Panduan Praktik Klinis (Ppk) Bph

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PPK BPH sebagai dasar pembuatan CP
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   PANDUAN PRAKTIK KLINIS (PPK) BENIGN PROSTATIC HYPERPLASIA (BPH) 1.   PENGERTIAN Pembesaran ukuran kelenjar prostat yang jinak. 2.   ANAMNESIS 1. Pancaran urin melemah 2. Rasa tidak puas saat miksi 3. Kalau mau miksi harus menunggu lama 4. Nokturia 5. Urgensi 6. Urin menetes setelah berkemih 7. Waktu miksi memanjang 8. Retensio urine 3.   PEMERIKSAAN FISIK Rectal Touche (RT): 1. Konsistensi kelenjar prostat kenyal 2. Kelenjar prostat tidak simetris 3. Ukuran kelenjar prostat teraba 2-3 ruas jari 4. Tidak teraba nodul pada perabaan kelenjar prostat 5. Sulcus medianus datar atau cembung 6. Pole atas tidak teraba (semakin besar semakin sulit teraba) 4.   KRITERIA DIAGNOSIS 1.   Adanya gejala obstruktif dan iritatif 2.   International Prostate Symptom Score (IPSS)   menentukan derajat berat atau ringan 3.   Memenuhi kriteria pemeriksaan fisik (RT) no. 1-6 4.   DIAGNOSIS KERJA Benign Prostatic Hyperplasia (BPH) 5.   DIAGNOSIS BANDING 1. Prostatitis 2. Batu buli-buli 3. Keganasan prostat 4. Infeksi Traktus Urinarius 5. Striktur Urethra 6. Batu uretra proksimal/prosterior 6.   PEMERIKSAAN PENUNJANG 1. Darah rutin 2. Urine rutin 3. Kultur Urine 4. Ureum kreatinin 5. GDS 6. PSA (< 5 ng/ml) 7. IVP (jika ada curiga obstruksi uropathy) 8. USG Abdomen 7.   TATA LAKSANA TINDAKAN OPERATIF Bila ada komplikasi (retensio urin, ISK, batu sal-kemih, hematuria, Skor IPSS > 19) 1. Open Prostatectomy (bila TUR-Prostat tidak dapat dilakukan) 2. TUR-Prostat Antibiotic profilaksis 1 jam sebelum operasi atau 24 jam post   TERAPI KONSERVATIF PERAWATAN operasi (Chephalosporin III) Jika skor IPSS < 8, atau 8-19 belum ada komplikasi/kontradiksi mutlak : pemberian terapi medikametosa ( α blocker atau 5 α reductase inhibitor selama6 bulan), selanjutnya diobservasi ulang 1. Open 5 hari post op 2. TUR-P 3 hari post op 8.   EDUKASI 1.   Penjelasan diagnosa, diagnosa banding, pemeriksaan penunjang 2.   Penjelasan rencana tindakan, lama tindakan, resiko dan komplikasi (Incontinensis urin) 3.   Penjelasan alternatif tindakan 4.   Penjelasan perkiraan lama rawat 9.   PROGNOSIS Ad vitam : dubia adbonam  Ad Sanationam : dubia adbonam Ad Fungsionam : dubia adbonam  10.   TINGKAT EVIDENS III 11.   TINGKAT REKOMENDASI C 12.   PENELAAH KRITIS SMF Bedah 13.   INDIKATOR (OUTCOME) 1. BAK spontan dan lancar, hematuria< 5 hari 2. Lama hari rawat : 7 hari (open), 3. Tidak terjadi Infeksi Luka Operasi (ILO) 4. Kesesuaian dengan hasil PA 14.   KEPUSTAKAAN 1. Cunningham, GR, Kadmon D. “Epidemiology and pathogenesis of benign prostatic hyperplasia”. UpToDate; updated Sep. 10, 2013.  2. “Urge incontinence”. MedlinePlus. US National Library of Medicine. Retrieved 26 October 2015. 3. White, JM; O’Brien, DP; Walker, HK; Hall, WD; Hurst JW (1990). Incontinence and Stream Abnormalities”.  4. Sarma, AV; Wei, JT (19 July 2012). Clinical Practice. “Benign prostatic hy perplasia and lower urinary tract symptomps.” The New England Journal of Medicine. 367 (3): 248-57. 5. McConnel JD. “Epidemiology, etiology, pathophysiology and diagnosis of benign prostatic hyperplasia”. In: Wals PC, Retik AB, Vaughan ED, Wein AJ. Campbel l’s urology. 7 th  ed. Philadelphia: WB Saunders Company; 1998. p.1429-52. 6. Principal of Surgery, Schwartz’s .
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