REFERAT BENIGN PROSTA PROSTAT HYPERPLASIA HYPERPLASIA (BPH) (BPH)
oleh : Rino Setiady, S.ked 406148064
Pembimbing : dr. Adi Purnomo, Sp.B dr. Suryo Aji, Sp.B
KEPANITERAAN KINIK I!" BE#AH R"!AH SAKIT BHA$ BH A$AN%KARA AN%KARA SE!ARAN% FAK"T FAK"TAS AS KE#&KTERAN KE#& KTERAN "NI'ERSITAS TAR"!ANA%ARA
#AFTAR ISI DAFTAR DAFTAR ISI........................................... ISI.................................................................. .............................................. ...................................................... ............................... .....i DAFTAR DAFTAR GAMBAR.................................... GAMBAR........................................................... .............................................. .............................................. ..............................ii .......ii BAB I PEDA!"#"A............................ PEDA!"#"A................................................... .............................................. ................................................. .......................... ....$ BAB II TI%A"A P"STA&A.......................... P"STA&A................................................. ....................................................................' .............................................' '.$ An()omi............................... An()omi...................................................... .............................................. .............................................. .......................................... ..........................' .......' '.' Fi*iologi.......................................... Fi*iologi................................................................. .............................................. .............................................. ......................................+ ...............+ '.+ Deini*i.......................... Deini*i................................................. .............................................. .............................................. ....................................................... ................................ '.- E)iologi......................................... E)iologi................................................................ .............................................. .......................................................................................................'. P()ologi........................................ P()ologi............................................................... .............................................. .............................................. ........................................./ ................../ './ M(nie*)(*i 0lini0......................................... 0lini0................................................................ .............................................. ............................................... ........................ 1 '.1 Pemeri0*((n Fi*i0......................................... Fi*i0................................................................ .............................................. ...............................................2 ........................2 '.3 Pemeri0*((n Penunj(ng................................... Penunj(ng.......................................................... .............................................. ..........................................$$ ...................$$ '.2 &ompli0(*i.................. &ompli0(*i......................................... .............................................. .............................................. ............................................... ........................ ........$ ........ $ '.$4 Pen()(l(0*(n((n....................... Pen()(l(0*(n((n.............................................. .............................................. .............................................. .........................................$/ ..................$/ BAB III &ESIMP"#A................................ &ESIMP"#A....................................................... .............................................. .................................................'/ ..........................'/ BAB I5 DATAR P"STA&A666666666666666666666666..'1
i
#AFTAR %A!BAR Al() Reprodu0*i Pri(............................................. Pri(.................................................................... .............................................. ........................................ .......................' ......' 7on( &elenj(r Pro*)().............................................. Pro*)()..................................................................... .............................................. ............................................+ .....................+ Benign Pro*)() !yperpl(*i(......................... !yperpl(*i(................................................ .............................................. .........................................................................................Pemeri0*((n 8olo0 Dubur.................................. Dubur......................................................... .............................................. .............................................. ........................$4 .$4 G(mb(r(n M(0ro*0opi* d(n Mi0ro*0opi* BP!......................................................... BP!.......................................................................$' ..............$' Si)o*0opi BP!.................................... BP!........................................................... .............................................. .............................................. ..................................... .................$+ ...$+ Sonogr(i Pro*)() orm(l........................................... orm(l.................................................................. .............................................. .......................................$+ ................$+ Sonogr(i BP!..................................... BP!............................................................ .............................................. ........................................................ ................................. .....$Ele9(*i D(*(r Buli y(ng Mengindi0(*i0(n BP!................................................. BP!......................................................................$.....................$Peni)r((n "SG norm(l d(n p(d( BP!........................................ BP!............................................................... ............................................$ .....................$ #o0(*i Re*ep)or (;Adrenergi0..................................... (;Adrenergi0............................................................ .............................................. ......................................$2 ...............$2 Miro<(9e Tr(n*ure)r(l.................................. Tr(n*ure)r(l......................................................... ......................................................................... .................................................. '4 Tr(n*ure)r(l %(rum Abl(*i In9(*i Minim(l...............................................................................'$ Minim(l...............................................................................'$ Thermo)her(pi Deng(n Air.................................... Air........................................................... .............................................. ............................................'$ .....................'$ Al(), 8(r( T"RP, T"RP, "re)r( pro*)()i( p(*( T"RP................................................... T"RP.................................................................... ..................'' .'' =pr(*i #(*er P(d( Pro*)().............................................. Pro*)()..................................................................... .............................................. ....................................'.............'In)er*)i)i(l l(*er 8o(gul()ion.................................... 8o(gul()ion........................................................... ........................................................... .................................... .....'Fo)o*ele0)i 5(por(*i (por(*i Pro*)().......................... Pro*)()................................................. .............................................. ...................................................' ............................'
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BAB I PEN#AH""AN
Pembe*(r(n pro*)() benign( ()(u lebih di0en(l *eb(g(i BP! *ering di)emu0(n p(d( pri( y(ng mem(*u0i u*i( l(nju). I*)il(h BP! ()(u benign prostatic hyperplasia *eben(rny( merup(0(n i*)il(h hi*)op()ologi*, y(i)u )erd(p() hiperpl(*i( *el;*el *)rom( d(n *el;*el epi)el 0elenj(r pro*)() Su()u peneli)i(n menyebu)0(n b(h<( pre9(len*i Benign( Pro*)() !iperpl(*i( >BP!? y(ng bergej(l( p(d( pri( beru*i( -4@-2 )(hun men(p(i h(mpir $. Ang0( ini mening0() deng(n ber)(mb(hny( u*i(, *ehingg( p(d( u*i( 4@2 )(hun pre9(len*iny( men(p(i h(mpir 4 d(n p(d( u*i( 34 )(hun men(p(i (ng0( *e0i)(r 34. Me*0ipun j(r(ng meng(n(m ji<(, BP! memberi0(n 0eluh(n y(ng menjeng0el0(n d(n mengg(nggu (0)i9i)(* *eh(ri;h(ri. &e(d((n ini (0ib() d(ri pembe*(r(n 0elenj(r pro*)() y(ng menyeb(b0(n )erj(diny( ob*)ru0*i p(d( leher buli;buli d(n ure)r( ()(u di0en(l *eb(g(i bladder outlet obstruction >B==?. =b*)ru0*i y(ng 0hu*u* di*eb(b0(n oleh pembe*(r(n 0elenj(r pro*)() di*ebu) *eb(g(i benign prostate obstruction >BP=?. =b*)ru0*i ini l(m( 0el(m((n d(p() menimbul0(n perub(h(n *)ru0)ur buli;buli m(upun ginj(l *ehingg( menyeb(b0(n 0ompli0(*i p(d( *(lur(n 0emih ()(* m(upun b(<(h. Ad(ny( BP! ini (0(n menyeb(b0(n )erj(diny( ob*)ru0*i *(lur(n 0emih d(n un)u0 meng()(*i ob*)ru0*i ini d(p() dil(0u0(n deng(n berb(g(i (r( mul(i d(ri )ind(0(n y(ng p(ling ring(n y(i)u *e(r( 0on*er9()i >non oper()i? *(mp(i )ind(0(n y(ng p(ling ber() y(i)u pembed(h(n. 8olo0 dubur ()(u digital rectal examina-tion >DRE? merup(0(n pemeri0*((n y(ng pen)ing p(d( p(*ien BP!, di*(mping pemeri0*((n i*i0 p(d( regio *upr(pubi0 un)u0 men(ri 0emung0in(n (d(ny( di*)en*i buli;buli. D(ri pemeri0*((n olo0 dubur ini d(p() diper0ir(0(n (d(ny( pembe*(r(n pro*)(), 0on*i*)en*i pro*)(), d(n (d(ny( nodul y(ng merup(0(n *(l(h *()u )(nd( d(ri 0eg(n(*(n pro*)(). &eurig((n *u()u 0eg(n(*(n p(d( pemeri0*((n olo0 dubur, )erny()( h(ny( '/;+- y(ng po*i)i 0(n0er pro*)() p(d( pemeri0*((n biop*i. Sen*i)ii)(* pemeri0*((n ini d(l(m menen)u0(n (d(ny( 0(r*inom( pro*)() *ebe*(r ++.
