kuliah prostat (2)

7/30/2019 Kuliah Prostat (2)

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Disorders of the Prostate

Dr.M.Galuh Richata, SpU


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Prostate Gland

A fibromuscular (30-50%) and glandular

(50-70%) organ

Weighs about 20 g; 2,5 cm in length

Prostatic secretions: 1/3 of semen,

discharged at ejaculation


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Prostate Gland


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BPH

Prostate Lobes (Lowsley):Anterior, Posterior, Median, Right Lateral, Left

Lateral.

Zonal Anatomy (3 Zones; McNeal, 1968)

- Peripheral zone (70% of the volume)

- Central zone (25%)

- Transition zone (5%)

McNeal, 1972 5 zones:- Anterior segment (fibromuscular area)

- Preprostatic sphincteric zone


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Prostate Gland


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Prostate Gland


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Disorders of the Prostate

Prostatitis most found inperipheralzone

Benign Prostate Hyperplasia (BPH)

develop in transition zone

Prostate Cancer mostly originates in

peripheral zone (70%), 10-20% from

transition zone, 5-10% central zone.


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Prostatitis

Most common urologic diagnosis in menunder 50 years of age.

Probably results from ascending urethral

infection intraprostatic reflux of urine? prostate anatomy?

Microorganism: Aerobic Gram-negative

(80% E coli, 10-15% Pseudomonas,Serratia, Klebsiella, Proteus)


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Prostatitis

Signs & Symptoms

- Rectal, low back, perineal pain

- Fever and chills- Urinary urgency, frequency, dysuria

- Acute urinary retention prostatic

sweeling- Malaise, arthralgia, myalgia

- Sometimes hematuria, cloudy urine


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Prostatitis

Physical ExamsDRE: prostate is tender, could be enlarged

(irregularly firm & warm)

LabBlood: Leucocytosis

Urine: pyuria, microscopic hematuria ,

bacteria

Urine culture identify the organism


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Prostatitis

DRE:


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Prostatitis

Management

- Antibiotics (guided by resistance test)

- Antipyretics- Analgesics

- Stool softeners

- Hydration- Bed rest


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Benign Prostate Hyperplasia

(BPH) Most common benign tumor in men

Incidence is age-related

Risk factor & Etiology: ??? (multi factorial,endocrine controlled)

Its main concern is Bladder Outlet

Obstruction (BOO)


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BPH


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BPH


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BPH

BPH BOO

complications:

- Urinary retention

- Urinary tractinfection

- Bladder stone

- Hematuria- Bladder diverticulae

- Renal impairment


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BPH

Sign & SymptomsBOO LUTS (Lower Urinary Tract Symptoms)

Obstructive Symptoms:

Weak Stream, Straining, Hesitancy,

Intermittency, Incomplete Emptying, TerminalDribbling

Irritative Symptoms:

Frequency, Nocturia, Dysuria, Urgency

IPSS International Prostate Symptoms Score


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BPH

General condition: state of pain, bodytemperature, signs of renal impairment

Suprapubic region: bladder: palpable?tenderness?

DRE: Prostate:- Size: 20-40-60 g?

- Consistency: Firm/Hard?

- Symmetric/Asymmetric?

- Surface: Smooth/Nodules?

- Tender/nontender?


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BPH

DRE:


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BPH

Lab

- General : blood, urine

- PSA (Prostate Specific Antigen)

Imaging

- Ultrasound (transabdominal, transrectal)- IVU


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BPH

ManagementFor General Pract i t ioners:

- No complication oral therapy

LUTS :Alpha Blockers, 5-Alpha

Reductase Inhibitors.

- Complications refer to Urologist

Urinary Retention catheterization

then refer to urologist


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BPH

Catheterization

Cystostomy/

BladderPuncture


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BPH

Management

Operative/Surgery

- Open

Prostatectomy

- Cystoscopy &

Trans Urethral

Resection ofProstate (TURP)


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BPH

Trans UrethralResection of

Prostate

(TURP)


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BPH

TURP


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Prostate Cancer

Carcinoma of the Prostate (CaP)

Most common cancer diagnosed

2nd

leading cause of cancer death inAmerican men

Prevalence increase rapidly with age

Risk Factor: still debatable 70% from the peripheral zone


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Prostate Cancer


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Prostate Cancer

Pattern of Progression- Local Extension

- Metastases (lymphogenous or

haematogenous) :- Lymph Node (obturator, common illiac)

- Bone

- Visceral (lung, liver, adrenal)


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Prostate Cancer


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Prostate Cancer

General Practitioners

Screening!Signs & Symptoms

- asymptomatic

- similar to BPH (LUTS, urinary retention,hematuria, etc)

- hematospermia (local extension)

- bone pain (metastases)


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Prostate Cancer

DRE :- Volume : can be small/large

- Consistency: hard, stony (indurat ion)

- Surface: uneven, nodule

- Asymmetric

Lab:

PSA : > 4 ng/mL


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Prostate Cancer

Any male with LUTS screening with DRE

found anything suspicious refer to

urologist

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