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PEMICU 4 BLOK UROGENITAL
“KENAPA KENCINGKU TIDAK LAMPIAS?”
ALMIRA NABILA VALMAI
405130193
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LOPros ! " "sBP#K!rs"$o%! Pros !S r"& 'r Ur( r!E)"*"*"%" "sV!r"&o&(+#"*ro&(+#(r$"! S&ro !+"s Tors"o T(s "sK(,!$!s!$
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PROSTATITISDefnisi R(!&s" "$-!%!s" &(+($.!r )ros !
E "o+o," • B!& (r"/ E o+"2 Pro (o's s))2 K+( s"(++! s))2Ps('*o%o$!s s))2 E$ (ro ! (r s))2 S(rr! "! s))
• No$ B!& (r"
T!$*! ,(.!+!
N (r" *" s(+!$,&!$,!$2 *!(r!6 !$ !r! )($"s *!$ !$'ss(r ! )'$,,'$, !,"!$ !7!62 *(%!% *!$ %($,,","+2s(r"$, (r&(%"6 *!$ %($,!+!%" *(s!&!$ '$ '&
(r&(%"62 6(%! 'r" 8!"r &(%"6$ ! %($,!$*'$, *!r!6 2"s! (r.!*" "%)o ($s"
K+!s":&!s" 1 K! (,or" I )ros ! " "s !& (r"!+ !&'
; K! (,or" II )ros ! " "s !& (r"!+ &ro$"s3 K! (,or" III )ros ! " "s $o$ !& (r"!+ &ro$"s <s"$*ro%! )(+="& &ro$"s 8III A/ s"$*ro%! )(+="& &ro$"s*($,!$ "$-!%!s"2 IIIB/ s"$*ro%! )(+="& &ro$"s $o$"$-!%!s"
4 K! (,or" IV )ros ! " "s "$-!%!s" !s"% o%! "&
P'r$o%o BB D!s!r>*!s!r Uro+o," E* 3 M!+!$,/ S!,'$, S( o
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B($",$ Pros ! ( # )(r)+!s"!
• K(+!"$!$ 6"s o+o,"s , &6!s *" !$*!" *($,!$)ro+" (r!s" s(+>s(+ )ros ! A&'%'+!s" s(+>s(+ *!$)(% (s!r!$ &(+($.!r %(r')!&!$ 6!s"+ *!r")ro+" (r!s" s(+ ()" (+ *!$ s ro%! )ros ! 8IPD
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E "o+o,"1 T(or" D"6"*ro (s os (ro$
• D!+!% s(+ )ros ! /
NADP# NADP T(s os (ro$ >>>>>>>>>>> D"6"*ro (s os (ro$
5 F r(*'& !s(
B(r"&! !$ *($,!$ RA 8r(s() or !$*ro,($↓Ko%)+(&s D#T F RA 8)!*! "$ " s(+ ↓S"$ (s"s )ro ("$ Gro7 6 @! or ↓P(r '% '6!$ s(+ )ros !
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; K( "*!&s("% !$,!$ Es ro,($ > T(s os (ro$
• Us"! '!/P(r !$*"$,!$ (s ro,($/ (s os (ro$
• @'$,s" (s ro,($ / – Pro+" (r!s" s(+>s(+ &(+($.!r )ros ! *($,!$
!r! /• s($s" ": !s s(+>s(+ )ros ! (r6!*!) r!$,s!$,!$
6or%o$ !$*ro,($
• .'%+!6 r(s() or !$*ro,($• H .'%+!6 !)o) os"s s(+ )ros ! > '%'r +( "6
)!$.!$,> %!ss! )ros ! +( "6 (s!r
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3 I$ (r!&s" S ro%! F E)" (+• D" (r($s"!s" *!$ )(r '% '6!$ s(+ ()" (+ )ros !
s( !r! "*!& +!$,s'$, *"&o$ ro+ o+(6 s(+>s(+s ro%! %(+!+'" s'! ' %(*"! or 8,ro7 6 ! or
(r ($ 'D#T*!$
(s r!*"o+
S(+ F S(+S ro%!
Gro7 6@! or
menstimulasi
mensintesis
M(%)($,!r'6" s(+
s ro%! " ' s($*"r"s( !r! !' o&r"$ *!$"$ r!&r"$2 s(r ! s(+()" (+ s( !r! )!r!&r"$
Pro+" (r!s" s(+
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5 T(or" S(+ S (%
• D!+!% &(+($.!r )ros ! *"&($!+ s'! 's (% (++2 !" ' / – s(+ !$, %(%)'$ !" &(%!%)'!$
(r)ro+" (r!s" s!$,! (&s ($s" – K(6"*')!$$ ! (r,!$ '$, &( (r!*!!$
6or%o$ !$*ro,($
• J"&! &!*!r 6or%o$ !$*ro,($ %($'r'$ !)o) os"s – J"&! !& "=" !s s (% (++ "*!& ()!