1
BAB II PE!BAHASAN I.
ANAT&!I PR&STAT &elenj(r pro*)() (d(l(h *(l(h *()u org(n geni)(li( pri( y(ng )erle)(0 di *ebel(h
inerior buli;buli d(n membung0u* ure)r( po*)erior. Pro*)() berben)u0 *eper)i pyr(mid )erb(li0 d(n merup(0(n org(n 0elenj(r ibromu*0uler y(ng mengelilingi ure)r( p(r* pro*)()i(. Bil( meng(l(mi pembe*(r(n org(n ini mene0(n ure)r( p(r* pro*)()i0( d(n menyeb(b0(n )erh(mb()ny( (lir(n urin 0elu(r d(ri buli;buli. Pro*)() merup(0(n 0elenj(r (0*e*ori )erbe*(r p(d( pri( )eb(lny( C ' m d(n p(nj(ngny( C + m deng(n leb(rny( C - m, d(n ber() '4 gr(m.
%aa* 1. A+at Re*od-ki P*ia
&elenj(r pro*)() )erb(gi ()(* lobu* : (. #obu* mediu* b. #obu* l()er(li* >' lobu*? . #obu* (n)erior d. #obu* po*)erior
P(d( 0elenj(r pro*)() jug( dib(gi d(l(m on( : (. 7on( An)erior ()(u 5en)r(l . Se*u(i deng(n lobu* (n)erior, )id(0 puny( 0elenj(r, )erdiri ()(* *)rom( ibromu*0ul(r. 7on( ini melipu)i *eper)ig( 0elenj(r pro*)(). b. 7on( Perier
2
Se*u(i deng(n lobu* l()er(l d(n po*)erior, melipu)i 14 m(**( 0elenj(r pro*)(). 7on( ini ren)(n )erh(d(p inl(m(*i d(n merup(0(n )emp() (*(l 0(r*inom( )erb(ny(0. . 7on( Sen)r(li*. #o0(*i )erle)(0 (n)(r( 0edu( du0)u* ej(0ul()oriu*, *e*u(i deng(n lobu* )eng(h melipu)i ' m(**( gl(ndul(r pro*)().7on( ini re*i*)en )erh(d(p inl(m(*i. d. 7on( Tr(n*i*ion(l. 7on( ini ber*(m(;*(m( deng(n 0elenj(r periure)r( di*ebu) jug( *eb(g(i 0elenj(r prepro*)()i0. Merup(0(n b(gi(n )er0eil d(ri pro*)(), y(i)u 0ur(ng lebih )e)(pi d(p() meleb(r ber*(m( j(ring(n *)rom( ibromu*0ul(r (n)erior menj(di benign pro*)()i hyperpi(*i( >BP!?. e. &elenj(r;&elenj(r Periure)r( B(gi(n ini )erdiri d(ri du0)u*;du0)u* 0eil d(n *u*un(n *el;*el (*in(r (bor)i )er*eb(r *ep(nj(ng *egmen ure)r( pro0*im(l.
%aa* /. ona Ke+ena* P*otat II.
FISI&&%I PR&STAT
Se0re) 0elenj(r pro*)() (d(l(h (ir(n *eper)i *u*u y(ng ber*(m(;*(m( *e0re) d(ri 9e*i0ul( *emin(li* merup(0(n 0omponen u)(m( d(ri (ir(n *emen. Semen beri*i *ejuml(h (*(m *i)r() *ehingg( p! ny( (g(0 (*(m >/,?. Sel(in i)u d(p() di)emu0(n enim y(ng be0erj( *eb(g(i ibrinoli*in y(ng 0u(), o*()(*e (*(m, enim;enim l(in d(n lipid. Se0re) pro*)() di0elu(r0(n *el(m( ej(0ul(*i mel(lui 0on)r(0*i o)o) polo*. 0elenj(r pro*)() jug( mengh(*il0(n (ir(n d(n pl(*m( *emin(li*, deng(n perb(nding(n (ir(n pro*)() $+;+' d(n (ir(n 9e*i0ul( *emin(li* -/;34 p(d( <(0)u ej(0ul(*i. 3
&elenj(r pro*)() dib(<(h peng(ruh Androgen Bodie* d(n d(p() dihen)i0(n deng(n pemberi(n S)ilbe*)rol. III.
#EFINISI
!iperpl(*i( Pro*)() Benign( *eben(rny( (d(l(h *u()u 0e(d((n dim(n( 0elenj(r periure)r(l pro*)() meng(l(mi hiperpl(*i( y(ng (0(n mende*(0 j(ring(n pro*)() y(ng (*li 0e perier. Sel(in i)u, BP! merup(0(n pembe*(r(n 0elenj(r pro*)() y(ng ber*i() jin(0 y(ng h(ny( )imbul p(d( l(0i;l(0i y(ng bi(*(ny( p(d( u*i( per)eng(h(n ()(u l(nju).
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%aa* 2. Benign Prostat Hyperplasia I'.
ETI&&%I !ingg( *e0(r(ng m(*ih belum di0e)(hui *e(r( p(*)i penyeb(b )erj(diny( hiperpl(*i(
pro*)() )e)(pi beber(p( hipo)e*i* menyebu)0(n b(h<( hiperpl(*i( pro*)() er() 0(i)(nny( deng(n pening0()(n 0(d(r dihidrotestosteron >D!T? d(n proses aging >menj(di )u(? . Beber(p( hipo)e*i* y(ng didug( *eb(g(i penyeb(b )imbulny( hiperpl(*i( pro*)() jin(0 (d(l(h : >$? Teori Dihidro)e*)o*)eron, >'? Ad(ny( 0e)id(0*eimb(ng(n (n)(r( e*)rogen; )e*)o*)eron, >+? In)er(0*i (n)(r( *el *)rom( d(n *el epi)el pro*)(), >-? Ber0ur(ngny( 0em()i(n *el >(pop)o*i*?, d(n >? Teori S)em *el. (. Teori Dihidro)e*)o*)eron >D!T? Dihidro)e*)o*)eron ()(u D!T (d(l(h me)(boli) (ndrogen y(ng *(ng() pen)ing p(d( per)umbuh(n *el; *el 0elenj(r pro*)(). Diben)u0 d(ri )e*)o*)eron di d(l(m *el pro*)() oleh enim ;redu0)(*e deng(n b(n)u(n 0oenim ADP!. D!T y(ng )el(h )erben)u0 beri0()(n deng(n re*ep)or (ndrogen >RA? memben)u0 0omple0* D!T;RA p(d( in)i d(n *el *el(nju)ny( )erj(di *in)e*i* pro)ein growth factor y(ng men*)imul(*i per)umbuh(n *el pro*)(). 4
P(d( berb(g(i peneli)i(n di0()(0(n b(h<( 0(d(r D!T p(d( BP! )id(0 j(uh berbed( deng(n 0(d(rny( p(d( pro*)() norm(l, h(ny( *(j( p(d( BP!, (0)i9i)(* enim ;redu0)(*e d(n juml(h re*ep)or (ndrogen lebih b(ny(0 p(d( BP!. !(l ini menyeb(b0(n p(d( BP! lebih *en*i)i )erh(d(p D!T *ehingg( repli0(*i *el lebih b(ny(0 )erj(di dib(nding0(n deng(n pro*)() norm(l. b.
