010 - Genito Urinari - Hipertrofi Benign Prostatik (BPH)
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Transcript of 010 - Genito Urinari - Hipertrofi Benign Prostatik (BPH)
![Page 1: 010 - Genito Urinari - Hipertrofi Benign Prostatik (BPH)](https://reader033.fdocument.pub/reader033/viewer/2022061603/5572026e4979599169a37e3f/html5/thumbnails/1.jpg)
BENIGN PROSTATIC
HYPERTROPHY (BPH)
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DefinisiDefinisi
Pembesaran pada Pembesaran pada kilang prostatkilang prostat
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ETIOLOGI
- Tidak diketahui- Kesan daripada jangkitan yang kronik- Tidak keseimbangan hormon, umur meningkat hormon testosteron
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PATOFISIOLOGI
- Peningkatan umur – berlaku ‘tissue hyperplasia’ (peningkatan yang abnormal ke atas bilangan sel)- Penyempitan salur urethra- Hipertrofi pundi kencing- pembangkakan ureter (hydroureter)- pembengkakan ginjal (hydronephrosis)
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BENIGN PROSTATIC HYPERTROPHY (BPH)
MANIFESTASI KLINIKAL
1. kerap kencing2. incontinence urin (laluan air
kencing bukan pada 3. salurannya secara tidak sengaja)4. kencing meleleh5. retensi urin
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6.Keinginan hendak kencing
( hesistency)
7.pancutan kencing lemah ( urgency )
8.nokturia (saluran air kencing pada waktu malam mengalami pembesaran kelenjar prostat
9.haematuria (jarang berlaku)
10.post micturition dribbling(pengeluaran air kencing keluar dari semasa ke semasa dari pundi kencing melalui urethra)
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DIAGNOSIS PERBEZAAN- Prostatitis- Cancer prostat- Cystitis(inflamasi pundi air kencing disebabkan oleh jangkitan)
- kalkuli pundi kencing
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BENIGN PROSTATIC HYPERTROPHY (BPH)
PENDIAGNOSAN
1. Sejarah• Umur melebihi 50 tahun• Retensi kronik• Kencing tak puas
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2.Ciri-ciri klinikal2.Ciri-ciri klinikal
Keinginan hendak kencing ( hesistency )Keinginan hendak kencing ( hesistency ) pancutan kencing lemah ( urgency )pancutan kencing lemah ( urgency ) nokturianokturia (saluran air kencing pada waktu malam (saluran air kencing pada waktu malam
mengalamimengalami pembesaran kelenjar prostat)pembesaran kelenjar prostat) haematuria (jarang berlaku)haematuria (jarang berlaku) post micturition dribblingpost micturition dribbling
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3. Pemeriksaan fizikal
- bladder distended
- palpable bladder
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4. Penyiasatan - cystoscopy(pemeriksaan pundi air
kencing dengan suatu alat sistoskop yg dimasukkan
melalui urethra) - ultrasound - intravenous pyelogram (IVP) - Biopsy
(pngambilan tisu utk pemeriksaan mikroskopik) - Urin FEME - pemeriksaan rektum (PR)
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BENIGN PROSTATIC HYPERTROPHY (BPH)
PENGURUSAN
Rawatan yang berkesan adalah pembedahan
Indikasi Pembedahan- Retensi urin akut- Infeksi kronik - Haematuria- Hydronephrosis(pengembungan atau pengembangan pelvis ginjal disebabkan penyekatan pengaliran air kencing)
- Penyekatan dibahagian leher pundi kencing
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BENIGN PROSTATIC HYPERTROPHY (BPH)
Terdapat 4 jenis pembedahan yang biasa Dilakukan.
1. Transurethral Rescetion of Prostate (TURP)2. Suprapubic Prostatectomy3. Retropubic Prostatectomy4. Perineal Prostatectomy
1. Transurethral Rescetion of Prostate (TURP)
- Tidak memerlukan pembedahan- Menggunakan alat resectoscope untuk membuang tisu prostat- Disadvantage – trauma urethra
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TRANSURETHRAL RESECTION OF PROSTATE (TURP)
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2. Suprapubic / Transversical Prostatectomy
- pembuangan melalui suprapubik
- disadvantage – sakit, penyembuhan mengambil masa yang lama
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SUPRAPUBIC / TRANSVESICAL PROSTATECTOMY
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3. Retropubic Prostatectomy
- pembuangan prostat melalui belakang Tulang pubik
-digunakan apabila kilang prostat terlalu besar
- pembuangan prostat melalui belakang Tulang pubik
-digunakan apabila kilang prostat terlalu besar
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RETROPUBIC / RETROVESICAL PROSTATECTOMY
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4. Perineal Prostatectomy
- pembuangan prostat melalui perineal
- jarang digunakan kerana komplikasi
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PERINEAL PROSTATECTOMY
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RAWATAN SELEPAS PEMBEDAHAN
- Posisi pesakit (fowler’s)- monitor tanda vital- ubatan – analgesik untuk 24jam
- antibiotik- penjagaan irigasi yang berterusan (sodium citrate dan normal saline)
pengelakkan pembekuan darah dan mengurangkan pendarahan
- penjagaan kateter-penjagaan carta aliran input dan output (I/O)-Penjagaan IV drip
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CONTINUOUS BLADDER IRRIGATION
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COMPLICATIONS OF BPH
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KOMPLIKASI
- Perdarahan
- retensi urin
- Infeksi ke atas trak urinari
- hydronephrosis
- kegagalan renal
KOMPLIKASI
- Perdarahan
- retensi urin
- Infeksi ke atas trak urinari
- hydronephrosis
- kegagalan renal
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