)ro*'&s" (r+( "6!$ s(+ s ro%! *!$ s(+
()" (+
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#")(r)+!s"! Pros !
P($ (%)"!$ L'%($
Ur( r!Pos (r"or
T(&!$!$!$I$ r!=(s"&!+
↑
Ginjal dan ureter• R(-'&s V(s"&o F
'r( (r• #"*ro'r( (r
• #"*ro$( ros"s• P"o$( ros"s)"(+o$( r" "s
• G!,!+ ,"$.!+
Buli – Buli• #")(r ro: O o
*(s r'sor• Tr! (&'+!s"
• S(+'+!
• D"=(r "&(+ '+" > '+"
P! o:s"o+o,"
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Gambaran Klinis
Obstruksi Iritasi• #(s" !$s"• P!$ !r!$ %"&s" +(%!6• I$ (r%" ($s"• M"&s" "*!& )'!s• M($( (s s( (+!6 %"&s"
• @r(&'($s"• No& 'r"• Ur,($s"• D"s'r"!
I Kelu!an "ada saluran kemi! bagian ba#a!
II Gejala "ada saluran kemi! bagian atas – N (r" )"$,,!$, – B($.o+!$ *" )"$,,!$, !$*! 6"*ro$( ros"s
– D(%!% !$*! "$ (&s" ! !' 'ros()s"sIII Gejala di luar saluran kemi!
– K(+'6!$ 6(r$"! "$,'"$!+"s 6(%oro"*
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D"!,$os!
• A$!%$(s"s – D($,!$ s"s (% s&or"$, *!r" #O !*!+!6 S&or
I$ (r$!s"o$!+ G(.!+! Pros ! ! !' I>PSS
– !$, (r6' '$,!$ *($,!$ &(+'6!$ %"&s" *" (r"$"+!" *!r" 0>5 – !$, (r6' '$,!$ *($,!$ &'!+" !s 6"*')
*" (r" $"+!" *!r" 1>
– S&or *" !," %($.!*" 3 *(r!.!• R"$,!$ 0>• S(*!$, >19• B(r! ;0>35
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D"!,$os!
• P(%(r"&s!!$ :s"& – R(,"o s')r!)' "&!
*"s ($s" =(s"&!
– @'$,s"$('ro%'s&'+(r(&s r(%" !s !7!6
– Co+o& *' 'r• P(% (s!r!$ )ros !• Ko$s"s ($s"• A*!< "*!& $o*'+
• P(%(r"&s!!$ P($'$.!$, – Pros ! ( S)(s": !$ ",($ – @+o7%( r" – USG< &! ( (r '$ '&
%($"+!" =o+'%( 'r"$r(s"*'!+
– TRUS
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T! !+!&s!$! )!*! BP#
Observasi Medikamentosa Operasi InvasifMinimal
Watchfulwaiting
• Penghambat
adrenergik α
• Penghambat
reduktase α
• Fitoterapi
• ormonal
• Prostatektomi
terbuka
• !ndourologi"
– #$%P
– #$IP
– #$&P
!lektrovaporasi
• #$M#
• #$'(
• )tent uretra
• #$*+
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DD BP#• K(,!$!s!$ /
!*($o&!rs"$o%!)ros ! 2 &!rs"$o%! s(+
r!$s"s"o$!+ VU2&!rs"$o%! s(+s&'!%os! )($"s
• I$ (&s" / s"s " "s2)ros ! " "s2 )($ !&"%($'+!r s(&s'!+
• G!$,,'!$ %( ! o+"&• B! ' 'r( r! *!$ ! '
&!$*'$, &(%"6
Ko%)+"&!s"• R( ($s" 'r"$• B! ' &!$*'$, &(%"62
ISK2 K(r's!&!$ ,"$.!+• I$&o$ "$($s"!• P$('%o$"!
• P(r*!r!6!$ (r+( "6!$• "%)o ($s"
Pro,$os"s• L( "6 *!r" 90 )!s"($
%($,!+!%" )(r !"&!$s( !,"!$ *!r" ,(.!+!10 %($,!+!%"&(&!% '6!$
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KARSINOMA PROSTAT
• K(,!$!s!$ !$,(r !$ !& *"!$ !r!
