Skenario 2

Mr. Brown, 60 y.o. come to emergency room with chief complain suddenly cannot voiding

spontaneously and suffered from lower abdominal pain.

From anamneses: since 6 months, he has weak of stream and strain of urination, hesitancy

(delay to start voiding), decreased force and caliber of stream, sensation of incomplete bladder

emptying, straining to urinate, post void dribbing, urgency (+), frequency (+), and nocturia (+)

On Physical Examination:

- Blood pressure : 150/90, heart rate 105 bpm Temp: 37 C

- Head and neck : normal

- Chest : normal

- Abdominal

Inspection : distend lower abdominal

Palpation : Bladder palpable 2 cm below the umbilicus

Additional Information :

- Sphincter tone is normal, prostate enlarge, consitency rubbery, no induration.

- DRE (Digital Rectal Examination) should be done after insert the catheter into the urethra.

- Laboratory finding

Serum creatinine : 1,0

Urine sediment : RBC 10/HPF, WBC 0-2/HPF

- Imaging : USG = Bilateral mild hydronephrossis, bladder is full, Prostate enlarge 6 cm x 5 cm

x 5 cm.

- IPSS (International Prostatic Symptoms Score) since 4 months ago : 28

(0-7 : mild; 8-19 : moderate; 20-35 : severe)

Klarifikasi Masalah

1. Voiding :

2. Lower abdominal pain :

3. Bladder :

4. Void dribbling

5. Nocturia

6. Hydronephrosis

Identifikasi Masalah

1. Mr. Brown, 60 y.o. come to emergency room with chief complain suddenly cannot

voiding spontaneously and suffered from lower abdominal pain

2. From anamneses: since 6 months, he has weak of stream and strain of urination,

hesitancy (delay to start voiding), decreased force and caliber of stream, sensation of

incomplete bladder emptying, straining to urinate, post void dribbing, urgency (+),

frequency (+), and nocturia (+)

3. On Physical Examination:

- Blood pressure : 150/90, heart rate 105 bpm Temp: 37 C

- Head and neck : normal

- Chest : normal

- Abdominal

Inspection : distend lower abdominal

Palpation : Bladder palpable 2 cm below the umbilicus

4. Additional Information :

- Sphincter tone is normal, prostate enlarge, consitency rubbery, no induration.

- DRE (Digital Rectal Examination) should be done after insert the catheter into the

urethra.

- Laboratory finding

Serum creatinine : 1,0

Urine sediment : RBC 10/HPF, WBC 0-2/HPF

- Imaging : USG = Bilateral mild hydronephrossis, bladder is full, Prostate enlarge 6

cm x 5 cm x 5 cm.

- IPSS (International Prostatic Symptoms Score) since 4 months ago : 28

(0-7 : mild; 8-19 : moderate; 20-35 : severe)

Analisis Masalah

1. A. Bagaimana anatomi dan fisiologi dari traktus urinarius ?

B. Bagaimana patofisiologi tidak bisa urinasi secara spontan ?

C. Bagaimana patofisiologi lower abdominal pain ?

2. A. Bagaimana patofisiologi dari abnormalitas yang ditemukan pada anamnesis ?

B. Bagaimana patofisiologi dari :

1) Urgency (+) ?

2) Frequency (+) ?

3) Nocturia ?

3. A. Bagaimana interpretasi dari hasil pemeriksaan fisik ?

B. Bagaimana patofisiologi dari :

1) Hypertension ?

2) Tachycardia ?

3) Distend lower abdominal ?

4) Bladder palpable 2cm under umbilical ?

4. A. Bagaimana interpretasi dari hasil pemeriksaan laboratorium ?

B. Bagaimana patofisiologi dari abnormalitas pada pemeriksaan laboratorium ?

5. A. Bagaimana interpretasi dari hasil pencitraan ?

B. Bagaimana patofisiologi dari abnormalitas pada pencitraan ?

C. Bagaimana criteria IPSS ?

6. Apa saja diagnosis banding pada kasus ini ?

7. Bagaimana cara mendiagnosis kasus ini ?

8. Apa diagnosis kerja kasus ini ?

9. Bagaimana patofisiologi pada kasus ini ?

10. Apa saja manifestasi klinik untuk kasus ini ?

11. Bagaimana penatalaksanaan pada kasus ini ?

12. Apa saja komplikasi yang dapat timbul untuk kasus ini ?

13. Bagaimana prognosis pasien pada kasus ini ?

14. Bagaimana KDU untuk kasus ini ?

Hipotesis

Mr. Brown, 60 th, mengalami retensi urin karena Benign Prostate Hyperplasia (BPH) disertai

hipertensi, bilateral hydronephrosis, dan takikardia.