bph & stone

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BASIC KNOWLEDGE IN UROLOGY PEERAPAT CHEEWAISRAKUL MD.

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Page 1: BPH & STONE

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