&(,!$!s!$ s"s (%'ro,($" !+"! )r"!
• Pr"! 50 !6'$• I$s"*($ )ros !
%($"$,&! / – M($"$,&! $ ! '%'r
6!r!)!$ 6"*')
– P($(,!&&!$ *"!,$os"s!$, +( "6 !"& – K(7!s)!*!!$ "$*"="*'
(r6!*!) &(,!$!s!$)ros ! %($"$,&!
• E "o+o,"/ – @!& or 6or%o$ – @!& or ,($( "& – @!& or +"$,&'$,!$ – D"( / %($,!$*'$,
+(%!&2 s's' !$,(r!s!+ *!r" "$! !$,2
red meat *!$ 6! "
%($"$,&! &!$&(.!*"!$ &!$&(r)ros !
– I$ (&s"
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P($ ( !r!$
• T'%or )!*! &(+($.!r )ros ! '% '6 &!)s'+)ros ! "$=!s" &( or,!$ s(&" !r$ !
• P($ ( !r!$ 8+"% o,($ %(+!+'" &(+($.!r +"% ()(+="s &(+($.!r +"% ( r( ro)(r" o$(!+
• P($ ( !r!$ 86(%! o,($ %(+!+'" =($! =(r ( r!+"s '+!$, )(+="s2 (%'r )ro&s"%!+2 =(r ( r!
+'% !+"s2 os !(2 )!r'2 6()!r2 *!$ o !&
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GAMBARAN KLINIS
• K'r!$, +( "6 10 )!s"($ *! !$, (ro ! &(*o& (r %($,(+'6 !*!$ ! ,!$,,'!$ s!+'r!$&(%"6 (r')! /
– M"&s" – N (r" s!! &($ "$, – #(%! 'r"! , %($!$*!&!$ !67! &!$&(r
(+!6 %($(&!$ 'r( r!• M( !s !s"s &( '+!$,/
– N (r" '+!$, – @r!& 'r *" (%)! %( !s !s"s
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DIAGNOSA
• P(%(r"&s!!$ o+o&*' 'r %($'$.'&&!$!*!$ ! $o*'+ &(r!s
!$, ($ '&$ ! "*!&(r! 'r!$
• K!*!r !$ ",($ )ros !s)(s":& 8PSA 2 !$,
"!s!$ ! %($"$,&!)!*! )($*(r" !
&!$&(r )ros !
P($ " r!!$
• Tr!$sr( !+ U+ r!so$o,r!:8TRUS – D"*!)! &!$ !r(! 6")o>(&o"&
8 0 , %(r')!&!$ s!+!6 s! '!$*! !*!$ ! &!$&(r )ros !
• CT S !$ *!$ MRI – CT s !$ *")(r"&s! ."&! *" 'r",!"
!*!$ ! %( !s !s"s )!*!+"% o$'*" 8N 2 !" ' )!s"($ ,%($'$.'&&!$ s&or G+(!so$
"$,," 8 ! !' &!*!r PSA"$,,"
• Bo$( S !$ – D",'$!&!$ '$ '& %($ !r"
%( !s !s"s 6(%! o,($ )!*!'+!$,
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T(r!)" )"+"6!$ K!rs"$o%!Pros !1 O s(r=!s"
– D" '.'&!$ )!s"($ s !*"'% T1 *($,!$ '%'r 6!r!)!$ 6"*')Q10 !6'$
; R!*"&!+ Pros ! (& o%"
– B(r')! )($,!$,&! !$ &(+($.!r )ros ! (rs!%!*($,!$ =(s"&'+! s(%"$!+"s
3 R!*"!s" – U$ '& )!s"($ '! *!$ '%or !$, (+!6
%($,!*!&!$ %( !s !s"s4 T(r!)" 6or%o$!+
– Ko$s() #',"$s !" ' / “s(+ ()" (+ )ros ! !&!$%($,!+!%" ! ro: ."&! s'% (r !$*ro,($ *" "!*!&!$”
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PENCEGA#AN
– D"( +(%!&2 s's' *!r" "$! !$,2 *!,"$, %(r!6*!$ 6! " 6!r's *"6"$*!r"
– V" !%"$ A2 &!ro ($2 &(*(+!"2 o%! 2 "&!$ +!' 2*!,"$,2 "."> "."!$ !,'s '$ '& %($'r'$&!$"$s"*($ &!$&(r )ros !
