Kuliah Trauma Urogenital - 2
Kuliah Trauma Urogenital - 2
Anatomi
Ginjal
Ureter
Buli buli
Uretra
TRAUMA UROGENITAL
Anatomi
Ginjal
Ureter
Buli buli
Uretra
Ginjal
Sepasang organ seperti kacang
Terletak retroperitonel diregio lumbal superior
Dilapisi oleh 3 lapis jaringan penunjang:
kapsul ginjal
kapsul adipose dan
fasia renalis
Ureter
Tubulus muscular yang menghubungkan ginjal ke buli
buli
Terletak di belakang rongga peritoneum
(retroperitoneal)
Panjang 25 – 30 cm
TRAUMA GINJAL
Trauma Ginjal
Sering
8-10% trauma tumpul / tajam abdomen
Separuh dari kejadian trauma urogenital
Di proteksi :
* Otot-otot lumbal
* Iga
* Vertebrae
Angka kesakitan / kematian ok trauma ginjal
tergantung :
Derajat trauma
Keterlibatan trauma organ lain
Fasilitas penanggulangan trauma
Buli-buli
Buli buli normal dapat menampung 350 – 450 mL
urine
Drainase kendung kemih bermuara ke vena iliaca
interna
Uretra
Tabung yang menyalurkan urine ke luar dari buli-buli
Secara anatomis uretra dibagi menjadi 2 bagian :
Uretra posterior dan
Uretra anterior
Mekanisme Trauma
Trauma tumpul -> penyebab trauma
Langsung, tidak langsung
Klasifikasi
* Ada beberapa macam
* Ditentukan oleh luas dan penatalaksanaan
Cedera Ginjal
* Minor
* Mayor
* Vaskuler
Cedera Minor
90% trauma ginjal
Kontusio ginjal
Laserasi parenkim superficial
Cedera Mayor
Laserasi korteks, medula tanpa ekstravasasi
Laserasi korteks, medula dengan
ekstravasasi
Cedera Vaskuler
Avulsi
Trombosis
Berdasarkan AAST ( American for The Surgery of Trauma
)
Berdasarkan AAST
( American for The Surgery of Trauma )
Dibagi 5 derajat
Derajat 1
Kontusio ginjal /subkapsularhematom
Tidak meluas
Hematuria dengan normal imaging
Derajat 2
Hematom perineal
Tdk meluas ke retroperitonium
Laserasi superficial ( < 1cm )
Tdk melibatkan collecting systim
Derajat 3
Renal laserasi ( > 2cm )
Sub capsular hematom
Perinephric hematom
Tdk melibatkan collecting systim
Derajat 4
Laserasi yang meluas ke collecting systim
Extravasasi
Trauma vasculer segmental infark
Derajat 5
Shattered kidney
Devaskularisasi / oklusi / trombosis
arteri / vena utama
Laserasi komplit
Extravasasi
UPJ avulsi
Pemeriksaan Radiologi
USG
* Melihat hemoperitoneum, kerusakan parenkim ,
pemeriksaan non invasif , sebagai pemeriksaan awal .
* Tdk dianjurkan utk evaluasi trauma
ginjal
* Dengan color doppler melihat vaskuler
Gambaran trauma ginjal pada USG :
Hematom sub capsular: adanya area hipoechoic,
bentuk bulan sabit,
Hematom intra renal akut… hiperechoic.
Laserasi high grade --- perubahan echogenitas dan
struktur ginjal.
CT Scan
Pemeriksaan yang sensitif dan spesifik
Menentukan derajat trauma
Tidak invasif
Dpt mengevaluasi organ lain
( hepar , lien , aorta )
kontras non kontras
Angiografi
Invasif
Delayed renal bleeding-pseudo-aneurisma
IVP normal
USG ginjal normal
CT scan ginjal normal
Gambar 1. Kidney trauma. Absent nephrogram. Abdominal radiograph after
intravenous contrast administration in a patient with hypotension after a
motor vehicle collision shows absent right nephrogram
Gambar 2. Kidney trauma. Grade 3 renal laceration on
abdominal radiograph. Abdominal radiograph after
intravenous contrast administration shows very
diminished left nephrogram and no urinary contrast
extravasation
Gambar 3. Kidney trauma. Grade 5 renal injury. Shattered kidney with renal
vein thrombosis (incomplete). Abdominal radiograph after intravenous
contrast administration shows absent right nephrogram
Gambar 4 Kidney trauma. Grade 1 renal injury, contusion. Image from a
contrast-enhanced CT scan of the abdomen in a patient with hematuria after a
motor vehicle collision shows ill-defined area of hypoenhancement in the
medial right kidney.
