urologic trauma

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UROLOGIC TRAUMA dr. Cut Rosnani SpRad

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Page 1: Urologic Trauma

UROLOGIC TRAUMA

dr. Cut Rosnani SpRad

Page 2: Urologic Trauma

Renal trauma Ureteral injury Bladder injury Urethral injury Injury to external genitalia

UROLOGIC TRAUMA

Page 3: Urologic Trauma

Plain foto (BOF – LLD) USG Abdomen CT Scan Abdomen Angiografi Foto dengan contrast bila perlu

IMAGING

Page 4: Urologic Trauma

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

Page 5: Urologic Trauma

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

Page 6: Urologic Trauma

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

Page 7: Urologic Trauma

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

Page 8: Urologic Trauma

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

Page 9: Urologic Trauma

Non Invasif : Plain foto (BNO) USGInvasif : IVP CT Scan Abdomen Angiografi

Pemeriksaan Radiologi

Page 10: Urologic Trauma

◦ Grade 1,2 : minor trauma◦ Grade 3,4,5 : major trauma

Renal Trauma

Page 11: Urologic Trauma

Grade I Contusion

◦ Hematuria (micro or gross)

◦ Urologic studies N

Hematoma◦ Subcapsular◦ Non expanding◦ Parenchyma N

Page 12: Urologic Trauma

Grade II Hematoma

◦ Perirenal◦ Nonexpanding

Laceration◦ < 1.0 cm◦ Renal cortex only◦ No urinary

extravasation

Page 13: Urologic Trauma

Grade III

Laceration◦ > 1.0 cm◦ Renal cortex only◦ No urinary

extravasation◦ Intact collecting

system

Page 14: Urologic Trauma

Grade IV Laceration

◦ Renal cortex◦ Renal medulla◦ Collecting system

Vascular◦ Main renal

artery/vein injury with contained hemorrage.

Page 15: Urologic Trauma

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.

Page 16: Urologic Trauma

Mechanism :1. External trauma 2. Surgical trauma

URETERAL INJURY

Page 17: Urologic Trauma

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

Page 18: Urologic Trauma

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

Page 19: Urologic Trauma

Hematuria Pelvic or lower abdominal pain Imaging : - cystography - CT cystography

BLADDER TRAUMA : Sign & symptom

Page 20: Urologic Trauma

Extraperitoneal Bladder Rupture:

Page 21: Urologic Trauma

Intraperitoneal: Dome is weakest

Page 22: Urologic Trauma

location Anterior urethra: bulbous & pendulous Posterior urethra: membrano - prostatic

Urethral TraumaProstatic

Membranous

Bulbous

Pendulous

Page 23: Urologic Trauma

73% is complete, 27% partial Rare in women Mechanism: pelvic fracture Triad:

◦ “Blood at the meatus”◦ Inability to urinate◦ Full bladder

Posterior urethral injuries

Page 24: Urologic Trauma

Posterior Urethral rupture

From McAnich JW. In Tanagho EA, McAninch JW, editors: Smith’s general urology, ed 14, Norwalk, Conn, 1995, Appleton & Lange.

Page 25: Urologic Trauma

Retrograde urethrogram:

Posterior Urethral Injury Diagnosis

Page 26: Urologic Trauma

Contrast extravasation + Contrast in bladder

Contrast extravasation only

Retrograde Urethrogram:Interpretation

PARTIAL Tear

COMPLETE Tear

Page 27: Urologic Trauma

Partial Tear

Page 28: Urologic Trauma

Complete Tear

Page 29: Urologic Trauma

Scrotal injuries Penile fracture Testis rupture

EXTERNAL GENITALIA