– K'r!$," %(ro&o& – #"$*!r" )!)!r!$ !6!$ &"%"! &!*%"'% 8C*
!$, (r*!)! )!*! !+! +"s r"& *!$ ! (r!" – S '*" :$!s (r"*( 8 $%& redu'tase t "e
bloker) *!)! %($ (,!6 %(%)(r+!% !(r.!*"$ ! C! )ros !
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STRIKTUR URETRADefnisiP($ (%)" !$ +'%($ 'r( r! &!r($! : ros"s )!*!*"$*"$,$ !
*tiologi
•I$ (&s"• Tr!'%!
S.!%s'6"*!.! R *!$ Jo$, D B'&' A.!r I+%' B(*!6
E* 3 J!&!r !/ P($(r " B'&' K(*o& (r!$ EGC;010 ) 49>51
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P! o:s"o+o," Tr!'%! I$ (&s"
Pros(s r!*!$,
J!r"$,!$ s"&! r"&s
P($ (%)" !$ +'%($ 'r( r! S r"& 'r 'r( r!
S.!%s'6"*!.! R *!$ Jo$, D B'&' A.!r I+%' B(*!6
E* 3 J!&!r !/ P($(r " B'&' K(*o& (r!$ EGC;010 ) 49>51
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D(r!.! P($ (%)" !$ Ur( r!• R"$,!$ / J"&! o&+'s" !$, (r.!*" &'r!$, *!r" 1
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Penatalaksanaan•D"+! !s" 8 's"$!s"
•Ur( ro o%" "$ (r$!•Ur( ro o%" (&s (r$!
8s'r,(r
Kom"likasi•I$ (&s" s!+'r!$ &(%"6•D"=(r "&(+ 'r( r!< B'+">
'+"•A s(s )(r"'r( r!•B! ' 'r( r!•@"s (+ 'r( ro>&' !$
•C! 'r( r!
Prognosis
•S(r"$, &!% '62 s(6"$,,!6!r's s(r"$, %($.!+!$")(%(r"&s!!$ !$, (r! 'ro+(6 *o& (r•D"&! !&!$ s(% '6 ."&!s( (+!6 *"+!&'&!$ o s(r=!s"
s(+!%! 1 !6'$ "*!&%($'$.'&&!$ !$*!> !$*!&(&!% '6!$•P($,'&'r!$ 'r"$!r -o7 r! (*!$ 'r( ro,r!% *!)!%(% !$ ' '$ '&
%($($ '&!$ "$,&! !$o r'&s" r(s"*'!+ ;P'r$o%o BB D!s!r>*!s!r Uro+o," E* 3 M!+!$,/ S!,'$, S( o
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EPIDIDIMITISDefnisi R(!&s" "$-!%!s" )!*! ()"*"*"%"s !$, *!)! (rs" !
!&' *!s!r Uro+o," E* 3 M!+!$,/ S!,'$, S( o ;011
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VARIKOKEL
• Defnisi / varises *" *!+!% s&ro '%• *tiologi / &(+!"$!$ )!*! &! ') =($! *"
s()!$.!$, &or*! s)(r%! "&! K(+!"$!$ &! ')
"$" %($,6!% ! !+"r!$ *!r!6 s(6"$,,! *!r!6%($,!+"r &(% !+" *!$ (r.!*" )(+( !r!$ =($!• Gejala / (r! ! s( !,!" %!ss! !$,
(r&(+o&>&(+o& *" s()!$.!$, &or*! s)(r%! "&!
• -era"i / )($,,'$!!$ )($ !$,,! s&ro '%2+",!s" 8)($,"&! !$ )(% '+'6 *!r!6 =($!s&ro '%
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#IDROKEL• Defnisi / )($"% '$!$ !"r!$ *" *!+!% s(+!)' !$,
%(% '$,&'s (s "s2 !$, %($ ( ! &!$)(% ($,&!&!$ +'$!& )!*! s!+!6 s! ' (s "s#"*ro&(+ "s! %(r')!&!$ !7!!$ +!6"r ! !' *"*!)! *"&(%'*"!$ 6!r" "s! 6!$ ! %($ (r!$, s!+!6 s! '%!')'$ &(*'! s"s" s&ro '%
• *tiologi / !*!$ ! &(,!,!+!$ )($' ')!$ s!+'r!$(%)! 'r'$$ ! (s "s *!r" ro$,,! )(r' &( *!+!%
s&ro '%2 )(r!*!$,!$ )!*! (s "s
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• Tors"o (s "s %(r')!&!$(r)(+'$ "r$ ! ,unikulus
s"ermatikus ,!$,,'!$ !+"r!$ *!r!6)!*! (s "s
• K!s's F 1/4000 )r"!!$, (r's"! Q ;5 !6'$
• P!+"$, !$ !& *"*(r" !)!*! !$!& %!s! )' (r !s
81;>;0 !6'$• T"*!& .!r!$, s(.!& .!$"$<! " !r' +!6"r %($*(r" !ors"o (s "s s(6"$,,!