&e)id(0*eimb(ng(n e*)rogen d(n )e*)o*)eron P(d( u*i( y(ng *em(0in )u(, 0(d(r )e*)o*)erone menurun, *ed(ng0(n 0(d(r e*)rogen rel()i )e)(p *ehingg( perb(nding(n (n)(r( e*)rogen : )e*)o*)erone rel()i mening0(). Tel(h di0e)(hui b(h<( e*)rogen di d(l(m pro*)() berper(n d(l(m )erj(diny( prolier(*i *el; *el 0elenj(r pro*)() deng(n (r( mening0()0(n *en*i)ii)(* *el; *el pro*)() )erh(d(p r(ng*(ng(n hormon (ndrogen, mening0()0(n juml(h re*ep)or (ndrogen, d(n menurun0(n juml(h 0em()i(n *el; *el pro*)() >(pop)o*i*?. !(*il (0hir d(ri *emu( 0e(d((n ini (d(l(h, me*0ipun r(ng*(ng(n )erben)u0ny( *el; *el b(ru (0ib() r(ng*(ng(n )e*)o*)erone menurun, )e)(pi *el @ *el pro*)() y(ng )el(h (d( mempuny(i umur y(ng lebih p(nj(ng *ehingg( m(**( pro*)() j(di lebih be*(r.
.
In)er(0*i *)rom( epi)el 8unh( >$21+? membu0)i0(n b(h<( dieren*i(*i d(n per)umbuh(n *el epi)el pro*)() *e(r( )id(0 l(ng*ung di0on)rol oleh *el; *el *)rom( mel(lui *u()u medi()or > growth factor ? )er)en)u. Se)el(h *el; *el *)rom( mend(p()0(n *)imul(*i d(ri D!T d(n e*)r(diol, *el; *el *)rom( men*in)e*i* *u()u growth factor y(ng *el(nju)ny( mempeng(ruhi *el; *el *)rom( i)u *endiri *e(r( in)r(0in d(n (u)o0rin, *er)( mempeng(ruhi *el; *el epi)el *e(r( p(r(0rin. S)imul(*i i)u menyeb(b0(n )erj(diny( prolier(*i *el; *el epi)el m(upun *)rom(.
d.
Ber0ur(ngny( 0em()i(n *el pro*)() > Apoptosis? Apop)o*i* *el p(d( *el pro*)() (d(l(h me0(ni*me i*iologi0 homeo*)()i* 0elenj(r pro*)(). P(d( j(ring(n nom(l, )erd(p() 0e*eimb(ng(n (n)(r( l(ju prolier(*i *el deng(n 0em()i(n *el. Ber0ur(ngny( juml(h *el;*el pro*)() y(ng (pop)o*i* menyeb(b0(n juml(h *el;*el pro*)() *e(r( 0e*eluruh(n m(0in mening0() *ehingg( meng(0ib()0(n per)(mb(h(n m(**( pro*)(). Didug( hormon (ndrogen berper(n d(l(m mengh(mb() pro*e* 0em()i(n *el 0(ren( *e)el(h
e.
dil(0u0(n 0(*)r(*i, )erj(di pening0()(n (0)i9i)(* 0em()i(n *el 0elenj(r pro*)(). Teori *)em ell
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I*(( d(n 8oey meng(ju0(n )eori ini berd(*(r0(n (*um*i b(h<( p(d( 0elenj(r pro*)(), *el(in (d( hubung(nny( deng(n *)rom( d(n epi)el, jug( (d( hubung(n (n)(r( jeni*;jeni* *el epi)el y(ng (d( di d(l(m j(ring(n pro*)(). S)em *el (0(n ber0emb(ng menj(di *el (pliying, y(ng 0edu(ny( )id(0 )erg(n)ung p(d( (ndrogen. Sel (pliying (0(n ber0emb(ng menj(di *el )r(n*i) y(ng )erg(n)ung *e(r( mu)l(0 p(d( (ndrogen, *ehingg( deng(n (d(ny( (ndrogen *el ini (0(n berprolier(*i d(n mengh(*il0(n per)umbuh(n pro*)() y(ng norm(l. '.
PAT&FISI&&%I Seb(gi(n be*(r hiperpl(*i( pro*)() )erd(p() p(d( on( transisional , *ed(ng0(n
per)umbuh(n 0(r*inom( pro*)() ber(*(l d(ri on( perifer. Per)umbuh(n 0elenj(r ini *(ng() berg(n)ung p(d( hormon )e*)o*)eron, y(ng di d(l(m *el; *el 0elenj(r pro*)() hormon (0(n dirub(h menj(di me)(boli) (0)i dihidro)e*)o*)eron >D!T? deng(n b(n)u(n enim redu0)(*e. Dihidro)e*)o*)eron inil(h y(ng *e(r( l(ng*ung mem(u m;RA di d(l(m *el; *el 0elenj(r pro*)() un)u0 men*in)e*i* pro)ein growth factor y(ng mem(u per)umbuh(n 0elenj(r pro*)(). Pembe*(r(n pro*)() menyeb(b0(n penyempi)(n lumen ure)r( pro*)()i0( d(n mengh(mb() (lir(n urine. &e(d((n ini menyeb(b0(n pening0()(n )e0(n(n in)r(9e*i0(l. "n)u0 d(p() mengelu(r0(n urine, buli; buli h(ru* ber0on)r(0*i lebih 0u() gun( mel(<(n )(h(n(n i)u. &on)r(0*i y(ng )eru* meneru* ini menyeb(b0(n perub(h(n (n()omi0 buli; buli berup( hipertrofi otot detrusor, trabekulasi, )erben)u0ny( selula, sakula, d(n divertikel buli- buli. Perub(h(n *)ru0)ur p(d( buli; buli )er*ebu), oleh p(*ien dir(*(0(n *eb(g(i 0eluh(n p(d( *(lur(n 0emih *ebel(h b(<(h ()(u lower urinary tract symptom (LU!" y(ng d(hulu di0en(l deng(n gej(l( prostatimus. Te0(n(n in)r(9e*i0( y(ng )inggi di)eru*0(n 0e *eluruh b(gi(n buli; buli )id(0 )er0eu(li p(d( 0edu( mu(r( ure)er. Te0(n(n p(d( 0edu( mu(r( ure)er ini d(p() menimbul0(n (lir(n b(li0 urine d(ri buli; buli 0e ure)er ()(u )erj(di refluks vesikoureter. &e(d((n ini ji0( berl(ng*ung )eru* (0(n meng(0ib()0(n
hidroureter,
hidronefrosis, b(h0(n (0hirny( d(p() j()uh 0e d(l(m g(g(l ginj(l. 'I.
!ANIFESTAS KINIK a.
Ke+-3an ada a+-*an kei3 aian a5a3 ("TS)
Terdiri ()(* gej(l( ob*)ru0*i d(n iri)(*i : &t*-ki •
!e*i*)(n*i
I*itai •
Fre0uen*i 6
•
P(n(r(n mi0*i lem(h
•
In)ermi)en*i
•
o0)uri
•
Mi0*i )id(0 pu(*
•
"rgen*i
•
Di*)en*i (bdomen
•
Di*uri(
•
Termin(l dribbling >mene)e*?
•
5olume urine menurun
•
Mengej(n *(() ber0emih
"rgen*i d(n di*uri( j(r(ng )erj(di, ji0( (d( di*eb(b0(n oleh 0e)id(0*)(bil(n de)ru*or *ehingg( )erj(di 0on)r(0*i in9olun)er.