Gambar. 5. Kidney trauma. Grade 1 renal injury, subcapsular
hematoma. CT scan of the abdomen with intravenous contrast in a
patient after a motor vehicle collision shows crescentic high-density
fluid collection around the left kidney. Note the well-defined outer
margin
Gambar 6. Kidney trauma. Grade 1 renal injury, subcapsular hematoma. CT
scan of the abdomen with intravenous contrast in a patient after a motor
vehicle collision; shows crescentic high-density fluid collection around the
left kidney. Note the well-defined outer margin and the mild deformity of the
renal parenchyma
Derajat II dan III
Gambar 17. Kidney trauma. Grade 5 renal injury. Shattered kidney. Contrast-
enhanced CT scan of the abdomen in a patient with hematuria and hypotension
after a motor vehicle collision shows transection of the right kidney with a large
hematoma around and between the 2 halves of the kidney. The 2 halves are both
perfused because there were 2 renal arteries Delayed images show urinary
contrast extravasation
Gambar 18. Kidney trauma. Grade 5 renal injury. Shattered kidney. Contrast-
enhanced CT scan of the abdomen in a patient with hematuria and hypotension
after a motor vehicle collision shows transection of the right kidney with a large
hematoma around and between the 2 halves of the kidney. The 2 halves are both
perfused because there were 2 renal arteries. Delayed images show urinary
contrast extravasation
Gambar 19 Kidney trauma. Grade 5 renal injury. Shattered kidney. Contrast-enhanced
CT scan of the abdomen in a patient with hematuria and hypotension after a motor
vehicle collision shows transection of the right kidney with a large hematoma around
and between the 2 halves of the kidney. The 2 halves are both perfused because there
were 2 renal arteries Delayed images show urinary contrast extravasation
Gambar 20. Kidney trauma. Grade 5 renal injury. Shattered kidney. Contrast-
enhanced CT scan of the abdomen in a patient with hematuria and
hypotension after a motor vehicle collision shows transection of the right
kidney with a large hematoma around and between the 2 halves of the
kidney. The 2 halves are both perfused because there were 2 renal arteries.
Delayed images show urinary contrast extravasation
Gambar 21. Kidney trauma. Grade 5 renal injury. Shattered kidney with renal vein
thrombosis (incomplete). CT scan of the abdomen with intravenous contrast
administration shattered right kidney and renal vein thrombus extending slightly
into the inferior vena cava
Gambar 22. Kidney trauma. Normal ultrasound with grade 5 renal injury.
Ultrasound gray-scale image of a patient involved in a motor vehicle
collision shows what appears to be a normal right kidney
Gambar 23 Kidney trauma. Grade 5 renal injury. Color Doppler ultrasound of
same motor vehicle collision patient as in Image 4 shows no blood flow within
the right kidney.
4.Arteriografy
Trauma Luar
a. Tajam
b. Tumpul
Iatrogenik
a. Ginekologis
b. Pembedahan rektum
c. Endoskopi
Pemeriksaan Radiologi
IVP ( Intra Vena Pyelografi )
RPG ( Retro Grade Pyelografi )
USG ( Ultra Sono Grafi )
CT Scan Abdomen/ CT cystografi
Klasifikasi :
Ada beberapa.
Menurut AAST, Concensus Societe International
D’urologie, dan berdasarkan temuan pada CT
Cystografi
Berdasarkan temuan pada pemeriksaan CT Cystografi
:
Type 1,2,3,4,4a,4b dan 5 .
Type 1: kontusio buli.
Type 2: ruptur intraperitonial.
Type 3: trauma intersititial buli
Type 4 : ruptur extra peritonial.
Type 4a: ruptur extraperitonial simple.
Type 4 b : ruptur extra peritonial kompleks.
Type 5 : trauma buli kombinasi
TRAUMA UROGENITAL
• Anatomi
– Ginjal
– Ureter
– Buli buli
– Uretra
Trauma Vesika Urinaria
Disebabkan : Trauma
- Tumpul
- Tajam
- Iatrogenik
Didaerah pelvis / abdomen bawah/
perineum
60-85 % trauma tumpul
15-40 % trauma tajam
Ruptur vesika urinaria : ke
Ekstra peritoneum
Intra peritoneum
Keduanya
Pemeriksaan :
Sistografi
CT scan abdomen - pelvis
Kontusio Vesika Urinaria
Normal
Tear Drop
Mudah sembuh
Etiologi
Trauma tumpul
Trauma tembus
Iatrogenik
Anatomi
Uretra posterior
* uretra prostatika
* uretra membranosa
Uretra anterior
3 segmen : * pars bulosa
* pars pendulans
* pars glanularis
sampai ke meatus uretra externa
Diagnosa
Tipe 1