BENIGN PROSTATE

HYPERPLASIA (BPH)

Disusun Oleh :
Ferji Rhenald Arditya
1061050010
Pembimbing :
dr. Ruyandi Hutasoit, Sp.U
KEPANITERAAN KLINIK ILMU BEDAH
FAKULTAS KEDOKTERAN
UNIVERSITAS KRISTEN INDONESIA
Periode 25 Juli 27 Agustus 2016
JAKARTA

Introduction
Lower Urinary Tract consist of vesica urinaria and uretra.

Function of lower urinary tract : storage and voiding urine

Failure function of lower urinary tract can cause lower urinary tract
symptoms

These symptoms have widespread human and social implications, causing discomfort,
shame and loss of self-confidence

Prevalence LUTS at UK and Sweden are men 72,3% and women 76,3%

Age > 40 years

Urinary Tract anatomy

Production, storage and avoid

the urine

Consist of renal, ureter, vesica

urinaria and uretra.

Renal: filtration

Ureter: voiding urine from

pielum to vesica urinaria.
Ureter wall consist of
trantitional cell mocous,
circular smooth muscle and
longitudinal smooth muscle.

Lower Urinary Tract

anatomy

Vesica urinaria: 3 layers of

detrussor muscle;
longitudinal muscle, circular
muscle, and longitudinal
muscle.

Mucosa of vesica : trantitional

cell

Uretra: Sphincter uretra

interna (smooth muscle)

Woman: uretra 3-5 cm

Man : uretra ....

Micturition
MicturitionProcess
Process

Lower Urinary Tract

Symptoms
Consist of:
Storage/iritation symptoms
Voiding/obstruction symptoms
Post-micturition Symptoms

Storage

Urgency
Frecuency
Nokturia
Disuria
Slow stream

LUTS

Voiding

Intermittency
Hesitancy
Straining

Post-micturition

post-micturition dribble
a feeling of incomplete emptying
bladder

Patofisiology

LUTD

LUTS

Pathofisiology
Storage dysfunction

Bladder overactivity (involuntary contraction or

decreased compliance) and decreased outlet
resistance may cause absolute or relative
failure of the bladder to store urine adequately.

Pathofisiology
Storage dysfunction

Storage
disfunction

Overactivity
Bladder
Bladder Outlet
Underactivity

Bladder Neck
Hypermobility
Intrinsic
Sphincter
Deficiency

Pathofisiology
Storage dysfunction

1.
.

Overactivity Bladder
Alterations in nerve and smooth muscle
excitability and changes in bladder urothelium
composed of neurotransmitters, sensory receptors,
and specific ion channels.

. Bladder-related

storage failure may also occur in the

absence of overactivity because of increased
afferent input from inflammation, irritation, other
causes of hypersensitivity, and pain. The causes may
be chemical, psychologic, or idiopathic

Pathofisiology
Storage dysfunction

2. Bladder Outlet Underactivity

urethra supported by the action of the levator
ani muscles through their connection to the
endopelvic fascia of the anterior vaginal wall.

Damage to the connection between this fascia and this

muscle, damage to the nerve supply, or direct
muscle damage can therefore influence continence.

Pathofisiology
Emptying/Voiding Dysfunction

Absolute or relative failure to empty

the bladder results from decreased
bladder contractility (a decrease in
magnitude or duration), increased
outlet resistance, or a combination.

Emptying/Voiding Dysfunction
1.

Detrusor Underactivity

failure of bladder contractility may result from failure or

impairment in one of the neuromuscular mechanisms for
initiating and maintaining a normal detrusor contraction.
Inhibition of the voiding reflex in a neurologically; it may be
by a reflex mechanism secondary to increased afferent
input, especially from the pelvic and perineal areas, or
may be psychogenic

 Non-neurogenic

causes also include

impairment of bladder smooth muscle
function, which may result from
overdistention, various centrally or
peripherally
acting
drugs,
severe
infection, or fibrosis.

Emptying/Voiding Dysfunction
2. Bladder Outlet Overactivity or Obstruction
failure of relaxation or active contraction of the striated
or smooth sphincter during bladder contraction.
Striated sphincter dyssynergia is other common cause of
functional or nonanatomic (as opposed to fixed anatomic)
obstruction in patients with neurologic disease or injury.
A common cause of outlet obstruction in the female is
compression or fibrosis following surgery for sphincteric
incontinence

Pathofisiology
Post Micturition Symptoms

Postvoid dribbling: involuntary leakage of

urine immediately after voiding.
Vesicovaginal reflux whereby urine is
trapped in the vagina during voiding, and
once stands the urine begins to dribble out.

In women, incomplete emptying was more

common.

Risk Factor

Age
Pregnancy/child birth (especially the
first delivery)
Overweight

Diagnostic Measure

Anamnesis
information concerning
previous pregnancy and
delivery, pathological
conditions, surgical
interventions, radiotherapy to
the pelvic region, neurological
diseases and previous trauma.

Diagnostic Measure
Neurogical exam
anal sphincter tonus
Serious and progresive Consultation
to neurologist

Urine Examination
A simple urinary test should be included
in the basic investigation to exclude
urinary tract infection and detect
haematuria.

Diagnostic Measure
Post-voiding residual volume
Post-voiding residual volume is
measured either with a catheter
post micturition or by a bladder
scan. This investigation is
important to exclude possible
urinary retention.

Diagnostic Measure
UrethrocystUrography, computer tomography
and/or ultrasoundoscopy
indicated when there is a macroscopic bleeding from the
urinary tract, when a tumor is suspected or to check the
upper urinary tract in the case of bladder outlet
obstruction.

Cystometry
Through fine catheters inserted in the bladder and vagina
or rectum the intravesical and intra-abdominal pressures
can be measured during filling and micturition.

Management

Behavioural
treatment

life-style
modification
s such as
weight loss
and smoke
cessation

Pelvic Floor
Muscle Training
(PFMT)

A training
programme should
always be
introduced by a
physiotherapist or
urotherapist and
should include
instructions to
correctly identify
the pelvic floor
muscles

Pharmacologica
l treatment

Surgical
treatment

Estrogen
substitution

Correction of
urethral
hypermobility

Antikolinergik/
antimuscarinic

Duloxetine
Desmopressin

strengthening
the urethral
support
Strengthening
the intrinsic
sphincter
mechanism

Thank You