bph & stone

BASIC KNOWLEDGE

IN UROLOGY

PEERAPAT CHEEWAISRAKUL MD.

UROLOGY

URINARY SYSTEM

MALE REPRODUCTIVE SYSTEM

URINARY SYSTEM

MALE REPRODUCTIVE SYSTEM

COMMON DISEASE

BENIGN PROSTATIC HYPERPLASIA ( BPH)

STONE DISEASE

COMMON PROBLEMS

ACUTE URINARY RETENTION (AUR) RENAL COLIC HEMATURIA ACUTE SCROTAL PAIN OBSTRUCTIVE ANURIA KUB INJURY

LUTS

Lower Urinary Tract Symptoms

1. Irritative Symptoms

2. Obstructive Symptoms

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

CAUSE OF LUTS

Benign Prostatic Hyperplasia (BPH) Stricture urethra Contracture Bladder Neck (CBN) Phimosis Urethral stone Blood clot

BPH

Benign Prostatic Hyperplasia (BPH)Benign Prostatic Hyperplasia (BPH)

BPH

MEN over 50 years old

Sign and symptom LUTS Acute urinary retention

Digital Rectal Examination (DRE)

TREATMENT OPTION

Watchful waitingMedical treatmentSurgical treatment

BPH

Line of Management Symptom score

(mild,moderate,severe) Quality of life , Bothersome Comorbidity

MEDICATION

1. Alpha adrenergic antagonist (α-Blocker)

2. 5α-reductase inhibitor

3. Phytotherapy

α-Blocker

PRAZOSIN ( Minipress®) DOXAZOSIN (Cardura XL®) ALFUZOSIN (Xatral XL®) TAMSULOSIN (Harnal®) TERAZOSIN (Hytrin®)

Side effect

Dizziness

Orthostatic hypotension

Retrograde ejaculation

Surgical management

Transurethral prostatectomy (TUR-P) Internal stent Transurethral microwave therapy(TUMT) Transurethral needle ablasion (TUNA) Laser prostatectomy Suprapubic prostatectomy (SPP)

INDICATION FOR SURGERY

RECURRENT URINARY RETENTION RECURRENT INFECTION RENAL IMPAIRMENT FROM BPH BLEEDING VESICAL CALCULI (VC) BLADDER DIVERTICULUM FAILURE MEDICAL TREATMENT

STENT

TUNA

Laser SurgeryLaser Surgery

LaserLaser

TUR-P

TUR-PTUR-P

TUR-P

TUR-P

Before - After

SUPRAPUBIC PROSTATECTOMY

COMPLICATION OF TUR-P

EARLY COMPLICATION

BLEEDING PERFORATION : prostatic capsule ,

bladder , rectum TURP SYNDROME

TURP-SYNDROME

WATER INTOXICATION HYPONATREMIA SYSTOLIC HYPERTENSION BRADYCARDIA CONFUSION

COMPLICATION OF TUR-P

LATE COMPLICATION URINARY INCONTINENCE RETROGRADE EJACULATION ERECTILE DYSFUNCTION CBN STRICTURE URETHRA RECURRENT ADENOMA

URINARY CALCULI

OPAQUE STONESEMI-OPAQUE STONENONOPAQUE STONE

SEMI-OPAQUE STONE

NONOPAQUE STONE

ACIDURIA (pH < 6) CYSTINE , XANTINE , URIC

ACID STONE MEDICAL TREATMENT

(HYDRATION +ALKALINIZE URINE)

RENAL CALCULI RENAL CALCULI (RC)

STAGHORN STONESTAGHORN STONE PELVIC STONE PELVIC STONE CALICEAL STONECALICEAL STONE￭ UPPER UPPER ￭ MIDDLEMIDDLE￭ LOWERLOWER

COMPLETECOMPLETE

STAGHORNSTAGHORN

STONESTONE

Post acoustic shadow

IVPIVP

URETERIC CALCULI (UC)

UPPER MIDDLE DISTAL

VESICAL CALCULI ( VESICAL CALCULI (VCVC))

PHLEBOLITH

CIRCULAR SMOOTH SURFACE CENTRAL HALO OUT OF KUB SYSTEM NEED NO TREATMENT

DISTAL UC VS PHLEBOLITH

TREATMENT

CONSERVATIVE ESWL ENDOSCOPY ( URS , PCNL ) OPEN STONE SURGERY

ESWL

PCNL

PCNL

URS

URS

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