Tae+ 1. Gej(l( =b*)ru0*i d(n Iri)(*i Benign( Pro*)() !iperpl(*i(
M(nie*)(*i 0lini* berup( ob*)ru0*i p(d( penderi)( hipepl(*i( pro*)() m(*ih )erg(n)ung )ig( (0)or, y(i)u: •
5olume 0elenj(r periure)r(l
•
El(*)i*i)(* leher 9e*i0(, o)o) polo* pro*)() d(n 0(p*ul pro*)()
•
&e0u()(n 0on)r(0*i o)o) de)ru*or
Timbulny( gej(l( #"TS merup(0(n m(nie*)(*i 0ompen*(*i o)o) buli;buli un)u0 mengelu(r0(n urine. P(d( *u()u *((), o)o) buli;buli meng(l(mi 0ep(y(h(n >()igue? *ehingg( j()uh 0e d(l(m (*e de0ompen*(*i y(ng diu(( dingin, 0on*um*i ob();ob()(n y(ng meng(ndung diure)i0um, minum )er)(lu b(ny(0? '? M(**( pro*)() )ib(;)ib( membe*(r >*e)el(h mel(0u0(n (0)i9i)(* *e0*u(l ine0*i pro*)()? +? Se)el(h meng0on*um*i ob();ob() y(ng d(p() menurun0(n 0on)r(0*i o)o) de)ru*or >golong(n (n)i0olinergi0 ()(u (drenergi;? "n)u0 menen)u0(n der(j() ber()ny( peny(0i) y(ng berhubung(n deng(n penen)u(n jeni* pengob()(n BP! d(n un)u0 menil(i 0eberh(*il(n pengob()(n BP!, dibu()l(h *u()u *0oring y(ng valid d(n reliable. Terd(p() beber(p( *i*)em *0oring, di (n)(r(ny( *0or #nternational $rostate !koring !ystem >IPSS? y(ng di(mbil berd(*(r0(n *0or 7
American Urological Association >A"A?. S0or A"A )erdiri d(ri 1 per)(ny((n. P(*ien dimin)( un)u0 menil(i *endiri der(j() 0eluh(n ob*)ru0*i d(n iri)()i mere0( deng(n *0(l( 4;. To)(l *0or d(p() ber0i*(r (n)(r( 4;+. S0or 4;1 ring(n, 3;$2 *ed(ng, d(n '4;+ ber().
.
%ea+a ada a+-*an kei3 aian ata
Merup(0(n penyuli) d(ri hiperpl(*i pro*)(), berup( gej(l( ob*)ru0*i (n)(r( l(in nyeri pingg(ng, benjol(n di pingg(ng >hidronero*i*?, dem(m >ine0*i uro*ep*i*?. 7.
%ea+a di +-a* a+-*an kei3
&eluh(n p(d( peny(0i) herni( hemoroid *ering mengi0u)i peny(0i) hiper)ropi pro*)(). Timbulny( 0edu( peny(0i) ini 0(ren( *ering mengej(n p(d( *(() mi0*i *ehingg( meng(0ib()0(n pening0()(n )e0(n(n in)r( (bdomin(l.
8
Gej(l( gener(li*()( jug( mung0in )(mp(0, )erm(*u0 0ele)ih(n, (nore0*i(, mu(l d(n mun)(h, d(n r(*( )id(0 ny(m(n p(d( epig(*)ri0 >Brunner Sudd(r)h, '44$?. Se(r( 0lini0 der(j() ber(), dib(gi menj(di - gr(di(*i, y(i)u: •
Der(j() $ : Ap(bil( di)emu0(n 0eluh(n pro*)()i*mu*, p(d( DRE >olo0 dubur? di)emu0(n penonjol(n pro*)() d(n *i*( urine 0ur(ng d(ri 4 ml.
•
Der(j() ' : Di)emu0(n )(nd( d(n gej(l( *eper)i p(d( der(j() $, pro*)() lebih menonjol, b()(* ()(* m(*ih )er(b( d(n *i*( urine lebih d(ri 4 ml )e)(pi 0ur(ng d(ri $44 ml.
•
Der(j() + : Seper)i der(j() ', h(ny( b()(* ()(* pro*)() )id(0 )er(b( l(gi d(n *i*( urin lebih d(ri $44 ml.
•
Der(j() - : Ap(bil( *ud(h )erj(di re)en*i )o)(l.
'II. PE!ERIKSAAN FISIK
Buli;buli y(ng )eri*i penuh d(n )er(b( m(**( 0i*)u* di d(er(h *upr( *imi*i* (0ib() re)en*i urine. &(d(ng;0(d(ng did(p()0(n urine y(ng *el(lu mene)e* y(ng merup(0(n per)(nd( d(ri in0on)inen*i( p(r(do0*(. 1) Pee*ikaan 7o+ok d--* diita+ *e7ta+ e9aination ( #RE )
Merup(0(n pemeri0*((n y(ng *(ng() pen)ing, DRE d(p() memberi0(ng(mb(r(n )onu* *ing)er (ni, mu0o*( re0)um, (d(ny( 0el(in(n l(in *eper)ibenjol(n di d(l(m re0)um d(n )en)u *(j( mer(b( pro*)(). P(d( per(b((n pro*)() h(ru* diperh()i0(n : −
&on*i*)en*i p(d( pembe*(r(n pro*)() 0eny(l
−
Ad(0(h (*ime)ri
−
Ad(0(h nodul p(d( pro*)()
−
Ap(0(h b()(* ()(* d(p() dir(b( d(n (p(bil( b()(* ()(* m(*ih d(p() dir(b( bi(*(ny( be*(r pro*)() diper0ir(0(n H/4 gr.
9
%aa* 4. Pee*ikaan :o+ok #--*
P(d( BP! (0(n di)emu0(n pro*)() y(ng lebih be*(r d(ri norm(l, permu0((n liin d(n 0on*i*)en*i 0eny(l. Pemeri0*((n i*i0 (p(bil( *ud(h )erj(di 0el(in(n p(d( )r(0)u* urin(ri( b(gi(n ()(* 0(d(ng;0(d(ng ginj(l d(p() )er(b( d(n (p(bil( *ud(h )erj(di pnieloneri)i* (0(n di*er)(i *(0i) pingg(ng d(n nyeri 0e)o0 p(d( pingg(ng. 5e*i( urin(ri( d(p() )er(b( (p(bil( *ud(h )erj(di re)en*i )o)(l, buli;buli penuh >di)emu0(n m(**( *upr( pubi*? y(ng nyeri d(n pe0(0 p(d( per0u*i. D(er(h inguin(l h(ru* mul(i diperh()i0(n un)u0 menge)(hui (d(ny( herni(. Geni)(li( e0*)ern( h(ru* pul( diperi0*( un)u0 melih() (d(ny( 0emung0in(n *eb(b y(ng l(in y(ng d(p() menyeb(b0(n g(nggu(n mi0*i *eper)i b()u di o**( n(9i0ul(ri* ()(u ure)r( (n)erior, ibro*i* d(er(h ure)r(, imo*i*, ondilom( di d(er(h me()u*.
