BENIGN PROSTATIC HYPERPLASIA

Revi Dinayanti, S.Ked

Supervisor:
Dr. Marta Hendry, SpU
Benign Prostatic Hyperplasia

Background
Anatomy

Benign Prostatic Hyperplasia

Zones of the prostate

Benign Prostatic Hyperplasia

Peripheral Zone
70% of the young
adult
Central Zone
25%
Transition Zone
5%
BPH uniformly
originates in the
transition zone

The Prevalence

Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia

Risk Factors

40 years and older

40 years and older

medical conditions such

medical
conditions
such
as obesity,
heart and
as obesity,
heart and
circulatory
disease,
and
circulatory
disease, and
type 2 diabetes
type 2 diabetes

family history of benign

family history of benign
prostatic hyperplasia
prostatic hyperplasia

lack of physical exercise

lack of physical exercise

Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia

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Benign Prostatic Hyperplasia

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Approach to a patient with BPH

History
History: :LUTS
LUTS
use
useIPSS
IPSS
Physical
PhysicalExamination
Examination

DRE
DRE
TRUS
TRUS
Serum
SerumPSA
PSA
Benign Prostatic Hyperplasia

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Benign Prostatic Hyperplasia

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Surgical
approaches

Surgical
approaches

Medical
management

Medical
management

Watchful
waiting

Watchful
waiting

Treatment

Identification
Name

: Mr. R

Sex

: Male

Age

: 57 years old

Address

: Prabumulih

Admission

: 2014

Register Number : RI 14022109

Occupation : Pensioner

Benign Prostatic Hyperplasia

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Anamnesis
Chief
Complain
t

Unable to
urinate

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Clinical Presentation
difficult
difficult
to
to
urinate
urinate
had to
hadto
to
push
push
begin to
begin
urinate
urinate

slow
slow
urine
urine
stream
stream

dribbling
dribbling

Since
Since
1
1
years
years
ago
ago
stopped
stopped
and
and
started
started
again
again
when
when
urinate
urinate

sensatio
sensatio
n of
n of
incomplit
incomplit
e
e
bladder
bladder
emptyin
emptyin
g
g

Benign Prostatic Hyperplasia

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More
More
severe
severe

pain
pain
while
while
urinatin
urinatin
gg

3
months
ago

Dificult
Dificult
to
tohold
hold
urinatio
urinatio
nn

>8x/day
>8x/day
ss

Urinate
Urinate
at
atnight
night
Benign Prostatic Hyperplasia

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2
2
month
month
s ago
s ago
Difficult to
Difficult
urinate to
urinate

Diagnosed
as BPH

administer
edadminister
to RSUD
ed
to RSUD
Prabumulih
Prabumulih

catheterize
d

Benign Prostatic Hyperplasia

administer
edadminister
to RSMH
ed to RSMH

Surgical
manageme
nt
18

History of Past Illnes

Stone found while urinating (-)
Hematuria (-)
Normal defecation
Catheterized 2 monts ago
Trauma (-).
DM and CVD (-)
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Physical Examination
General
Examination
Sensorium : Compos Mentis
BP
: 140/90 mmHg
PR
: 81 x/minute
RR
: 20 x/minute
Temp
: 36,4oC

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Local Examination
CVA
CVA Region
Region
Inspection
Inspection :: Bulging
Bulging (-)
(-)
Palpation
Palpation :: Both
Both ballotement
ballotement
(-)
(-)
Percussion:
Percussion: Both
Both CVA
CVA pain
pain (-)
(-)

External
External Genitalia
Genitalia
Inspection
Inspection :: there
there is
is no
no
urethra
urethra bloody
bloody discharge
discharge
and
and had
had been
been
circumcised.
circumcised. There
There is
is aa
urethra
urethra catheter
catheter No
No 16F.
16F.

Suprapubic
Suprapubic Region
Region
Inspection
Inspection :: Bulging
Bulging (-)
(-)
Palpation
Palpation :: Pain
Pain (-)
(-)

Rectal
Rectal Toucher
Toucher
Examination
Examination
TSA
TSA good
good
Prostate
Prostate enlargement
enlargement (+)
(+)
(the
(the prostates
prostates surface
surface is
is
flat
flat and
and its
its consistence
consistence is
is
rubbery),
rubbery), mucosa
mucosa good,
good,
feces
feces (+),
(+), blood
blood (-).
(-).

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Additional Examination

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Laboratory Examination
Examination

Normal
Range

Result

Hb(g/dl)

13,2-17,3

14,9

Ht (%)

43-49

41

Leucocytes (mm3)

4,5-11 x 103

7 x 103

BSS (mg/dl)

< 200

99

Ureum (mg/dl)

16,6-48,5

28

Creatinine (mg/dl)

0,7-1,2

1,31

Na (mEq/L)

135-155

145

K (mEq/L)

3,6-5,6

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USG of Abdomen
Abdomen
examination of
this patient
showed
enlargement of
the prostate
(3,55 x 3,59 x
4,22 cm) and the
other
organ(Ren,
Liver,
gallbladder,
lien/pancreas)
were normal

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Diagnosis
Benign
Prostatic
Hyperplasia

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Treatment

Pro TURP

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Prognosis

Fungsionam : Dubia
Vitam
: Dubia ad Bonam

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THANK YOU

Thank You
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I
P
S
S

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Rectal Exam
Danger Signs on RE

Firm to hard nodules

Irregularities, unequal
lobes

Induration

Stony hard prostate

Any palpable nodular

abnormality suggests
cancer

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watchful

waiting

Minimal
Minimal
symptom
symptom
s
s

Avoiding
Avoiding
fluid
at
fluid
night at
night

Watchfu
Watchfu
l
l
waiting
waiting

Fu once
once
aFu
year
a year

Avoid
Avoid
caffeine
caffeine
and
and
alcohol
alcohol
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Medication

5
reductas
e
inhibitor
1
adrener
gic
blockers

blocks the conversion

of testosterone to
dihydrotestosteron

Relax the smooth

muscle of prostate

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TURP

(Transurethral Resection Of The

Prostate)
Gold Standard of care
for BPH

n
n

Uses an electrical knife

to surgically cut and
remove excess prostate
tissue
Effective in relieving
symptoms and restoring
urine flow
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TRUS

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PSA

>10
>10ng/ml
ng/ml

50% chance of
Ca
20% chance of
Ca

4-10
4-10
ng/ml
ng/ml

Normal

0,5-4
0,5-4
ng/ml
ng/ml

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