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PEMBESARAN PROSTAT
JINAK
ARRY RODJANI
DEPARTEMEN UROLOGI
FKUI / RSCM
JAKARTA
Initial evaluation of LUTS
Urologist GP Family
practitioner
US 37% 25% 24%
France 25 30% 65 75%
Italia Most
UK Most
German 50% 50%
1. History 1. Uroflowmetry
2. I-PSS & QoL 2. Residual urine
3. Physical examination 3. Urodynamic
and DRE 4. Imaging of the
4. Urinalysis & serum prostate byTAUS or
creatinin TRUS
5. Serum PSA 5. Imaging of the upper
6. Voiding diary UT by USG or IVU
6. endoscopy of the
lower UT
(International Consultation BPH, 2000)
Anamnesis
Operasi / trauma / batu sal kemih
Penyakit menular seksual
Penyakit susunan syaraf pusat
DM
Disfungsi ereksi
Pemakaian obat yang mempengaruhi otot
detrusor
ISK, hematuria, retensio urin
Symptoms associated with BPH
Voiding symptoms Storage symptoms
Hesitancy Frequency
Straining Urgency
Weak stream Nocturia
Intermittency Urge incontinence
Terminal dribbling Nocturnal incontinence
Prolong voiding Small voided volume
Urinary retention Pain
Overflow incontinence
Note: all the symptom may occur in conditions other than BPH. The symptoms
may occur in all combinations and usually not all symptoms are present in the
individual patient.
Penyebab LUTS
Kelainan struktural atau fungsional trak.
Urinarius bawah (buli, leher buli,
PROSTAT, mekanisme sfingter distal,
urethra)
QoL
senang sekali (=0) s/d buruk sekali (=6)
Pemeriksaan fisik
Umum
Neurologi
Urologi
Pemeriksaan fisik
Colok dubur
Tonus spingter ani
Reflek bulbo-cavernosus
Hemoroid / tumor
Prostat :
penonjolan prostat
konsistensi
nodul / tumor
nyeri tekan
Laboratorium
Urinalisa
Prostate Specific antigen (PSA)
Fungsi ginjal (ureum & kreatinin)
Lain-lain:
Gula darah
Kultur urin
Sitologi urin
Voiding diary
(frequency volume chart)
Pencatatan 3 X 24 jam
Sangat berguna bila nokturia dominan
Mengetahui kebiasaan berkemih
Membedakan nocturnal polyuria atau
excessive fluid intake
1. ISK berulang
2. Buli-buli teraba
3. RT: prostat abnormal
4. Menolak MM / WW
5. Hematuria mikro/makroskopis
6. PSA > 4 ng/ml
7. Gagal MM
8. Retensio urin berulang / menetap
9. Batu buli-buli
10. Renal insufisiensi
DIAGNOSTIC TESTS
Initial evaluation: Optional tests:
Recommended tests Urologic evaluation
1. History 1. Uroflowmetry
2. I-PSS & QoL 2. Residual urine
3. Physical examination 3. Urodynamic
and DRE 4. Imaging of the
4. Urinalysis prostate byTAUS or
5. Serum PSA TRUS
6. Voiding diary 5. Imaging of the upper
UT by USG or IVU
6. endoscopy of the
lower UT
(International Consultation BPH, 2000)
Uroflowmetry
Untuk mendapat data-data :
Volume BAK
Pancaran maksimum (Q max)
Pancaran rata-rata (Q ave)
Lama pancaran
Uroflowmetry
Residual urine
Sisa urin yang tertinggal dalam buli-buli setelah
berkemih
> 50 ml = abnormal
> 300ml= ret. Kronik