/) #e*aat e*at ot*-ki
10
Der(j() ber() ob*)ru0*i d(p() diu0ur deng(n menen)u0(n juml(h *i*( urin *e)el(h mi0*i *pon)(n. Si*( urin di)en)u0(n deng(n mengu0ur urin y(ng m(*ih d(p() 0elu(r deng(n 0()e)eri*(*i. Si*( urin d(p() pul( di0e)(hui deng(n mel(0u0(n ul)r(*onogr(i 0(ndung 0emih *e)el(h mi0*i. Si*( urin lebih d(ri $44 bi(*(ny( di(ngg(p *eb(g(i b()(* un)u0 indi0(*i mel(0u0(n in)er9en*i p(d( hiper)roi pro*)().Der(j() ber() ob*)ru0*i d(p() pul( diu0ur deng(n mengu0ur p(n(r(n urin p(d( <(0)u mi0*i, y(ng di*ebu) urolo
'III. PE!ERIKSAAN PEN"N;AN%
$. Pemeri0*((n l(bor()orium : (. Sedimen urin "n)u0 men(ri 0emung0in(n (d(ny( pro*e* ine0*i ()(u inl(m(*i p(d( *(lur(n 0emih. Menge9(lu(*i (d(ny( eri)ro*i), leu0o*i), b(0)eri, pro)ein ()(u glu0o*(. b. &ul)ur urin Men(ri jeni* 0um(n y(ng menyeb(b0(n ine0*i d(n *e0(ligu* menen)u0(n *en*ii)(* 0um(n )erh(d(p beber(p( (n)imi0rob( y(ng diuji0(n . F((l ginj(l Men(ri 0emung0in(n (d(ny( penyuli) y(ng mengen(i *(lur(n 0emih b(gi(n ()(*. Ele0)roli), B", d(n 0re()inin bergun( un)u0 in*ui*ien*i ginj(l 0roni* p(d( p(*ien y(ng memili0i po*)9oid re*idu >P5R? y(ng )inggi . d. Gul( d(r(h Men(ri 0emung0in(n (d(ny( penye0i) di(be)e* melli)u* y(ng d(p() menimbul0(n 0el(in(n per*(r((n p(d( buli;buli >buli;buli neurogeni0? e. Pen(nd( )umor PSA >pro*)() *pe*ii0 (n)igen? %i0( urig( (d(ny( 0eg(n(*(n pro*)() '. Pemeri0*((n P()ologi An()omi BP! diiri0(n oleh berb(g(i 0ombin(*i d(ri hiperpl(*i( epi)el d(n *)rom( di pro*)(). Beber(p( 0(*u* menunju00(n prolier(*i h(lu*;o)o) h(mpir murni, me*0ipun 0eb(ny(0(n menunju00(n pol( ibro(denomyom()ou* hyperpl(*i(
11
%aa* . %aa*an !ak*okoi dan !ik*okoi Benina P*otat Hie*+aia
+. Peni)r((n p(d( Benign( Pro*)() !iperpl(*i(: (. Fo)o polo* Bergun( un)u0 men(ri (d(ny( b()u op(0 di *(lur(n 0emih, (d(ny( b()u0(l0ulo*( pro*)() d(n 0(d(ng0(l( menunju0(n b(y(ng(n buli;buli y(ng penuh )eri*i urine, y(ng merup(0(n )(nd( *u()u re)en*i urine b. Pemeri0*((n ul)r(*onogr(i )r(n*re0)(l >TR"S? Ad(l(h )e* "SG mel(lui re)um. D(l(m pro*edur ini, probe dim(*u00(n 0e d(l(m re0)um meng(r(h0(n gelomb(ng *u(r( di pro*)(). Gem( pol( gelomb(ng *u(r( merup(0(n g(mb(r d(ri 0elenj(r pro*)() p(d( l(y(r )(mpil(n. "n)u0 menen)u0(n (p(0(h *u()u d(er(h y(ng (bnorm(l )(mp(0 mem(ng )umor, digun(0(n probe d(n g(mb(r "SG un)u0 mem(ndu j(rum biop*i un)u0 )umor y(ng diurig(i. %(rum mengumpul0(n beber(p( po)ong j(ring(n pro*)() un)u0 pemeri0*((n deng(n mi0ro*0op. Biop*y )eru)(m( dil(0u0(n un)u0 p(*ien y(ng diurig(i memili0i 0eg(n(*(n pro*)(). Tr(n*re0)(l ul)r(*onogr(i >TR"S? *e0(r(ng jug( digun(0(n un)u0 pengu0ur 9olume pro*)(), (r(ny( (n)(r( l(in : •
Me)ode *)ep pl(nime)ryJ.
K(ng menghi)ung 9olume r()(;r()( (re(
horion)(l diu0ur d(ri d(*(r *(mp(i pun(0. •
Me)ode di(me)er. K(ng mengg(bung0(n pengu0ur(n )inggi >!heigh)? ,leb(r >L#leng)h? deng(n rumu* : >! N L N #?
. Si*)o*0opi D(l(m pemeri0*((n ini, di*i*ip0(n *ebu(h )(bung 0eil mel(lui pembu0((n ure)hr( di d(l(m peni*. Pro*edur ini dil(0u0(n *e)el(h *olu*i numb* b(gi(n d(l(m
peni*
*ehingg( *en*(*i
*emu(
hil(ng. T(bung,
di*ebu)
*ebu(h
y*)o*opeJ , beri*i len*( d(n *i*)em (h(y( y(ng memb(n)u do0)er melih() b(gi(n d(l(m ure)r( d(n 0(ndung 0emih. Te* ini memung0in0(n do0)er un)u0 menen)u0(n u0ur(n 0elenj(r d(n mengiden)ii0(*i lo0(*i d(n der(j() ob*)ru0*i.
12
%aa* 6. %aa*an Sitokoi Benina P*otat Hie*+aia
d. "l)r(*onogr(i )r(n* (bdomin(l •
G(mb(r(n *onogr(i benign( hyperpl(*i( pro*)() menunju0(n pembe*(r(n b(gi(n d(l(m gl(ndul(, y(ng rel()i hipoehoi dib(nding on( perier. 7on( )r(n*i*i hipoe0oi0 enderung mene0(n on( en)r(l d(n perier. B()(* y(ng memi*(h0(n hyperpl(*i( deng(n on( perier (d(l(h *urgi(l (p*uleJ.
•
"SG )r(n*(bdomin(l m(mpu pul( mende)e0*i (d(ny( hidronero*i* ()(upun 0eru*(0(n ginj(l (0ib() ob*)ru0*i BP! y(ng l(m(.
%aa* <. %aa*an Sono*a=i P*otat No*a+
%aa* 8. %aa*an Sono*a=i Benina P*otat Hie*+aia
e.Si*)ogr(i buli
13
%aa* >.%aa*an E+e?ai #aa* B-+i yan !enindikaikan Benina P*otat Hie*+aia
-. Pemeri0*((n l(in : Pemeri0*((n der(j() ob*)ru0*i pro*)() d(p() diper0ir(0(n deng(n (r( mengu0ur: •
•
Re*idu(l urin : %uml(h *i*( urin *e)el(h mi0*i, deng(n (r( mel(0u0(n 0()e)eri*(*i"SG *e)el(h mi0*i P(n(r(n urinlo< r()e : Deng(n menghi)ung juml(h urine dib(gi deng(n l(m(ny( mi0*i berl(ng*ung >mlde)i0? ()(u deng(n (l() urolome)ri y(ng meny(ji0(n g(mb(r(n gr(i0 p(n(r(n urin. Alir(n y(ng ber0ur(ng *ering p(d( BP!. P(d( (lir(n urin y(ng lem(h, (lir(n urinny( 0ur(ng d(ri $m#* d(n )erd(p() pening0()(n re*idu urin. Post-void residual mengu0ur juml(h (ir *eni y(ng )er)ingg(l di d(l(m
0(ndung 0emih *e)el(h bu(ng (ir 0eil. PR5 0ur(ng d(ri 4 m# umum menunju00(n pengo*ong(n 0(ndung 0emih y(ng mem(d(i d(n pengu0ur(n $44 *(mp(i '44 ml ()(u lebih *ering menunju00(n *umb()(n. P(*ien dimin)( un)u0 bu(ng (ir 0eil *eger( *ebelum )e* d(n *i*( urin di)en)u0(n oleh "SG ()(u 0()e)eri*(*i.
%aa* 10. %aa*an Pan7a*an "*in No*a+ dan ada BPH
&e)er(ng(n : 14
%aa*an a+i*an -*in ata @ de5aa -da yan aitoatik, a+i*an -*in +ei3 da*i 1, -*in *eid- > ada -+t*aono*a=i.
G(mb(r(n (lir(n urin b(<(h : de<(*( )u( deng(n benign( hyperpl(*i( pro*)(), )erlih() <(0)u ber0emih mem(nj(ng deng(n (lir(n urin 0ur(ng d(ri $4m#*, p(*ien ini urin re*iduny( $44 m#. I.
