BAB I PRESENTASI KASUS BENIGN PROSTATE HYPERPLASIA
I.1
I.2
Identitas
Nama
: Tn. S
Umur
: 68 tahun
Jenis kelamin
: Laki-laki
Alamat
: Jombang Gardu RT 01/RW 09, Cilegon
Tanggal masuk
: 28 Febuari 2011
No. CM CM
: 72 71 71 18
Anamnesis
Autoanamnesis dan alloanamnesis A. Kelu Keluha han n uta utama ma
: Pas Pasien ien meng mengel eluh uh nyer nyerii pada pada saat saat bua buang ng air kecil kecil
B. Keluhan Keluhan tambahan tambahan : Buang air kecil kecil harus mengedan mengedan,, sering tidak tuntas, menetes dan terasa sakit, buang air kecil menjadi lebih sering, dan tampak benjolan pada daerah pubis
C. Riwayat penyakit penyakit sekarang : Pasien datang ke Poli Bedah RSUD Cilegon dengan keluhan gejala nyeri setiap kali buang air kecil. Pasien menyatakan pertama kali dirasakan sejak 1 tahun yang lalu. Pasien mengeluh harus mengedan agar air kencingnya keluar, selain itu pasien merasakan buang air kecil tidak tuntas atau tidak puas. Pasien menyatakan gejala yang dirasakan menjadi bertambah, bertambah, pasien pasien merasa merasa BAK menjadi menjadi lebih sering sering dan dan air kencing kencing yang keluar menetes dan terasa sakit. Pada daerah pubis tampak benjolan dan tidak nyeri apabila di tekan. Gejala ini tanpa disertai dengan demam.
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D. Riwayat Riwayat penyak penyakit it dahu dahulu lu : •
Pasien tidak pernah mengalami penyakit seperti ini sebelumnya
•
Riwayat pernah kencing mengeluarkan batu disangkal
•
Riwa Riwayat yat pern pernah ah nyeri nyeri buan buang g air kecil kecil dise diserta rtaii buang buang air kecil kecil
berwarna kemerahan kemerahan disangkal disangkal •
Pasien memiliki riwayat hipertensi
•
Riwayat DM dan jantung disangkal
E. Riwa Riwaya yatt penya penyakit kit kel kelua uarga rga : Pasi Pasien en meny menyan angk gkal al bahw bahwaa dala dalam m kelu keluar arga gany nyaa ada ada yang yang pern pernah ah mengalami keluhan seperti dia.
I.3
Pemeriksaan Fisik
A. Kead Keadaa aan n umum umum
: tamp tampak ak saki sakitt seda sedang ng
B. Ke Kesadaran
: compos mentis
C. Vital sign −
−
Tekanan darah
: 130/90 mmHg
Nadi
: 84 x/menit x/menit
−
Pernafasan
−
Suhu
: 20 x/menit : 36,5 º C
D. Statu Statuss Gene General ralisa isata ta −
Kepala
: normocephal
−
Mata
: co conjungtiva an anemis ((-/-), sk sklera ik ikterik ((-/-),
pupil bulat isokor, reflek cahaya (+/+) −
Hidu Hidung ng
: Tida Tidak k ada ada pern pernafa afasa san n cupin cuping g hid hidun ung, g, muko mukosa sa tidak tidak hiperemis, sekret tidak ada, tidak ada deviasi septum
−
Telin Telinga ga
−
Mulut
: Sime Simetri tris, s, tidak tidak ada ada kelain kelainan an,, oto otore re (-/-) (-/-) : Bibir tidak sianosis, gusi tidak ada perdarahan, lidah
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Leher
: Ti Tidak ad ada de deviasi tr trakhea, ti tidak ad ada pe pembesaran kelenjar tiroid dan getah bening, JVP tidak meningkat −
•
Thorax
Paru-paru : Inspeksi
: Bentuk dan pergerakan pernafasan kanan-kiri simetris
Palpasi
: Fremitus taktil simetris kanan-kiri
Perkusi
: Sonor pada kedua lapang paru
Auskultasi
: Su Suara na nafas vesikuler pa pada se seluruh la lapangan paru, wheezing wheezing (-/-), ronkhi ronkhi (-/-)
•
Jantung : Inspeksi
: Ictus cordis tidak terlihat
Palpasi
: Ictus cordis tidak teraba.
