bph & stone
TRANSCRIPT
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
THANK YOU