K&!PIKASI Re)en*i urine (0u) @ 0e)id(0 m(mpu(n un)u0 mengelu(r0(n urin, di*)en*i •
•
0(ndung 0emih, nyeri *upr(pubi0 Re)en*i urine 0roni0 @re*idu urin O 44ml, p(n(r(n lem(h, buli )er(b(, )id(0
nyeri Ine0*i )r(0)u* urin(ri( • B()u buli • !em()uri • In0on)inen*i(;urgen*i • !idroure)er • !idronero*i* ; g(nggu(n p(d( ung*i ginj(l • !iperpl(*i( Pro*)() Penyempi)(n lumen ure)r( po*)erior Te0(n(n in)r(9e*i0( mening0()
Buli;buli:
Ginj(l d(n ure)er:
!iper)roi o)o) de)ru*or
Relu0* 5"
Tr(be0ul(*i
!idroure)er
Selul(
!idronero*i*
Di9er)i0el buli;buli
G(g(l ginj(l
!idronero*i*
!idroure)er
!iper)oi o)o) de)ru*or Benign( pro*)() hiperpl(*i 15
.
PENATAAKSANAAN
Tid(0 *emu( p(*ien hiperpl(*i( pro*)() perlu menj(l(mi )ind(0(n medi0. &(d(ng; 0(d(ng mere0( y(ng mengeluh #"TS ring(n d(p() *embuh *endiri )(np( mend(p()0(n )er(pi (p(pun ()(u h(ny( deng(n n(*eh() *(j(. (mun (d(pul( y(ng membu)uh0(n )er(pi medi0(men)o*( ()(u )ind(0(n medi0 y(ng l(in 0(ren( 0eluh(nny( *em(0in p(r(h. Tuju(n )er(pi hyperpl(*i( pro*)() (d(l(h >$? memperb(i0i 0eluh(n mi0*i, >'? mening0()0(n 0u(li)(* hidup, >+? mengur(ngi ob*)ru0*i in)r(9e*i0(, >-? mengemb(li0(n ung*i ginj(l ji0( )erj(di g(g(l ginj(l, >? mengur(ngi 9olume re*idu urine *e)el(h mi0*i d(n >/? meneg(h progrei)(* peny(0i). !(l ini d(p() dieg(h deng(n medi0(men)o*(, pembed(h(n ()(u )ind(0(n endourologi y(ng 0ur(ng in9(*i.
=b*er9(*i L()hul <(i)ing
Medi0(men)o*( Pengh(mb() (drenergi 0 Pengh(mb() redu0)e*e Fi*io)er(pi !ormon(l
=per(*i Pro*)()e0)omi )erbu0(
Endourologi
•
In9(*i9e minim(l T"MT
•
T"BD
•
S)en) ure)r(
•
T"A
$. T"RP '. T"IP +. T"#P Ele0)o9(por(*i Tae+ 2. Pi+i3an Te*ai ada Hie*+aia P*otat Benina Ri<(y() Pemeri0*((n i*i0 DRE "rin(li*( PSA >mening0())id(0?
Inde0* gej(l(
Gej(l( ring(n >A"AQ1? )d0 (d(
Gej(l( *ed(ng
Re)en*i urin(ri(gej(l( y(ng berhubung(n dg BP! !em()uri( per*i*)en) B()u buli Ine0*i *(lur(n urin(ri( berul(ng
Te* di(gno*)i "rolo< =per(*i Re*idu urin o*)9oid Te* di(gno*)i Pre**ure lo< "re)ro*i*)o*0opi Ter(pi non;in9(*i Pilih(n )er(pi pro*)() Ter(pi medi* L()hul <(i)ing Ter(pi minim(l"SG Ter(pi in9(*i in9(*i =per(*i
16
Baan /. Penata+akanaan Benina P*otat Hie*+aia
Pen()(l(0*(n((n L()ull <(i)ing
il(i inde0* gej(l( BP! Gej(l( hil(ng)imbul
Ee0 *(mping Ri*i0o 0eil , d(p() )erj(di re)en*i urin(ri(
Pen()(l(0*(n((n medi* Alph(;blo0er*
Sed(ng /;3
(lph(;redu)(*e inhibi)or*
Ring(n +;-
Ter(pi 0ombin(*i Ter(pi in9(*i minim(l Tr(n*ure)r(l miro<(9e he()
Sed(ng /;1
G(*)eru*u* h(lu*;$$ !idung ber(ir;$$ S(0i) 0ep(l(;$' Menggigil;$ M(*(l(h ere0*i;3 &ehil(ng(n h(*r() *eN; Ber0ur(ngny( *emen;- 0ombin(*i
T"A
Sed(ng 2
=per(*i T"RP, l(*er oper(*i *ejeni*
Ber() $-;'4
=per(*i )erbu0(
Ber()
Sed(ng;ber() 2;$$
"rgen*ire0uen*i;'3;1- Ine0*i;2 Pro*edur 0edu( dibu)uh0(n;$4; $/ "rgen*ire0uen*i;+$ Ine0*i;$1 Pro*edur 0edu( dibu)uh0(n;'+ Re)en*i urin(ri(;$;'$ "rgen*ire0uen*i;/;22 G(nggu(n ere0*i;+;$+ In0on)inen*i( / 17
Tae+ 4. Penata+akaan Be*daa*kan Ni+ai Indek %ea+a Benina P*otat Hie*+aia
(.
L()hul <(i)ing Pilih(n )(np( )er(pi ini di)uju0(n un)u0 p(*ien BP! deng(n *0or IPSS dib(<(h 1, y(i)u 0eluh(n ring(n y(ng )id(0 mengg(nggu (0)i9i)(* *eh(ri; h(ri. P(*ien )id(0 mend(p() )er(pi n(mun h(ny( diberi penjel(*(n mengen(i *e*u()u h(l y(ng mung0in d(p() memperburu0 0eluh(nny(, mi*(lny( >$? j(ng(n meng0on*um*i 0opi ()(u (lohol *e)el(h m(0(n m(l(m, >'? 0ur(ngi 0on*um*i m(0(n(n ()(u minum(n y(ng mengiri)(*i buli;buli >0opio0el()?,
>+?
b()(*i
penggun((n
ob();ob()
inluen(
y(ng
meng(ndung
enilprop(nol(min, >-? 0ur(ngi m(0(n(n ped(*(d(n (*in, d(n >? j(ng(n men(h(n 0ening )erl(lu l(m(. Se(r( periodi0 p(*ien dimin)( un)u0 d()(ng on)rol deng(n di)(ny( 0eluh(nny( (p(0(h menj(di lebih b(i0 >*eb(i0ny( mem(0(i *0or y(ng b(0u?, di*(mping i)u dil(0u0(n pemeri0*((n l(bor()orium, re*idu urin, ()(u urolome)ri. %i0( 0eluh(n mi0*i ber)(mb(h jele0 d(rip(d( *ebelumny(, mung0in perlu dipi0ir0(n )er(pi y(ng l(in.
b.
Medi0(men)o*( Tuju(n )er(pi medi0(men)o*( (d(l(h beru*(h( un)u0 : >$? mengur(ngi re*i*)(n*i o)o) polo* pro*)() *eb(g(i 0omponen din(mi0 penyeb(b ob*)ru0*i inr(9e*i0( deng(n ob(); ob()(n pengh(mb() (drenergi (l( >(drenergi (l( blo0er d(n >'? mengur(ngi 9olume pro*)()
*eb(g(i
0omponen
*)()i
deng(n
(r(
menurun0(n
0(d(r
hormone
)e*)o*)eronedihidro)e*)o*)eron >D!T? mel(lui pengh(mb() ;redu0)(*e. $?
Pengh(mb() re*ep)or (drenergi0 . Mengendur0(n o)o) polo* pro*)() d(n leher 0(ndung 0emih, y(ng memb(n)u un)u0 mering(n0(n ob*)ru0*i 0emih di*eb(b0(n oleh pembe*(r(n pro*)() di BP! . Ee0
*(mping
d(p()
)erm(*u0
*(0i)
0ep(l(,
0elel(h(n,
()(u
ring(n.
"mumny( digun(0(n (lph( blo0er BP! )erm(*u0 ta-+oin >Flom(N?, a+=-oin >"roN()r(l?, d(n ob();ob()(n y(ng lebih )u( *eper)i te*aoin >!y)rin?
