TRAUMA UROGENITALIA

dr. JUFRIADY ISMY, SpU

Sub Bagian Urologi / Lab Ilmu Bedah
RSUZA/ F.K.NSYIAH

Rujukan:
Smiths General Urology
Campbells Urology

Trauma Urogenitalia

Ginjal
Ureter
Buli-buli
Urethra
Genitalia eksterna

GINJAL

klinis
mekanisme trauma
klasifikasi
evaluasi dan diagnosa
terapi

Trauma Urogenitalia
klinis:
anamnesa : mode of injury
pem.fisik : jejas
urinalisis : hematuria

mekanisme trauma:

tr.tajam, tr.tumpul

Trauma Urogenitalia
klasifikasi :
1. Trauma ginjal minor (85% kasus)
grade I & II

2. Trauma ginjal mayor (15% kasus)

grade III, IV, & V

3. Trauma vaskular

Organ Injury Scaling Committee

Moore et al. Organ Injury Scaling: Sleen, Liver and Kidney, The
Journal of Trauma, 29: 1664; 1989.

Grade I
Contusion
Hematuria
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.

Pedicule Injury

Trauma Urogenitalia
evaluasi dan diagnosa

anamnesa
jejas
urin keluar? Warna?
hati2 trauma organ lain: costae,
abdomen

IVP

(harus dilakukan, terutama untuk melihat

ginjal kontralateral)

USG, arteriografi (angiography) bila

perlu
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Trauma Urogenitalia
Terapi: prinsip konservatif
indikasi bedah:

perdarahan tak dapat diatasi

injury renovascular
parenkhim tidak viable
ektravasasi urin luas
pembedahan: laparotomi eksplorasi,
repair, k/p nefrektomi

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Trauma Urogenitalia
terapi: prinsip konservatif
observasi:

tanda2 vital: T/N/t

masa lumbal
warna urine serial
tanda anemis / Hb serial

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URETER
paling jarang, ok. mobile & kaliber
kecil
Kausa:
trauma eksterna
trauma iatrogenik: operasi obsgin

diagnosis:
Anamnesa
hematuria
klinis, IVP, RPG
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BLADDER

anamnesa
pem. fisik
urinalisis
radiologik
terapi

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Types of rupture
Extraperitoneal
Most common
Pelvic # in 89-100%
Bladder rupture in 5-10% of all pelvic #

Intraperitoneal
Extravasation of urine in abdomen
Sudden force to full bladder
Associated injuries +++
Mortality (20%)

Trauma Urogenitalia
anamnesa
trauma langsung
tumpul
tajam / penetrasi

deselerasi mendadak
hematuria / retensi urin

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Clinical Presentation
McConnel et al. Rupture of the bladder. Urol Clin North Am. 1982.
Carroll et al. Major bladder trauma: Mechanisms of injury and a
unified method of diagnosis and repair. Journal of Urology. 1984.

98% : Gross hematuria

2%: Microscopic hematuria + Pelvic #
Morey AF et al. Bladder rupture after blunt trauma : guidelines for
diagnostic imaging. Journal of Trauma-Injury Infections & Critical
Care. 51(4): 683-6, 2001 Oct.

100%: Gross hematuria

85% Pelvic #

Trauma Urogenitalia
pem. fisik:
jejas suprapubik
nyeri suprapubik
akut abdomen
gross hematuria hebat
shock hemoragik

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BLADDER
radiologik
sistografi: ekstravasasi urin
IVP bila perlu
bedakan ruptura ekstra atau intra
peritoneal
lihat adakah fraktura pelvis

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PENATALAKSANAAN
Extra Peritoneal : Pasang kateter
Intra peritoneal : Operatif

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URETHRA

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Prostatic
Membranous
Bulbous

Pendulous

URETHRA
- Klasifikasi :
1. Trauma Uretra Posterior

Kecelakaan lalu lintas : 90% karena fraktur pelvis

Manipulasi kateter

Manipulasi endoskopi

2. Trauma Uretra Anterior

Manipulasi kateter atau endoskopi

Straddle injury

Kecelakaan lalu lintas

Self manipulasi : erotic manipulation

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Posterior Urethral rupture

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

Trauma Urogenitalia
Urethra
klinis
pem. fisik
radiologik dan klasifikasi
terapi

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Trauma Urogenitalia
Urethra
klinis
kausa
trauma eksternal:
trauma tumpul kecepatan tinggi
crush injury
saddle back injury

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Trauma Urogenitalia
Urethra
klinis
pem. fisik:
3 gejala utama (trias)
retensi urin
bloody discharge
prostat melayang (RT)

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Trauma Urogenitalia
Urethra
radiologik
urethrogram retrograde :
extravasasi uretra posterior atau
anterior

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Retrograde
Urethrogram

Retrograde Urethrogram:
Interpretation
Contrast extravasation + Contrast in
bladder
PARTIAL Tear
Contrast extravasation only
COMPLETE Tear

Partial Tear

Complete Tear

Kozin, Berlet. Handbook of Common Orthopaedic Fractures, 4th ed., 2000.

Management
Partial tear
careful passage of 12-14 Fr. Foley.
If any resistance: Urology

Complete tear:
Urology + suprapubic cath.

If Foley already there and suspect

tear:
LEAVE FOLEY IN PLACE
Small tube alongside the foley
Angiocath 16-gauge
Modified urethrogram

Trauma Urogenitalia
Urethra
terapi
ruptura u. posterior: sistostomi
ruptura u. anterior: repair primer
(dalam 6 jam pasca kejadian) atau
sistostomi

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Trauma Urogenitalia

Genitalia eksterna
penis
testis
skrotum
vas deferens & epididimis

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Trauma Urogenitalia
Genitalia eksterna
penis
fraktura penis: kavernosografi
amputasi penis traumatika

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