Referat Benign Hiperplasia Prostat

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      2$3 PE%ERI)(AAN

    FI(I) $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 10

      2$ PE%ERI)(AAN

    PEN,NAN-$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 1

      2$4

    )O%P/I)A(I $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

    $$$$ 21

      2$10

    PENATA/A)(ANAAN $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

    $$ 22

     

    BAB III

    )E(I%P,/AN $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

    2

    DAFTAR

    P,(TA)A $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

    2.

    BAB I

    PENDAH,/,AN

    1$1 /atar Bela*ang$

    !

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    Pe"#esaran prostat #enigna atau le#ih +i*enal se#agai BPH sering

    +ite"u*an pa+a pria &ang "e"asu*i usia lan5ut$ Istilah BPH atau benign

     prostatic hyperplasia se#enarn&a "erupa*an istilah histopatologis' &aitu

    ter+apat hiperplasia sel6sel stro"a +an sel6sel epitel *elen5ar prostat 1'2'!

    (uatu penelitian "en&e#ut*an #ah7a pre8alensi Benigna Prostat

    Hiperplasia 9BPH &ang #erge5ala pa+a pria #erusia 0;4 tahun "en

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    tan+a +ari *eganasan prostat$ )e

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     TINA,AN P,(TA)A

    2$1 Anato"i Prostat$

    )elen5ar prostat a+alah salah satu organ genitalia pria &ang

    terleta* +i se#elah in?erior #uli6#uli +an "e"#ung*us uretra

    posterior$ Prostat #er#entu* seperti p&ra"i+ ter#ali* +an "erupa*an

    organ *elen5ar @#ro"us*uler &ang "engelilingi uretra pars

    prostati

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    Pa+a *elen5ar prostat 5uga +i#agi +ala"  Cona : !

    a$ ona Anterior atau entral $

    (esuai +engan lo#us anterior' ti+a* pun&a *elen5ar' ter+iri atas

    stro"a @#ro"us*ular$ ona ini "eliputi sepertiga *elen5ar prostat$

    #$ ona Peri?er

    (esuai +engan lo#us lateral +an posterior' "eliputi 30= "assa

    *elen5ar prostat$ ona ini rentan terha+ap ina"asi +an

    "erupa*an te"pat asal *arsino"a ter#an&a*$

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    as*ularisasi *elen5ar prostat &ang uta"a #erasal +ari a$ 8esi

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    2$! De@nisi$

    Hiperplasia prostat 5ina* 9BPH' 5uga +i*enal se#agai hipertro@

    prostat 5ina*' a+alah +iagnosis histologis &ang +itan+ai oleh proli?erasi

    ele"en seluler prostat$ O#stru*si *an+ung *e"ih se*un+er *arena BPH

    +apat "en&e#a#*an retensi urin' insu@siensi gin5al' in?e*si saluran *e"ih

    #erulang' he"aturia gross' +an #atu *an+ung *e"ih$

      Gambar 3. Benign Prostat Hyperplasia

    2$ Etiologi$

    4

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    Hingga se*arang' pen&e#a# BPH "asih #elu" +apat +i*etahui

    se

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    +ari DHT +an estra+iol' sel6sel stro"a "ensintesis suatu growth factor 

    &ang selan5utn&a "e"pengaruhi sel stro"a itu sen+iri' &ang

    "en&e#a#*an ter5a+in&a proli?erasi sel6sel epitel "aupun stro"a$

    $ Ber*urangn&a *e"atian sel prostat Apoptosis sel pa+a sel prostat a+alah "e*anis"e @siologi* ho"eostatis

    *elen5ar prostat$ Pa+a 5aringan no"al' ter+apat *esei"#angan antara la5u

    proli?erasi sel +engan *e"atian sel$ Ber*urangn&a 5u"lah sel6sel prostat

    &ang apoptosis "en&e#a#*an 5u"lah sel6sel prostat se

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    Pe"#esaran prostat "en&e#a#*an pen&e"pitan lu"en uretra

    prostati*a +an "engha"#at aliran urine$ )ea+aan ini "en&e#a#*an

    pening*atan te*anan intra8esi*al$ ,ntu* +apat "engeluar*an urine' #uli6

    #uli harus #er*ontra*si le#ih *uat guna "ela7an tahanan itu$ )ontra*si &ang terus "enerus ini "en&e#a#*an peru#ahan anato"i* #uli6 #uli

    #erupa hipertro otot detrusor, trabekulasi,  ter#entu*n&a selula' sakula,

    +an divertikel buli- buli. Peru#ahan stru*tur pa+a #uli6 #uli terse#ut' oleh

    pasien +irasa*an se#agai *eluhan pa+a saluran *e"ih se#elah #a7ah

    atau lower urinary tract symptom (LT!"  &ang +ahulu +i*enal +engan

    ge5ala prostatimus. 

