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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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