Perkusi
: Batas atas sela iga III garis mid klavikula kiri Batas kanan sela iga V garis sternal kanan Batas kiri sela iga V garis midklavikula kiri
Auskultasi
−
: Bunyi jantung I – II murni, murmur (-)
Abdomen : Inspeksi
: Perut datar simetris.
Palpasi
: Hepar dan Lien tidak membesar, nyeri tekan epig epigas astr triu ium m
(+), (+),
nyer nyerii
Lepa Lepass
muskuler (-) Perkusi Auskultasi
−
: Timpani : Bising usus (+) normal
Ekstremitas Superior Inferior
: Sianosis (-), oedem (-), ikterik (-) : Sianosis (-), oedem (-), ikterik (-) (-)
(-), (-),
defan efanss
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E. Stat Status us Loka Lokali liss Regio Costovertebra Costovertebra - Inspeksi
: Bentuk pinggang simetris, benjolan (-)
- Palpasi
: Bimanual Ballotement ginjal (-)
- Pe Perkusi
: Nyeri Ketok (-)
Regio Supra Pubis - Inspeksi
: Terdapat rambut pubis, tidak ada benjol jolan
- Palpasi
: Nyeri Tekan (-), Nyeri Lepas (-), Defance Muscular (-)
- Perkusi
: Timpani
- Auskultasi
: Bising Usus (+) Normal
Regio Genetalia Eksterna Eksterna - Inspeksi
: Orifisium uretra eksterna baik
- Palpasi
: Testis teraba dua buah, kanan dan kiri. Konsistensi Kenyal.
Regio Anal - Inspeksi
: Bentuk Normal, benjolan(-)
- Rectal Rectal Touche Toucherr : Sfingte Sfingterr Ani Ani Menjepi Menjepitt Pada mukosa teraba massa yang konsistensinya kenyal, permukaan permukaan sedikit tidak rata, batas tegas, puncak agak sulit dicapai. Tidak teraba nodul - Hands ndscoo coon
: Darah rah, len lendir dan fes feses tid tidak ada ada
F. Peme Pemerik riksa saan an penu penunja njang ng Laboratorium ( tanggal 28 Febuari 2011 ) Hb
: 13,1 g/dl
Ht
: 40 %
Leukosit
: 8 640/ul
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I.4
Masa pembekuan
: 10’
Golongan darah
: B/Rh +
Gluko lukosa sa darah arah sew sewaktu aktu
: 111 111 mg/d mg/dll
SGOT
: 24 u/l
SGPT
: 11 u/l
Ureum
: 43 mg/dl
Kreatinin
: 1,0 mg/dl
Asam urat
: 3,9 mg/dl
HbsAg
: non-reaktif
Resume
A. Anamnesis Pasien laki-laki berumur 68 tahun datang dengan keluhan : −
Nyeri pada pada saat buang buang air air kecil
−
Keluhan dirasakan sudah satu tahun yang lalu
−
Pasien harus mengedan agar air kencingnya keluar
−
Pasien merasakan buang air kecil tidak tuntas atau tidak puas
−
Pasien merasa BAK menjadi lebih sering dan air kencing yang keluar menetes dan terasa sakit
−
Pada daerah pubis tampak benjolan dan tidak nyeri apabila di tekan
−
Tanpa disertai dengan demam
B. Peme Pemerik riksa saan an fisik fisik Status generalisata
: dalam batas normal
Status lokalis - Regio Costovertebra
: Tidak Ada Kelainan
- Regio Suprapubis
: Tidak Ada Kelainan
- Regio Genetalia Eksterna : Tidak ada kelainan - Regio Anal Rectal Toucher
: Tonus Sfingter ani (+), pada mukosa teraba
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Handscoon
I.5
: Darah, lendir dan feses tidak ada
Diagnosis Ke Kerja
Benign prostat hiperplasia
I.6
Diagnosis Banding
- Striktur urethra - Karsinoma prostat - Prostatitis