     Te*anan intra8esi*a &ang tinggi +iterus*an *e seluruh #agian #uli6

    #uli ti+a* ter*e

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     Ter+iri atas ge5ala o#stru*si +an iritasi :

    "abel 1. -e5ala O#stru*si +an Iritasi Benigna Prostat Hiperplasia

    %ani?estasi *linis #erupa o#stru*si pa+a pen+erita hipeplasia

    prostat "asih tergantung tiga ?a*tor' &aitu:

    • olu"e *elen5ar periuretral

    • Elastisitas leher 8esi*a' otot polos prostat +an *apsul prostat

    • )e*uatan *ontra*si otot +etrusor

     Ti"#uln&a ge5ala /,T( "erupa*an "ani?estasi *o"pensasi otot #uli6

    #uli untu* "engeluar*an urine$ Pa+a suatu saat' otot #uli6#uli

    "engala"i *epa&ahan 9?atigue sehingga 5atuh *e +ala" ?ase

    +e*o"pensasi &ang +i7u5u+*an +ala" #entu* retensi urin a*ut$

     Ti"#uln&a +e*o"pensasi #uli6#uli ini +i+ahului oleh ?a

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    2 %assa prostat ti#a6ti#a "e"#esar 9setelah "ela*u*an a*ti8itas

    se*sual in?e*si prostat

    ! (etelah "eng*onsu"si o#at6o#at &ang +apat "enurun*an

    *ontra*si otot +etrusor 9golongan anti*olinergi* atau a+renergi

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    %erupa*an pen&ulit +ari hiperplasi prostat' #erupa ge5ala o#stru*si

    antara lain n&eri pinggang' #en5olan +i pinggang 9hi+rone?rosis'

    +e"a" 9in?e*si urosepsis$

    '. Gejala di luar saluran kemih

    )eluhan pa+a pen&a*it hernia he"oroi+ sering "engi*uti

    pen&a*it hipertropi prostat$ Ti"#uln&a *e+ua pen&a*it ini *arena

    sering "enge5an pa+a saat "i*si sehingga "enga*i#at*an

    pening*atan te*anan intra a#+o"inal$

    -e5ala generalisata 5uga "ung*in ta"pa*' ter"asu*

    *eletihan' anore*sia' "ual +an "untah' +an rasa ti+a* n&a"an

    pa+a epigastri* 9Brunner J (u++arth' 2001$ (e

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    pinggang$ esi

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    2$ Pe"eri*saan Penun5ang$

    1$ Pe"eri*saan la#oratoriu"

    a$ (e+i"en urin ,ntu* "en

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    a$ Foto polos Berguna untu* "en

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    Gambar . Gambaran #istoskopi 0enigna Prostat

    iperplasia

    +$ ,ltrasonogra@ trans a#+o"inal

    • -a"#aran sonogra@ #enigna h&perplasia prostat

    "enun5u*an pe"#esaran #agian +ala" glan+ula' &ang

    relati? hipoe

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    Gambar 7.Gambaran +le8asi *asar 0uli 9ang /engindikasikan

    0enigna Prostat iperplasia

    $ Pe"eri*saan lain:

    Pe"eri*saan +era5at o#stru*si prostat +apat +iper*ira*an +engan

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    Pen&e"pitan lu"en uretra posterior Q

     Te*anan intra8esi*a "ening*at Q Q

    Buli6#uli: -in5al +an ureter:

    Hipertro@ otot +etrusor Reu*s ,

     Tra#e*ulasi Hi+roureter

    (elula Hi+rone?rosis

    Di8erti*el #uli6#uli -agal gin5al

    2$10 Penatala*sanaan

     Ti+a* se"ua pasien hiperplasia prostat perlu "en5ala"i tin+a*an

    "e+i*$ )a+ang6*a+ang "ere*a &ang "engeluh /,T( ringan +apat

    se"#uh sen+iri tanpa "en+apat*an terapi apapun atau han&a

    +engan nasehat sa5a$ Na"un a+apula &ang "e"#utuh*an terapi

    "e+i*a"entosa atau tin+a*an "e+i* &ang lain *arena *eluhann&a

    se"a*in parah$

     Tu5uan terapi h&perplasia prostat a+alah 91 "e"per#ai*i *eluhan

    "i*si' 92 "ening*at*an *ualitas hi+up' 9! "engurangi o#stru*si

    intra8esi*a' 9 "enge"#ali*an ?ungsi gin5al 5i*a ter5a+i gagal gin5al'

    9 "engurangi 8olu"e resi+u urine setelah "i*si +an 9. "en

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    O#ser8asi %e+i*a"ento

    sa

    Operasi In8asi8e "ini"al

    at

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    0agan 2. Penatalaksanaan 0enigna Prostat iperplasia

    a$ at

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    (e#uah *o"ponen penting +ari /,T( se*un+er a*i#