BPH & STONE
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Transcript of BPH & STONE
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BASIC KNOWLEDGE
IN UROLOGY
PEERAPAT CHEEWAISRAKUL MD.
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UROLOGY
URINARY SYSTEM
MALE REPRODUCTIVE SYSTEM
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URINARY SYSTEM
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MALE REPRODUCTIVE SYSTEM
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COMMON DISEASE
BENIGN PROSTATIC HYPERPLASIA ( BPH)
STONE DISEASE
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COMMON PROBLEMS
ACUTE URINARY RETENTION (AUR) RENAL COLIC HEMATURIA ACUTE SCROTAL PAIN OBSTRUCTIVE ANURIA KUB INJURY
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LUTS
Lower Urinary Tract Symptoms
1. Irritative Symptoms
2. Obstructive Symptoms
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Irritative Symptoms
1. Frequency
2. Urgency
3. Nocturia
Obstructive Symptoms
1. Hesitancy
2. Straining
3. Intermittency
4. Poor stream
5. Dribbling
6. Sense of residual urine
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CAUSE OF LUTS
Benign Prostatic Hyperplasia (BPH) Stricture urethra Contracture Bladder Neck (CBN) Phimosis Urethral stone Blood clot
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BPH
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Benign Prostatic Hyperplasia (BPH)Benign Prostatic Hyperplasia (BPH)
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BPH
MEN over 50 years old
Sign and symptom LUTS Acute urinary retention
Digital Rectal Examination (DRE)
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TREATMENT OPTION
Watchful waitingMedical treatmentSurgical treatment
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BPH
Line of Management Symptom score
(mild,moderate,severe) Quality of life , Bothersome Comorbidity
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MEDICATION
1. Alpha adrenergic antagonist (α-Blocker)
2. 5α-reductase inhibitor
3. Phytotherapy
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α-Blocker
PRAZOSIN ( Minipress®) DOXAZOSIN (Cardura XL®) ALFUZOSIN (Xatral XL®) TAMSULOSIN (Harnal®) TERAZOSIN (Hytrin®)
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Side effect
Dizziness
Orthostatic hypotension
Retrograde ejaculation
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Surgical management
Transurethral prostatectomy (TUR-P) Internal stent Transurethral microwave therapy(TUMT) Transurethral needle ablasion (TUNA) Laser prostatectomy Suprapubic prostatectomy (SPP)
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INDICATION FOR SURGERY
RECURRENT URINARY RETENTION RECURRENT INFECTION RENAL IMPAIRMENT FROM BPH BLEEDING VESICAL CALCULI (VC) BLADDER DIVERTICULUM FAILURE MEDICAL TREATMENT
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STENT
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TUNA
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Laser SurgeryLaser Surgery
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LaserLaser
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TUR-P
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TUR-PTUR-P
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TUR-P
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TUR-P
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Before - After
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SUPRAPUBIC PROSTATECTOMY
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COMPLICATION OF TUR-P
EARLY COMPLICATION
BLEEDING PERFORATION : prostatic capsule ,
bladder , rectum TURP SYNDROME
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TURP-SYNDROME
WATER INTOXICATION HYPONATREMIA SYSTOLIC HYPERTENSION BRADYCARDIA CONFUSION
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COMPLICATION OF TUR-P
LATE COMPLICATION URINARY INCONTINENCE RETROGRADE EJACULATION ERECTILE DYSFUNCTION CBN STRICTURE URETHRA RECURRENT ADENOMA
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URINARY CALCULI
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OPAQUE STONESEMI-OPAQUE STONENONOPAQUE STONE
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SEMI-OPAQUE STONE
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NONOPAQUE STONE
ACIDURIA (pH < 6) CYSTINE , XANTINE , URIC
ACID STONE MEDICAL TREATMENT
(HYDRATION +ALKALINIZE URINE)
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RENAL CALCULI RENAL CALCULI (RC)
STAGHORN STONESTAGHORN STONE PELVIC STONE PELVIC STONE CALICEAL STONECALICEAL STONE■ UPPER UPPER ■ MIDDLEMIDDLE■ LOWERLOWER
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COMPLETECOMPLETE
STAGHORNSTAGHORN
STONESTONE
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Post acoustic shadow
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IVPIVP
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URETERIC CALCULI (UC)
UPPER MIDDLE DISTAL
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VESICAL CALCULI ( VESICAL CALCULI (VCVC))
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PHLEBOLITH
CIRCULAR SMOOTH SURFACE CENTRAL HALO OUT OF KUB SYSTEM NEED NO TREATMENT
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DISTAL UC VS PHLEBOLITH
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TREATMENT
CONSERVATIVE ESWL ENDOSCOPY ( URS , PCNL ) OPEN STONE SURGERY
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ESWL
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PCNL
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PCNL
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URS
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URS
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THANK YOU