I.7
Terapi
Operatif : Prostatektomi
I.8
I.9
Prognosis
Quo ad vitam
: Dubia ad bonam
Quo ad func functi tio onam nam
: Du Dubia bia ad ad bo bonam nam
Laporan ran Op Opera erasi ( 01 Ma Maret 20 2011 )
Diagnosis pre-operasi
: BPH
Diagnosis post-operasi: BPH Tehnik operasi
: Open prostatektomi
Follow Up 28 Febuari 2011
s/ - pasien mengeluh nyeri pada saat buang air kecil - pasien mengeluh buang air kecil sedikit ( tidak puas ) dan tidak ada keluar batu - pasien selalu mengedan pada saat buang air kecil o/ - Tekanan nan dar daraah - Nadi P
:13 :130/90 /90 mm mmHg : 84 x/menit
f
20 /
it
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- KS
: CM
Status lokalis pubis Ins Inspeks peksii
: tam tamp pak benj benjol olan an pada pada pubi pubiss
Palp Palpas asii
: Nyer Nyerii teka tekan n (-), (-), kon konsi sist sten ensi si ken kenya yal, l, bat batas as teg tegas as,, immo immobi bile le
a/ Pre-op BPH th/ IVFD 20 tpm
01 Maret 2011
s/ - pasien mengeluh nyeri pada luka operasi - pusing (+), mual (+), muntah (+) 10x/hari berisi makanan+lendir - nafsu makan menurun, DC 3 way (+), drainase (+), irigasi (+) o/ - Tekanan nan dar daraah
:15 :150/90 /90 mm mmHg
- Nadi
: 84 x/menit
- Pernafasan
: 20 x/menit
- Suhu
: 36 º C
- KU
: sedang
- KS
: CM
Status lokalis pubis Insp Inspek eksi si
: tamp tampak ak luk lukaa ditu ditutu tupi pi ole oleh h verb verban and, d, rem rembe besa san n darah darah (-) drainase (+), DC 3 way (+), urine jernih, irigasi (+) jernih dan lancar
Palpa alpassi
: Nye Nyeri ri teka tekan n (+ (+) pad padaa dae daera rah h lu luka ope operasi rasi
a/ post-op BPH ( H+1) th/ - IVFD RL 28 tpm
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- Nadi
: 84 x/menit
- Pernafasan
: 20 x/menit
- Suhu
: 36 º C
- KU
: sedang
- KS
: CM
Status lokalis pubis Insp Inspek eksi si
: tamp tampak ak luk lukaa ditu ditutu tupi pi ole oleh h verb verban and, d, rem rembe besa san n darah darah (-) drainase (+), DC 3 way (+), urine jernih, irigasi (+) jernih dan lancar
Palpa alpassi
: Nye Nyeri ri teka tekan n (+ (+) pad padaa dae daera rah h lu luka ope operasi rasi
a/ post-op BPH ( H+2 ) th/ - IVFD RL 28 tpm - Pelastin 2 x 1 ( ST ) - Remopain 3 x 1 - Kalnex 3 x 1 - Vit.K 3 x 1
04 Maret 2011
s/ - pasien mengeluh pusing tetapi sudah berkurang - mual (-), muntah (-) o/ - Tekanan nan dar daraah
:14 :140/90 /90 mm mmHg
- Nadi
: 80 x/menit
- Pernafasan
: 20 x/menit
- Suhu
: 36 º C
- KU
: sedang
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BAB II TINJAUAN PUSTAKA BENIGN PROSTATE HYPERPLASIA ( BPH )
Pendahuluan