()(u do9aoin >8(rdur(?. =b();ob()(n ini (0(n mening0()0(n p(n(r(n urin d(n meng(0ib()0(n perb(i0(n gej(l( d(l(m beber(p( minggu d(n )id(0 berpeng(ruh p(d( u0ur(n pro*)().
18
G(mb(r $-. #o0(*i Re*ep)or
'?
;Adrenergi0 >α$;AR*?
α$
Pengh(mb() redu0)(*e =b() ini be0erj( deng(n (r( mengh(mb() pemben)u0(n dihidro)e*)o*)eron >D!T? d(ri )e*)o*)erone y(ng di0()(li*i* oleh enim redu0)(*e di d(l(m *el pro*)(). Menurunny( 0(d(r D!T menyeb(b0(n *in)e*i* pro)ein d(n repli0(*i *el;*el pro*)() menurun. Pembe*(r(n pro*)() di BP! *e(r( l(ng*ung )erg(n)ung p(d( D!T, *ehingg( ob() ini menyeb(b0(n pengur(ng(n ' per0ir((n u0ur(n pro*)() lebih d(ri / *(mp(i $' bul(n.
.
Ter(pi In9(*i Minim(l Diperun)u0(n un)u0 p(*ien y(ng mempuny(i ri*i0o )inggi )erh(d(p pembed(h(n $? Miro<(9e )r(n*ure)hr(l. P(d( )(hun $22/, FDA menye)ujui per(ng0() y(ng menggun(0(n gelomb(ng mi0ro un)u0 mem(n(*0(n d(n mengh(nur0(n j(ring(n pro*)() y(ng berlebih. D(l(m pro*edur y(ng di*ebu) miro<(9e )hermo)her(py )r(n*ure)hr(l >T"MT?, per(ng0() mengirim gelomb(ng mi0ro mel(lui 0()e)er un)u0 mem(n(*0(n b(gi(n pro*)() dipilih un)u0 *e)id(0ny( $$$ der(j() F(hrenhei). Sebu(h *i*)em pendingin melindungi *(lur(n 0emih *el(m( pro*edur. Pro*edur ini mem(0(n <(0)u *e0i)(r $ j(m d(n d(p() dil(0u0(n *e(r( r(<() j(l(n )(np( (ne*)e*i umum. T"MT belum dil(por0(n menyeb(b0(n di*ung*i ere0*i ()(u in0on)inen*i(. Me*0ipun )er(pi miro<(9e )id(0 menyembuh0(n BP!, )(pi mengur(ngi gej(l( re0uen*i 0ening, urgen*i, )eg(ng, d(n in)ermi)en*i.
19
G(mb(r $$. !i7*o5a?e T*an-*et3*a+
'? Tr(n*ure)hr(l j(rum (bl(*i. %ug( p(d( )(hun $22/, FDA menye)ujui )r(n*ure)hr(l j(rum (bl(*i in9(*i minim(l >T"A? *i*)em un)u0 pengob()(n BP!. Si*)em T"A memberi0(n energy r(diore0uen*i )ing0() rend(h mel(lui j(rum 0emb(r un)u0 region pro*)() y(ng membe*(r. Shield* melindungi ure)r( d(ri 0eru*(0(n (0ib() p(n(*. Si*)em T"A mening0()0(n (lir(n urin d(n mengur(ngi gej(l( deng(n ee0 *(mping y(ng lebih *edi0i) ji0( dib(nding0(n deng(n re*e0*i
)r(n*ure)hr(l
d(ri
pro*)()
>T"RP?.
%aa* 1/. T*an-*et3*a+ ;a*- A+ai In?ai= !inia+
+? T3e*ot3e*ay denan ai*. Ter(pi ini menggun(0(n (ir p(n(* un)u0 mengh(nur0(n j(ring(n 0elebih(n d(l(m pro*)(). Sebu(h 0()e)er meng(ndung beber(p( lub(ng dipo*i*i0(n d(l(m ure)r( *ehingg( b(lon pengob()(n )erle)(0 di 20
)eng(h pro*)(). Sebu(h 0ompu)er mengon)rol *uhu (ir, y(ng meng(lir 0e b(lon d(n mem(n(*0(n j(ring(n pro*)() *e0i)(rny(. Si*)em ini memo0u*0(n p(n(* di
%aa* 12. Thermo)her(py deng(n Air d.
Bed(h 1) =per(*i )r(n*ure)hr(l.
P(d( jeni* oper(*i, *(y()(n e0*)ern(l )id(0 diperlu0(n. Se)el(h memberi0(n (ne*)e*i, (hli bed(h men(p(i pro*)() deng(n mem(*u00(n in*)rumen mel(lui ure)r(. Pro*edur y(ng di*ebu) re*e0*i )r(n*ure)hr(l d(ri pro*)() >T"RP? digun(0(n un)u0 24 per*en d(ri *emu( oper(*i pro*)() dil(0u0(n un)u0 BP!. Deng(n T"RP, (l() y(ng di*ebu) re*e)o*ope dim(*u00(n mel(lui peni*. The re*e)o*ope, y(i)u p(nj(ng *e0i)(r $' ini d(n di(me)er $ ' ini, beri*i l(mpu, 0()up un)u0 mengend(li0(n (ir(n irig(*i, d(n loop li*)ri0 y(ng memo)ong j(ring(n d(n *egel pembuluh d(r(h. 8(ir(n irig(n y(ng dip(0(i (d(l(h (u(de* . 0erugi(n d(ri (u(de* (d(l(h *i()ny( y(ng hipo)oni* *ehingg( d(p() m(*u0 mel(lui *ir0ul(*i *i*)emi0 d(n menyeb(b0(n hipo)ermi( rel()i9e ()(u gej(l( in)o0*i0(*i (ir y(ng di0en(l deng(n *indrom T"RP. Di)(nd(i deng(n p(*ien y(ng mul(i geli*(h, *omnolen d(n )e0(n(n d(r(h mening0() d(n )erd(p() br(di0(rdi. %i0( )id(0 *eger( di()(*i, p(*ien (0(n meng(l(mi edem( o)(0 d(n j()uh 0e d(l(m 0om(. "n)u0 mengur(ngi ri*i0o )imbulny( *indrom( T"RP oper()or h(ru* memb()(*i diri un)u0 )id(0 mel(0u0(n re*e0*i lebih d(ri $ j(m d(n b(ru mem(*(ng *i*)o*)omi )erlebih d(uhlu *ebelum re*e0*i dih(r(p0(n d(p() mengur(ngi penyer(p(n (ir 0e *i*)emi0.
21
Sel(m( oper(*i 24;meni), (hli bed(h menggun(0(n loop 0(<() re*e)o*ope un)u0 menghil(ng0(n j(ring(n ob*)ru0*i *()u b(gi(n p(d( *u()u <(0)u. Po)ong(n;po)ong(n j(ring(n dib(<( oleh (ir(n 0e 0(ndung 0emih d(n 0emudi(n dibu(ng 0elu(r p(d( (0hir oper(*i. Pro*edur )r(n*ure)hr(l 0ur(ng )r(um()i* d(rip(d( ben)u0 oper(*i )erbu0( d(n memerlu0(n <(0)u pemulih(n lebih pende0. S(l(h *()u ee0 *(mping y(ng mung0in T"RP (d(l(h ej(0ul(*i re)rogr(de, ()(u 0e bel(0(ng. D(l(m 0ondi*i ini, *emen meng(lir mundur 0e d(l(m 0(ndung 0emih *el(m( 0lim(0* bu0(nny( 0elu(r ure)r(. Sel(m( oper(*i Perd(r(h(n Sindrom T"RP Peror(*i
P(*( bed(h dini Perd(r(h(n Ine0*i lo0(l*i*)emi0
P(*( bed(h l(nju) In0on)inen*i Din*ung*i ere0*i Ej(0ul(*i re)rogr(de S)ri0)ur ure)r(
Be*aai Peny-+it T"RP, Se+aa a--n Sete+a3 Peeda3an
(a)
22 (b) (c)
%aa* 14. (a) a+at T"RP, () 7a*a e+ak-kan T"RP, (7) -*et*a *otatika a7a T"RP
Pro*edur bed(h y(ng di*ebu) in*i*i )r(n*ure)hr(l d(ri pro*)() >T"IP?, pro*edur ini meleb(r ure)hr( deng(n membu() beber(p( po)ong(n 0eil di leher 0(ndung 0emih, di m(n( )erd(p() 0elenj(r pro*)(). Pro*edur ini digun(0(n p(d( hiperpl(*i pro*)() y(ng )id(0 )(r)(lu be*(r, )(np( (d( pembe*(r(n lobu* mediu* d(n p(d( p(*en y(ng umurny( m(*ih mud(.