%($,!&" ! &!$
&(6"+!$,!$ (s "s !"&
TORSIO TESTIS
M
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MKr(%!s
(r
S'6'(s "s
Tors"o T(s "s
B"+! %($,!+!%" )(r,(r!&!$(r+( "6!$/
K(!*!!$ !$, %($ ( ! &!$)(r,(r!&!$ (r+( "6!$/
1 P(r' !6!$ s'6' %($*!*!&8 (r($!$,
; K( !&' !$3 L! "6!$ !$, (r+( "6!$4 B! '&
5 C(+!$! !$, &( !D( (&!s"
Tr!'%! !$, %($,($!"
S&ro '% T(r)(+"$ "r$ ! '$"&'+'s
s)(r%! "&'s %($ ( ! &!$o s r'&s" !+"r!$ *!r!6 (s "ss(6"$,,! (s "s %($,!+!%" /
1 #")o&s"!; E*(%! (s "s
3 Is&(%"!
N(&ros"s T(s "s
P! o,($(s"s
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G!% !r!$ K+"$"s
P(%(r"&s!!$ @"s"&• T(s "s %(% ($,&!&
• L( !& +( "6 "$,," *!$ 6or" o$ !+ *!r")!*! (s "ss"s" &o$ r!+! (r!+• P!*! )(r%'+!!$ ors"o (s "s *!)! *" r! ! +"+" !$
! !' )($( !+!$ '$"&'+'s s)(r%! "&'s 8 "!s!$ !"*!& *" s(r !"$ *(%!%
• P!s"($ %($,(+'6 $ (r" 6( ! *" *!(r!6 s&ro '% S" ! $ ! %($*!*!& *!$ *""&' " )(% ($,&!&!$ (s "s
8!&' s&ro '% $ (r" %($.!+!r &( *!(r!6 "$,'"$!$< )(r' s( (+!6
!7!6 "+! "*!& *"7!s)!*!" s(r"$, *"&! !'&!$ *($,!$!)($*"s" "s !&'
P!*! ! " ,(.!+!$ ! "*!& &6!s !&$" G(+"s!62 r(7(+! !' "*!& %!' %($ 's'"
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P(%(r"&s!!$ P($'$.!$,
• sedimen urin "*!& %($'$.'&!$ !*!$ ! +('&os" 'r"$• dara! "*!& %($'$.'&!$ !$*! "$-!%!s" ke'uali
"ada torsio testis ang suda! lama• '$ '& %(% (*!&!$ ors"o (s "s *($,!$ &(!*!!$ !&'
s&ro '% !$, +!"$ /1 s ( os&o) Do))+(r; '+ r!so$o,r!: Do))+(r
3 s&"$ ",r!: (s "s
DD1 E)"*"*"%" "s !&'; #(r$"! s&ro !+"s "$&!rs(r! !3 #"*ro&(+ (r"$ (&s"4 T'%or (s "s5 E*(%! s&ro '%
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KANKER TESTIS&!$&(r ;0>35 !6'$90I$s"*($
• E "o+o," (+'%*"&( !6'"• @!& or R(s"&o/
K(,!$!s!$Kr") or&"s%'sG!$,,'!$G!$,,'!$R"7! !@!& or
S! 6*(=! K2 #!rr"s JE T(s " '+!r!$ (r M(*s !)( r( (r($ ( ;01;
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G(.!+! K+"$"s
• M!ss! *" (s "s2 "*!& $ (r"• ;0 )!s"($ *! !$, *($,!$
%( !s !s(/ – N (r" ! *o%($2 $ (r" )"$,,!$,2
%!+!"s(2 +( !r,"
• DD/ – E)"*"*%" "s2 or&6" "s2 6"*ro&(+
S! 6*(=! K2 #!rr"s JE T(s " '+!r !$ (r M(*s !)(
r( (r($ ( ;01;
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A$!%$(s! PD"!,$os!
S! 6*(=! K2 #!rr"s JE T(s " '+!r !$ (r M(*s !)(
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