acute retention urine ec hyperplasia of prostate
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AcuteAcute
UrinaryUrinaryRetention ec.Retention ec.
SuspectSuspectHyperplasiaHyperplasia
of Prostateof ProstatePenyaji :
dr. IreneMargaretha
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Tn. S ; 63 tahunTidak isa !A" sejak # ja$
%&'((')%(*
%#.+% a$
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Primary Survey (1)Primary Survey (1)
Airway Bebas
gasping/gurgling/stridor ()
!reathing Nafas spontan
"a#as spontan$ %% & ' /menit$
penggunaan otot pernapasan()
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Primary Survey (')Primary Survey (')
*ir+ulation Perfusi baik
Akral hangat (+), sianosis/pallor (-), TD =
11/! ""#g,
,isa-ility $%& ' )* +-
posure Ti.ak .ite"ukan
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Se+ondarySe+ondarySurveySurvey
Sujecti,eSujecti,e 0-e+tive0-e+tive
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Sea2 am yang lalu pasien tida2 -isa!A4 sama se2ali dan tim-ul se+arati-ati-a$ perut -agian -awahdirasa2an sangat nyeri menunu2an
2ondisi a2ut.Sea2 1 -ulan yang lalu pasien seringharus menunggu permulaan mi2si (51/-ulan) mengedan -ila !A4 (5
1/-ulan)$ aliran !A4 lemah (51/-ulan)$ urin menetes dia2hir!A4(51/-ulan)$ !A4 terputus dantim-ul rasa tida2 lampias saat !A4 (5
1/-ulan).
47 & Tida2 -isa !A4 sea2 am47 & Tida2 -isa !A4 sea2 amS8Pus2esS8Pus2es
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Selain itu pasien uga mengeluh2anmenadi sering !A4 terutama di malah
hari (51/-ulan)$ dan nyeri di a2hir !A4(51/-ulan)$ pasien tida2 merasa2an2eluhan tida2 -isa menahan !A4.
9ealageala diatas menadi ma2in -erat 1minggu tera2hir.9eala lain & nyeri pinggang$ demam$ !A4
-erpasir disang2al.%iwayat 2onsumsi o-at$ al2ohol$ 2opi$ dan
teh disang2al$ riwayat operasi disang2al$riwayat trauma tulang -ela2ang disang2al.
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%iwayat Penya2it ,ahulu%iwayat Penya2it ,ahulu%iw ,ia-etes mellitus ()%iw :ipertensi ()%iw antung ()
%iw Stro2e ()%iw !atu ginal ()%iw Penya2it ginal ()
%iwayat 4eluarga%iwayat 4eluargadisang2al
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Tanda
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Pemeri2saanPemeri2saan
@isi2@isi2
8ata &4A /$ S /$ Pupil iso2or 'mm/'mm$ %*BC/C$ %*TB C/C
T:T & dalam -atas normal
Beher & pem-esaran 49! () Thora & *or & S1 S' reguler$ 9()$ 8()Pulmo & ves C/C$ %h /$ Dh /
A-domen & *em-ung$ supel$ distensi
(C)$ nyeri te2an suprapu-i2$ tera-a
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Pemeri2saan "eurologisPemeri2saan "eurologis
Tanda rangsang meningeal◦ 4a2u 2udu2 & ◦ 4ernig & ◦ BaseFue & ◦ !rudGins2i & ◦ !rudGins2i &
%eHe Patologis & /%eHe @isiologis & C' C'
C' C'8otori2 & 2esan tida2 terdapatadanya lateralisasi
Sensori2 & 2esan tida2 ada
penurunan sensoris
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Pem-ahasaPem-ahasa
nn
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1. Tida2 !isa !A41. Tida2 !isa !A4tiologi & @ 0 " B
◦
ar$akologi & 2onsumsi o-ato-atan(antiaritmia$ antihistamin$ anti2olinergi2$simpatomimeti2$ antipar2inson$ m.relaan$ dll)
◦ -struksi saluran ke$ih& #a2tor intrinsi2
(pem-esaran prostat$ -atu sal. 4emih$ stri2tururetra$ *a !uli);$#a2tor e2strinsi2 (massa 9T ygmene2an leher -uli)$ lainlain (*a prostat$phimosis$ paraphimosis)
◦ /eurologi : +edera yg mengenai sara# (sara#otonom/peri#er$ ota2 dan medula spinalis)
◦ Infeksi Saluran "e$ih : Prostatitis$ uretritis$ dll
◦ 0ain1lain : 4ompli2asi operasi dan anestesi
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Anamnesa◦ Tida2 -isa !A4 spontan$ ti-ati-a dan nyeri pada
perut -awah %etensi 7rine A47T
◦ 9eala B7TS & *oi.ing &"pto"s & #esiten0 (menunggu
permulaan mi2si)$ &training (mengedan saatmi2si)$ eak strea"ing (aliran lemah)$ Ter"inal.ribbling (dia2hir !A4 urin menetes)$2nter"itten0 (rasa tida2 lampias/mi2si
terputus) ; &torage &"pto"s & 3re4uen0 (#re2uensi !A4
menadi le-ih sering)$ No0turia (!A4 seringdimalam hari)$ Dsuria (nyeri dia2hir mi2si)$geala 5rgen0 (2einginan !A4 yang sulitditahan) tida2 ditemu2an pada pasien ini.
Pada pasien ini&Pada pasien ini&
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9eala lain & nyeri pinggang$demam$ !A4 -erpasir disang2al.