Kelenjar prostat merupakan organ tubuh pria yang paling sering mengalami pembesaran, pembes aran, baik baik jinak maupu maupun n ganas. ganas. Dengan Dengan bertambahn bertambahnya ya usia, usia, kelenjar kelenjar prostat prostat juga mengalami pertumbuhan, sehingga menjadi lebih besar. Pada tahap usia tertentu banyak pria mengalami pembesaran prostat yang disertai gangg gangguan uan buang air kecil. Gejala ini merupakan tanda awal Benign Prostatic Hyperplasia (BPH). Pembesaran kelenjar prostat mempunyai angka morbiditas yang bermakna pada populasi popula si pria lanjut lanjut usia. usia. Hiperplasia Hiperplasia prostat prostat sering sering terjadi terjadi pada pria pria diatas usia 50 tahun (50-79 (50 -79tahu tahun) n) dan men menyeb yebabk abkan an pen penuru urunan nan kua kualita litass hid hidup up ses seseora eorang. ng. Sebe Sebenarn narnya ya perubahan-peru peruba han-perubahan bahan kearah terjadiny terjadinyaa pembe pembesaran saran prostat sudah dimula dimulaii sejak dini, dimulai dim ulai pad padaa peru perubah bahan-p an-peru erubah bahan an mik mikros roskop kopik ik yan yang g kem kemudi udian an ber berman manifes ifestasi tasi menjadi kelainan makro makroskopik skopik (kelenjar membe membesar) sar) dan kemud kemudian ian bermani bermanifes fes denga dengan n gejala klinik. Dengan adanya hiperplasia ini akan menyebabkan terjadinya obstruksi saluran kemih dan untuk mengatasi obstruksi ini dapat dilakukan berbagai cara mulai dari tindakan yang paling ringan yaitu secara konservatif (non operatif) sampai tindakan yang paling berat yaitu operasi.
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I.
Definisi
Benign Prostate Hyperplasia (BPH) sebenarnya adalah suatu keadaan dimana kelenjar periuretral prosta prostatt menga mengalami lami hiperplasia yang akan mendesak jaringan prosta prostatt yang asli ke perifer perifer dan menjadi simpa simpaii bedah.
II.
Anatomi dan Fisiologi Anatomi
Prostat merupakan kelenjar berbentuk konus terbalik yang dilapisi oleh kaps kapsul ul fibro fibromu musk skule ulerr, yang yang terlet terletak ak di sebel sebelah ah infer inferio iorr vesik vesikaa urina urinaria ria,, meng mengel elili iling ngii bagi bagian an prok proksi simal mal uretra uretra (uret (uretra ra pars pars prosta prostatik tika) a) dan dan berad beradaa disebelah disebelah anterior rektum. Bentuknya Bentuknya sebesar sebesar buah kenari dengan berat normal pada orang dewasa kurang lebih 20 gram, dengan dengan jarak basis ke apex kurang lebih 3 cm, lebar yang paling jauh 4 cm dengan tebal 2,5 cm.
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homogen berwarna abu-abu, dengan kista kecil berisi cairan seperti susu, kista ini disebut kelenjar prostat.6 Mc Neal (1976) membagi kelenjar prostat dalam beberapa zona, antara lain adalah: zona perifer, zona sentral, zona transisional, zona fibromuskuler anterior, dan zona periuretral. Sebagian besar hiperplasia prostat terdapat pada zona transisional yang letaknya proksimal dari sfincter eksternus di kedua sisi dari dari verum verumon ontan tanum um dan dan di zona zona periu periuret retral ral.. Kedu Keduaa zona zona terseb tersebut ut hany hanyaa merupakan 2% dari seluruh volume prostat. Sedangkan pertumbuhan karsinoma prostat prostat berasal dari dari zona perifer. perifer.