/) =pen *urgery.
D(l(m beber(p( 0(*u* 0e)i0( *ebu(h pro*edur )r(n*ure)hr(l )id(0 d(p() digun(0(n, oper(*i )erbu0(, y(ng memerlu0(n in*i*i e0*)ern(l, d(p() digun(0(n. =pen *urgery *ering dil(0u0(n 0e)i0( 0elenj(r *(ng() membe*(r >O$44 gr(m?, 0e)i0( (d( 0ompli0(*i, ()(u 0e)i0( 0(ndung 0emih )el(h ru*(0 d(n perlu diperb(i0i. Pro*)()e0*omi )erbu0( dil(0u0(n mel(lui pende0()(n *upr(rubi0 )r(n*9e*i0(l >Freyer? ()(u re)ropubi0 inr(9e*i0(l >Millin?. Penyuli) y(ng d(p() )erj(di (d(l(h in0on)inen*i( uirn >+?, impo)en*i( >;$4?, ej(0ul(*i re)rogr(de >/4;34? d(n 0on)r(0)ur leher buli;buli >+4?. Perb(i0(n gej(l( 0lini* 3; $44. 2) =per(*i l(*er
23
&elenj(r pro*)() p(d( *uhu /4;/o8 (0(n meng(l(mi 0o(gul(*i d(n p(d( *uhu y(ng lebih d(ri $44 o8 meng(l(mi 9(por(*i. Te0ni0 l(*er menimbul0(n lebih *edi0i) 0ompli0(*i *(y(ngny( )er(pi ini membu)uh0(n )er(pi ul(ng ' *e)i(p )(hun. &e0ur(ng(nny( (d(l(h : )id(0 d(p() diperoleh j(ring(n un)u0 pemeri0*((n p()ologi >0eu(li p((d !o:KAG o(gul()ion?, *ering b(ny(0 menimbul0(n di*uri p(*( bed(h y(ng d(p() berl(ng*ung *(mp(i ' bul(n, )id(0 l(ng*ung d(p() mi0*i *pon)(n *e)el(h oper(*i d(n pe(0 lo< r()e lebih rend(h d(rip(d( p(*( T"RP. Ser() l(*er mel(lui ure)r( 0e d(l(m pro*)() menggun(0(n y*)o*ope d(n 0emudi(n memberi0(n beber(p( *embur(n energi y(ng berl(ng*ung +4 *(mp(i /4 de)i0. Energi l(*er mengh(nur0(n j(ring(n pro*)() d(n menyeb(b0(n penyu*u)(n.
%aa* 16. &e*ai ae* ada P*otat a) In)er*)i)i(l l(*er o(gul()ion. Tid(0 *eper)i pro*edur l(*er l(in, 0o(gul(*i
l(*er in)er*)i*i(l )emp() ujung probe *er() op)i0 l(ng*ung 0e j(ring(n pro*)() un)u0 mengh(nur0(nny(.
%aa* 1<. In)er*)i)i(l l(*er o(gul()ion ) Po)o*ele)i 9(pori*(*i pro*)() >P5P?.
P5T (;energi l(*er )inggi un)u0 mengh(nur0(n j(ring(n pro*)(). 8(r( *(m( deng(n T"RP, h(ny( *(j( )e0ni0 ini mem(0(i roller b(ll y(ng *pe*ii0 deng(n me*in di()ermi y(ng u0up 0u(), *ehingg( m(mpu membu() 9(por(*i 0elenj(r pro*)(). Te0ni0 ini u0up (m(n )id(0 menimbul0(n 24
perd(r(h(n p(d( *(() oper(*i. (mun )e0ni0 ini h(ny( diperun)u0(n p(d( pro*)() y(ng )id(0 )erl(lu be*(r >H4 gr(m? d(n membu)uh0(n <(0)u oper(*i y(ng lebih l(m(.
%aa* 18. Po)o*ele)i 9(pori*(*i pro*)() e.
&on)rol ber0(l( •
L()hull <(i)ing &on)rol *e)el(h / bul(n, 0emudi(n *e)i(p )(hun un)u0 menge)(hui (p(0(h )erd(p() perb(i0(n 0lini*
•
Pengob()(n pengh(mb() ;redu0)(*e Di0on)rol p(d( minggu 0e;$' d(n bul(n 0e;/
•
Pengob()(n pengh(mb() ;(drenegi0 Se)el(h / minggu un)u0 menil(i re*pon )erh(d(p )er(pi deng(n mel(0u0(n pemeri0*((n IPSS urolome)ri d(n re*idu urin p(*( mi0*i
•
Ter(pi in9(*i9e minim(l Se)el(h / minggu, + bul(n d(n *e)i(p )(hun. Sel(in dil(0u0(n penil(i(n *0or mi0*i, jug( diperi0*( 0ul)ur urin
•
Pembed(h(n P(ling l(mb() / minggu p(*( oper(*i un)u0 menge)(hui 0emung0in(n penyuli).
25
BAB III KESI!P"AN
!iperpl(*i( 0elenj(r pro*)() mempuny(i (ng0( morbidi)(* y(ng berm(0n( p(d( popul(*i pri( l(nju) u*i(. Deng(n ber)(mb(h u*i(, u0ur(n 0elenj(r d(p() ber)(mb(h 0(ren( )erj(di hiperpl(*i( j(ring(n ibromu*0uler d(n *)ru0)ur epi)el 0elenj(r >j(ring(n d(l(m 0elenj(r pro*)()?. Gej(l( d(ri pembe*(r(n pro*)() ini )erdiri d(ri gej(l( ob*)ru0*id(n gej(l( iri)()i. Pen()(l(0*(n((n BP! berup( <()hul <(i)ing, medi0(men)o*(, )er(pi bed(h 0on9en*ion(l, d(n )er(pi minim(l in9(*i. Progno*i* un)u0 BP! berub(h;ub(h d(n
26
)id(0 d(p() dipredi0*i p(d( )i(p indi9idu <(l(upun gej(l(ny( enderung mening0(). (mun BP! y(ng )id(0 *eger( di)ind(0 memili0i progno*i* y(ng buru0 0(ren( d(p() ber0emb(ng menj(di 0(n0er pro*)().
BAB I' #AFTAR P"STAKA
$. &o(r Ro*em(ry A, Moore Frederi0 A. Sh<(r)* Priniple* o Surgery 3)h Edi)ion. Sing(pore: The MGr(<;!ill 8omp(nie*, In '44 '. M(n*joer A, Supr(h(i)(, L(rdh(ni. '444. Pembe*(r(n Pro*)() %in(0. D(l(m: %apita selekta %edokteran. Medi( Ae*ul(piu*, %(0(r)( +'2;+--. +. Mulyono, A. $22. Pengob()(n BP! P(d( M(*( &ini. D(l(m : $embesaran $rostat &inak. K(y(*(n penerbi) IDI, %(0(r)( -4;-3.. -. Purnomo, B(*u0i B. 'asar 'asar Urologi. Edi*i &edu(. %(0(r)( : S(gung Se)o. 27