%iwayat 2onsumsi o-at$ al2ohol$2opi$ dan teh disang2al$ riwayatoperasi disang2al$ riwayat traumatulang -ela2ang disang2al.
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Pemeri2saan @isi2Pemeri2saan @isi2A-domen & distensi
(C)$ nyeri te2ansuprapu-i2$ tera-a
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S2oring PSS &S2oring PSS &
Total s2oring B7TS & 1' 9ealaSedang
Iuality o# Bi#e & 6 Tida2 !ahagia
Penanganan segera 2
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,ari Anamnesa dan,ari Anamnesa danPemeri2saan Jsi2 dapatPemeri2saan Jsi2 dapat
disimpul2an&disimpul2an&◦ ,idapat2an -ahwa pasien terse-utmengalamai geala B7TS dan dari hasilpemeri2saan didpat2an -ahwa 2elenarprostat pasien mengalami pem-esaran
Retensi Urin Akut karena HiperplasiaProstat 34uriga 5inak6
◦ tiologi & 0-stru2si saluran 2emih(:iperplasia prostat )
◦ %etensi urine a2ut ini merupa2an salah 12asus gawat darutat urologi oleh se-a-itu perlu ditangani dengan +epat 7eko$presi !uli1uli denganpe$asangan "ateter
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AssesmenAssesmen
tt
Acute Urinary Retention
ec. Suspect Hyperplasia ofProstate
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'. %etensi 7rine A2ut'. %etensi 7rine A2ut
,eJnisi & 2etida2mampuan seseoranguntu2 mengeluar2an urin yangter2umpul di dalam vesi2a urinariahingga daya tampung vesi2a urinaria
mele-ihi 2apasitas ma2simal.4lasiJ2asi &
◦ %etensi urine A2ut & teradi ti-ati-a$vesi2a urinaria penuh$ rasa sa2it yanghe-at.
◦ %etensi urine 4ronis & teradi perlahan$rasa nyeri minimal.
i l i i i
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tiologi %etensi 7rinetiologi %etensi 7rine(@0"B)(@0"B)1. @arma2ologi (1)
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Pada Pria
◦ @a2tor intrinsi2 & pem-esaranprostat$ -atu saluran 2emih$ stri2tururetra$ 2an2er vesi2a urinaria.
◦
@a2tor e2strinsi2 & -ila ada massa diluar saluran 2emih yang mene2anleher 2andung 2emih seperti massapada saluran gastrointestinal.
◦ @a2tor lain & 2an2er prostat$phimosis$ paraphimosis.
'. 0-stru2si Saluran 4emih (1)
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Pada wanita & Prolaps organ pelvis(*ysto+ele/%e+to+ele) dan massa uterusyang mene2an leher 2andung 2emih
Penye-a- paling -anya2 retensi urinpada pria adalah pem-esaran prostat(53K).
4an2er vesi2a urinaria a2an ditandai
dengan adanya bloo. 0lot pada urinnamun tida2 nyeri (Painless#ae"aturia)
'. 0-stru2si Saluran 4emih (')
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3. "eurologi
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Pada pria &◦ Prostatitis & yang dise-a-2an oleh
-a2teri gram negative seperti 60oli dan Proteus sp sehingga dapatmenye-a-2an inHamasi danpem-eng2a2an pada prostat.
◦ 7retritis & menye-a-2an edema padauretra sehingga menye-a-2an retensiurin
Pada wanita &
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Penye-a- lain (2ompli2asi operasi &stri2tur uretra$ e#e2 anestesi $ postpartum$ trauma& ruptur uretra).
5. Bainlain
9 - 4li i (1)9 - 4li i (1)
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9am-aran 4linis (1)9am-aran 4linis (1)0UTS 3Lower Urinary Tract Symptoms6
Voiding Symptoms
◦ Hesitency & menunggu permulaan mi2si
◦ Straining & mengedan saat mi2si
◦ Weak streaming & pan+aran mi2si yang lemah
◦ Terminal dribbling & dia2hir mi2si menetes
◦ Intermittency & rasa tida2 lampias/mi2si terputus
Storage Symptoms
◦ Frequency & #re2uensi !A4 menadi le-ih sering
◦ Nocturia : !A4 menadi le-ih sering dimalam hari
◦ ysuria & nyeri dia2hir mi2si
◦ Urgency & 2einginan !A4 yang sulit ditahan
,i i,i i
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,iagnosis,iagnosisAnamnesis B7TS (mengguna2an
+he+2 list PSS)Pemeri2saan @isi2 &
◦ A-domen & tera-a
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Planning (79, P4*Planning (79, P4**ilanda2)*ilanda2)Pro "ateterisasi Uretra 2ateter no
1 $ 57 = ++ warna 2uning ernih
Lvaluasi ulang a-domen & nyeri te2ansuprapu-i2 sudah tida2 ada dan
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3. ,e2ompresi
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a. 4ateterisasi 7retraa. 4ateterisasi 7retra
ndi2asi 2ateterisasi &◦
8engeluar2an urin dari
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!entu2 4ateter 7retra!entu2 4ateter 7retra
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Alat Tro2ar SistostomiAlat Tro2ar Sistostomi
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Pemasangan SistostomiPemasangan Sistostomi Tro2ar Tro2ar
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Terapi @arma2ologi (1) Terapi @arma2ologi (1)
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Terapi @arma2ologi (') Terapi @arma2ologi (')
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Terima Terima4asih4asih
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