrom
TURP kira-kira 0,5-7% dengan angka kematian 0,2-0,8%.1,2
Laporan Kasus
Laki laki usia 79 tahun datang ke poli urologi RS Columbia Asia Pulomas dengan keluhan sulit
BAK sejak 2 hari SMRS. Dari hasil pemeriksaan USG ginjal dan vesica urinaria didapatkan
gambaran sistitis berat dd massa buli, pembesaran prostat (volume 156 ml) sehingga pasien
didiagnosa dengan BPH dan direncanakan tindakan TURP. Pasien memiliki riwayat ACS
STEMI anterior late onset, Hipertensi dengan HHD. 1 hari setelah tindakan TURP, pasien
mengeluhkan adanya sesak napas sejak sore hari dan semakin memberat ketika malam hari, nyeri
dada (-), mual (+), muntah (-). Dokter penanggung jawab pasien memberikan instruksi agar
pasien dirawat di HDU.
Pada pemeriksaan fisik didapatkan: konjungtiva pucat +/+, sclera ikterik +/+. Pada pemeriksaan
thorax: SNV +/+, rhonki basah halus +/+
Pemeriksaan Laboratorium: Trombositopenia 29.000, Hb
Pemeriksaan USG Abdomen: Fatty liver grade 1, sludge kandung empedu, efusi pleura minimal
kanan.
Pasien didiganosis Sepsis ec Sindrom TURP, ACKD, NSTEMI pada CAD susp Endocarditis,
Trombositopenia ec DIC, Icterus parenkimal ec NAFLD dd sepsis
Diskusi
The pathophysiology of MIS-C is not well understood. It is thought to result from an abnormal
immune response to the virus, with some clinical similarities to KD, MAS, and cytokine release
syndrome. However, MIS-C appears to have an immunophenotype that is distinct from KD and
MAS. Most affected children have positive serology for SARS-CoV-2 with negative polymerase
chain reaction (PCR), a finding that further supports the hypothesis that MIS-C is related to
immune disregulation occurring after acute infection has passed.1,2,3
 Hb 11,4
Ht 34,7
Leukocyte 9.960
Trombosit 450.000
Neutrofil 65,1
Lymphocyte 23,7
D-dimer 646
SARS COV Not
PCR detected

Conclusions
Incidence of pediatric MIS-C, temporarily associated with SARS-CoV-2, appears daily, calling
pediatricians’ attentions to this new diagnosis with more fatal outcomes than Kawasaki cases.
The diagnosis is challenging due to the variety of clinical and laboratory manifestations, with
both positive and negative COVID-19 results, but that should not delay therapy as soon as the
diagnostic suspicion is generated.

References:
1. Carneiro J. D. A., et al. Proposed recommendations for antithrombotic prophylaxis for
children and adolescents with severe infection and/or multisystem inflammatory
syndrome caused by SARS COV 2. Clinics 2020;75:e2252.
2. Rubens JH. Acute covid-19 multisystem inflammatory syndrome in children. BMJ
2021;372:n385.
3. Hoste L, et al. Multisystem inflammatory syndrome in children related to covid 19: a
systematic review. Eur J Pediatr.