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Prostat mempunyai kurang lebih 20 duktus yang bermuara di kanan dari verumontanum dibagian posterior dari uretra pars prostatika. Di sebelah depan dida didapa patk tkan an ligam ligament entum um pubo pubo pros prostat tatika ika,, di sebe sebelah lah bawa bawah h ligame ligamentu ntum m triangulare inferior dan di sebelah belakang didapatkan fascia denonvilliers. Fascia denonvilliers terdiri dari 2 lembar, lembar depan melekat erat dengan prostat dan vesika seminalis, sedangkan lembar belakang melekat secara longgar dengan fascia pelvis dan memisahkan prostat dengan rektum. Antara fascia endopelvic dan kapsul sebenarnya dari prostat didapatkan jaringan peri prostat prostat yang berisi pleksus pleksus prostatovesikal prostatovesikal..
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Pada BPH, kapsul pada prostat terdiri dari 3 lapis : 1. kaps kapsul ul anato anatomi miss 2. kaps kapsul ul chiru chirurg rgicu icum, m, ini ini terja terjadi di akiba akibatt terje terjepit pitnya nya kelen kelenjar jar pros prostat tat yang yang sebenarnya (outer zone) sehingga terbentuk kapsul 3. kapsul kapsul yang terbentuk terbentuk dari jaringan jaringan fibromuskuler fibromuskuler antara bagian bagian dalam (inner
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Vaskularisasi
Vaskular askularisas isasii kelenjar kelenjar prostat prostat yanng yanng utama utama berasal berasal dari a. vesikali vesikaliss inferior (cabang dari a. iliaca interna), a. hemoroidalis media (cabang dari a. mesenterium inferior), dan a. pudenda interna (cabang dari a. iliaca interna). Cabang-cabang dari arteri tersebut masuk lewat basis prostat di Vesico Prostatic Junction. Junction. Penyebaran arteri di dalam prostat dibagi menjadi 2 kelompok , yaitu: 1. Kelomp Kelompok ok arteri arteri urethra, urethra, menemb menembus us kapsul kapsul di poster postero o lateral lateral dari darivesico prostatic prostatic junction dan dan memb member erii perd perdar arah ahan an pada pada lehe leherr buli buli-b -bul ulii dan dan kelompok kelenjar periurethral. 2. Kelompok Kelompok arteri kapsule, kapsule, menembus menembus sebelah lateral dan memberi memberi beberapa beberapa cabang yang memvaskul memvaskularisasi arisasi kelenjar kelenjar bagian perifer (kelompok (kelompok kelenjar paraurethral). paraurethral).
Aliran Limfe
Aliran limfe dari kelenjar prostat membentuk membentuk plexus di peri prostat prostat yang kemudian bersatu untuk membentuk beberapa pembuluh utama, yang menuju ke kelenjar limfe iliaca interna , iliaca eksterna, obturatoria dan sakral.
Persarafan
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Hipe Hi perpl rplasi asiaa pr pros ostat tat me meru rupa paka kan n pe peny nyak akit it pa pada da pr pria ia tu tuaa da dan n jar jaran ang g ditem dit emuk ukan an se sebe belu lum m us usia ia 40 ta tahu hun. n. Pr Pros ostat tat no norma rmall pa pada da pr pria ia me meng ngala alami mi peningkatan pening katan ukuran yang lambat dari lahir sampai puber pubertas, tas, waktu itu ada peningkatan pening katan cepat dalam ukuran ukuran,, yang kontin kontinyu yu sampa sampaii usia akhir 30-an. Pertengahan dasawarsa ke-5, prostat bisa mengalami perubahan hyperplasia. Pada Pa da us usia ia la lanj njut ut be bebe bera rapa pa pr pria ia me meng ngal alam amii pe pemb mbes esar aran an pr pros osta tatt benigna. benig na. Keadaan Keadaan ini dialami oleh 50% pria yang berusia 60 tahun dan kurang lebih 80% pria yang berusia 80 tahun.
IV.
