urologic trauma
TRANSCRIPT
UROLOGIC TRAUMA
dr. Cut Rosnani SpRad
Renal trauma Ureteral injury Bladder injury Urethral injury Injury to external genitalia
UROLOGIC TRAUMA
Plain foto (BOF – LLD) USG Abdomen CT Scan Abdomen Angiografi Foto dengan contrast bila perlu
IMAGING
Initial dalam evaluasi trauma abdomen Pemeriksaan BOF meliputi diaphragma
s/d. cavum pelvis. Penting bila waktu ada KU pasien baik
dilakukan diaphragma foto (tegak) atau LLD (20 menit).
Plain Foto
Melihat udara bebas Cairan bebas (floating intestine) Kelainan tulang (fraktur) terutama coste-
coste kanan Perubahan countur organ Melihat struktur intestine (bowel pattern)
Kegunaan dari Plain Foto
Keuntungan : Non invasif dan
dapat dilakukan dengan cepat
Evaluasi cairan bebas di empat kuadran
Evaluasi organ padat, hepat, lien, ginjal.
Kerugian : Personal dependent Bila KU penderita
menurun maka waktu pemeriksaan relatif singkat
Px. Sulit dimobilisasi, bila KU menurun
Sering terganggu bayangan gas usus
Keuntungan / Kerugian USG
Dilakukan bila dicurigai trauma pada organ padat atau berongga
Tanpa persiapan dengan pemasangan sonde lambung
Dilakukan dengan injeksi zat contrast media 50 – 100 cc
Back up anestesi bila pasien gelisah Irisan mulai diaphragma s/d. daerah yang
dicurigai cavum pelvis
Pemeriksaan CT Scan
Mayoritas kasus grade 1 Dicurigai
◦Significant flank ecchymosis / hematuria◦Fractur Lower rib (T8-12) ◦Hematom (soft tissue swelling) pada
daerah abdomen sisi lateral (flank area)◦Hematuria
Nausea vomitus
TRAUMA RENAL
Non Invasif : Plain foto (BNO) USGInvasif : IVP CT Scan Abdomen Angiografi
Pemeriksaan Radiologi
◦ Grade 1,2 : minor trauma◦ Grade 3,4,5 : major trauma
Renal Trauma
Grade I Contusion
◦ Hematuria (micro or gross)
◦ Urologic studies N
Hematoma◦ Subcapsular◦ Non expanding◦ Parenchyma N
Grade II Hematoma
◦ Perirenal◦ Nonexpanding
Laceration◦ < 1.0 cm◦ Renal cortex only◦ No urinary
extravasation
Grade III
Laceration◦ > 1.0 cm◦ Renal cortex only◦ No urinary
extravasation◦ Intact collecting
system
Grade IV Laceration
◦ Renal cortex◦ Renal medulla◦ Collecting system
Vascular◦ Main renal
artery/vein injury with contained hemorrage.
Grade V Completely
shattered kidney.
Avulsion of renal hilum (pedicule) which devascularizes kidney.
Kennon et al. Radiographic assessment of renal trauma: our 15-year experience. The Journal of Trauma, 154: 353-355; August 1995.
Mechanism :1. External trauma 2. Surgical trauma
URETERAL INJURY
Symptoms : fever, flank and lower quadrant pain, if bilateral anuria
Signs : acute hydronephrosis, sign & symptoms of acute peritonitis may be (+)
Imaging : IVU, RPG, CT
URETERAL INJURY : Sign & symptom
86% due to blunt abdominal trauma 90% assoc with pelvic fx 60% extraperitoneal, 30% intraperitoneal, 10 – 12% combined injuries Mechanism of injury : - intraperitoneal - extraperitoneal
BLADDER TRAUMA
Hematuria Pelvic or lower abdominal pain Imaging : - cystography - CT cystography
BLADDER TRAUMA : Sign & symptom
Extraperitoneal Bladder Rupture:
Intraperitoneal: Dome is weakest
location Anterior urethra: bulbous & pendulous Posterior urethra: membrano - prostatic
Urethral TraumaProstatic
Membranous
Bulbous
Pendulous
73% is complete, 27% partial Rare in women Mechanism: pelvic fracture Triad:
◦ “Blood at the meatus”◦ Inability to urinate◦ Full bladder
Posterior urethral injuries
Posterior Urethral rupture
From McAnich JW. In Tanagho EA, McAninch JW, editors: Smith’s general urology, ed 14, Norwalk, Conn, 1995, Appleton & Lange.
Retrograde urethrogram:
Posterior Urethral Injury Diagnosis
Contrast extravasation + Contrast in bladder
Contrast extravasation only
Retrograde Urethrogram:Interpretation
PARTIAL Tear
COMPLETE Tear
Partial Tear
Complete Tear
Scrotal injuries Penile fracture Testis rupture
EXTERNAL GENITALIA