Etiologi
Hing Hingga ga seka sekara rang ng masi masih h belu belum m dike diketa tahu huii seca secara ra past pastii peny penyeb ebab ab terjadinya terjadinya hiperplasia hiperplasia prostat, prostat, tetapi beberapa hipotesis hipotesis menyebutkan menyebutkan bahwa hiperplasia
prostat
erat
kaitannya
dengan
peningkatan
kadar dehidrotestosteron kadar dehidrotestosteron (DHT) dan proses aging (menjadi tua). Beberapa teori atau hipotesis yang diduga sebagai penyebab timbulnya hiperplasia prostat adalah: 1. Teori eori Hormo Hormonal nal
Deng Dengan an berta bertamb mbah ahny nyaa usia usia akan akan terjad terjadii perub perubaha ahan n kese keseim imba bang ngan an hormo hormonal, nal, yaitu yaitu antara antara hormon hormon testoste testosteron ron dan hormon hormon estroge estrogen. n. Karena Karena
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dari fungsional fungsional histologis, prostat terdiri dari dua bagian yaitu sentral sekitar uretra yang bereaksi terhadap estrogen dan bagian perifer yang tidak bereaksi terhadap estrogen.
Factor (Faktor Pertumbuhan) 2. Teori Growth Factor (Faktor
Peranan Peranan dari gro dari growth wth factor ini factor ini sebaga sebagaii pemacu pemacu pertumb pertumbuha uhan n stroma stroma kele kelenja njarr pros prostat tat.. Terda erdapat pat empat empat peptic growth growth factor yaitu: basic tra transfo nsform rmin ing g
growth
fact facto or,
tran ransform formin ing g
growth
facto actor r 1,
transforming growth growth factor 2, dan epidermal growth factor .
3. Teori peningkat peningkatan an lama hidup sel-sel sel-sel prostat prostat karena berkurangn berkurangnya ya sel yang mati
(stem cell hypothesis) hypothesis) 4. Teori Sel Stem (stem
Seperti pada organ lain, prostat dalam hal ini kelenjar periuretral pada seorang dewasa berada dalam keadaan keseimbangan “ steady “ steady state”, state”, antara pertumbuhan pertumbuhan sel dan sel yang mati, keseimbanga keseimbangan n ini disebabkan disebabkan adanya kadar testosteron tertentu dalam jaringan prostat yang dapat mempengaruhi sel stem sehingga dapat berproliferasi. Pada keadaan tertentu jumlah sel stem
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Pada berbagai penelitian dikatakan bahwa kadar DHT pada BPH tidak jauh berbeda berbeda dengan dengan kadarnya kadarnya pada prostat prostat normal, normal, hanya pada BPH, BPH, aktivitas enzim 5α-reduktase dan jumlah reseptor androgen lebih banyak pada BPH. Hal ini menyebabkan sel-sel prostat pada BPH lebih sensitif terhadap DHT sehingga replikasi sel lebih banyak terjadi dibandingkan dengan prostat normal. Testoste estosteron ron yang yang dihasilk dihasilkan an oleh oleh sel leydig leydig pada pada testis testis (90%) (90%) dan
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perkembanga perkem bangan n pada masa tingkat embriologik, embriologik, sehingga jaringan periuretral dapat tumbuh lebih cepat dari jaringan sekitarnya. Selain Sela in teo teori-te ri-teori ori di atas masih ban banyak yak lag lagii teo teori ri yan yang g me menera nerangk ngkan an tentang penyebab terjadinya BPH seperti; teori tumor jinak, teori rasial dan faktor fakt or sos sosial, ial, teor teorii infe infeksi ksi dari zatzat-zat zat yan yang g bel belum um dik diketah etahui, ui, teo teori ri yan yang g berhubunga berhub ungan n dengan aktifitas hubun hubungan gan seks, teori pening peningkatan katan kolester kolesterol, ol, dan da n Zn ya yang ng ke kesem semua uany nyaa ter terse sebut but ma masi sih h be belu lum m jel jelas as hu hubu bung ngan an seb sebab ab-akibatnya.
V.
Patofisiologi
Pada BPH terdapat dua komponen yang berpengaruh untuk terjadinya gejala yaitu komponen mekanik dan komponen dinamik. Komponen mekanik ini ber berhub hubung ungan an den dengan gan ada adanya nya pem pembes besaran aran kele kelenjar njar peri periure uretra tra yan yang g aka akan n
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buli-buli buli-bu li ke ureter atau terjadi refluks vesico vesico-ureter -ureter.. Keadaan ini jika berlangsung berlang sung terus akan menga mengakibatka kibatkan n hidrou hidroureter reter,, hidron hidronefrosis efrosis,, bahka bahkan n akhirnya dapat jatuh ke dalam gagal ginjal.
VI.
Gambaran Klinis
Gejala Gejala hiperpla hiperplasia sia prostat prostat dapat dapat menimb menimbulk ulkan an keluhan keluhan pada pada saluran saluran kemih maupun keluhan di luar saluran kemih. 1. Gejala pada saluran kemih bagian bawah
Keluhan pada saluran kemih sebelah bawah ( LUTS ( LUTS ) terdiri atas gejala obst obstruk ruktif tif dan dan gejal gejalaa iritat iritatif. if. Gejal Gejalaa obst obstruk ruktif tif diseb disebabk abkan an oleh oleh karen karenaa penyempitan penyempitan uretara pars prostatika prostatika karena didesak didesak oleh prostat yang membesar dan kegagalan otot detrusor untuk berkontraksi cukup kuat dan
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Gejala iritatif disebabkan disebabkan oleh karena pengosongan pengosongan vesica urinaria yang tidak tidak sempur sempurna na pada pada saat miksi miksi atau diseba disebabka bkan n oleh oleh hipersen hipersensiti sitifitas fitas otot otot detrus detrusor or karena karena pembes pembesaran aran prostat prostat menyeb menyebabk abkan an rangsa rangsanga ngan n pada pada vesica, vesica,
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sedangkan keluhan yang menyangkut kualitas hidup pasien diberi nilai dari 1 hingga 7. Dari skor I-PSS itu dapat dikelompokkan gejala LUTS dalam 3 derajat, yaitu: - Ringan : skor 0-7 - Sedang : skor 8-19 - Berat : skor 20-35 Timbulnya gejala LUTS merupakan menifestasi kompensasi otot vesica urinaria untuk mengeluarkan urin. Pada suatu saat otot-otot vesica urinaria akan mengalami kepayahan (fatique) sehingga jatuh ke dalam fase dekompensasi yang diwujudkan dalam bentuk retensi urin akut. Faktor pencetus Kompensasi Dekompensasi (LUTS) Retensi urin
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dapat menahan untuk berkemih berkemih
e. Beraapa kali terjadi arus lemah sewaktu memulai kencing
0
1
2
3
4
5
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2. Gejala pada saluran kemih bagian atas
Keluhan akibat penyulit hiperplasi prostat pada saluran kemih bagian atas berupa gejala obstruksi obstruksi antara lain nyeri pinggang, pinggang, benjolan di pinggang pinggang (yang merupa merupakan kan tanda tanda dari hidron hidronefro efrosis sis)., )., atau demam demam yang yang merupa merupakan kan tanda tanda dari infeksi atau urosepsis.
3. Gejala di luar saluran kemih
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2.
Urin : •
Kultur urin + sensitifitas test
•
Urinalisis dan pemeriksaan mikroskopik
•
Sedimen
Sedime Sedimen n urin diperik diperiksa sa untuk untuk mencari mencari kemung kemungkin kinan an adanya adanya proses proses
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tulang
dari
carsinoma
prostat.
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Apabila Apabila penderi penderita ta sudah sudah dipasan dipasang g kateter kateter oleh oleh karena karena retensi retensi
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Angka normal laju pancaran urin ialah 10-12 ml/detik dengan
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•
derajat 3 : penonjolan 2-3 cm ke dalam rektum
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•
Derajat empat, apabila sudah terjadi retensi urin total.
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