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Kelompok 3

 Putri wulan S. 05020004  Eka Mahyuni 05020058


 Adya Jati N. 05020007  Devi Putri N. 05020062
 Muhammad Syarif 05020010  Ayu Lidya P. 05020067
 M.Lutfi Azizi 05020013  Shonnif Akbar 04020022
 Febriendo Fanny 05020015  Dina Wahyu
 Istin Erisda 05020020  Dian Pratiwi
 Qarina El-Hariza 05020022  Windy O.
 Wijayanto 05020024  Arief Rahman
 M.Hidayat 05020027  Sri indriyawati
 Annisa Putri A. 05020030  Retno ayu
 Ita Riyanti 05020035  Doddy adi
 Aryati Susilo 05020038  Rio ardona
 Rosa Indira 05020040  Yunika
 Dendy dwi R. 05020045  Riyadh
 Najwa J. H. 05020046  Guruh
 Suriani 05020051  nouval
 Ferrita Aisya K. 05020054
Seorang pria berusia 57 tahun datang ke dr.
dengan mengeluh kencingnya sedikit. Keadaan
ini sudah dirasakan sejak 3 hari ini. Beberapa
hari ini badan lemah,mual,muntah, dan demam.
Sudah hampir setahun ini merasakan nyeri
pinggang dan beberapa kali keluar batu sebesar
kedelai dan kencing berwarna merah seperti
darah. Pada pemeriksaan fisis, keadaan
lemah,kesan anemis, tekanan darah 90/60, nadi
104/menit,suhu tubuh 37,8° C menunjukkan
nyeri ketok pada pinggang kiri.
 Oligouria
 fever
 Noncolicky renal pain
 Urinary stone
 Hematuria
 Flank pain
 Oligouria  obstruction of urinary tract
 Fever  infalamation / infection (urosepsis )
 Noncolicky renal pain  distention of the
renal capsule.
 Urinary stone  pathologycal proses
 Hematuria  trauma of urinary tract mucosa
because stone.

Sumber : Smith’s General Urology, 17 Edition, 2008


Color Atlas Pathophysiology,2000
 symptoms similar to those of renal colic can be caused by
noncalculus conditions
› in women
 gynecologic processes that must be considered include ovarian torsion,
ovarian cyst and ectopic pregnancy
› in men
 symptoms of testicular processes, such as a tumor, epididymitis or prostatitis,
may mimic the symptoms of distal ureteral stones
 other general causes of abdominal pain, such as appendicitis,
cholecystitis, diverticulitis, colitis, constipation, hernias or even
arterial aneurysms, may produce symptoms that mimic renal colic
 other urological lesions may also mimic of urolithiasis
› for example lesions such as congenital ureteropelvic junction
obstruction, renal or ureteral tumors, and other causes of ureteral
obstruction

http://www.gpnotebook.co.uk/simplepage.cfm?ID=x20090113103910749131&linkID=71700&cook=no
FBC (full blood count), serum creatinine,
calcium, phosphate, urate, proteins and
alkaline phosphatase.
Biochemistry Investigations  ph, hematuria,
leukosituria, Crystalluria
Urine culture: secondary infection.
BOF
IVP / IVU
USG
Retrograde or antegrade pyelography
Bartley G. Cilento, Jr., Gerald C. Mingin, and Hiep T. Nguyen 2006, Pediatric Surgery and Urology Long-term Outcomes,Second Edition, Cambridge University Press, PP 698

Rbus: Renal or Bladder Ultra Sonography


ESWL: Extra Corporeal Shock Wave Lithotripsy
Herditair

Intrinsic factor Age :30-50

Etiology & Gender : man


epidemiology 3x > woman

Extrinsic
Next page…
factor
Geografi

Climate & temperature

Diet : purin,ocsalat, & calsium


Intake water : ↓ intake water & ↑ mineral
calsium in water   insidense

Occupation : sedentary life


Precipitation-
crystallization theory

Matrix-nucleation
theory

Crystallization-
inhibition theory
• Organic
• anorganic

Crystal -
Presipitation Nucleation Agregation Big crystal
cristal

N : Metastable in Urinary tract


urine Cystal
retention obstruction
Magnessium

ion

Sitrat
Crystallization-
inhibition theory
1. Glikosaminoglikan
(GAG )
Protein & organic 2.Tamm Horsfall
subtantion Protein ( THP )
3. Nefrokalsin
4.Osteopontin
Oxalate Urate Cystine Silicate
urolithiasis urolithiasis urolithiasis urolithiasis
1. CONSERVATIVE OBSERVATION
2. DISSOLUTION AGENTS
3. RELIEF OF OBSTRUCTION
4. EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY
5. URETEROSCOPIC MANAGEMENT
6. PERCUTANEOUS NEPHROSTOLITHOTOMY
7. OPEN STONE SURGERY
• ESWL is indicated for treatment of most renal calculi <1.5 to 2 cm
in size.
• Insertion of a temporary internal stent is recommended for stones
>1.5 cm in size to prevent steinstrasse or ureteral obstruction
caused by passage of stone fragments.
• Although its primary use is in the fragmentation of renal calculi,
ESWL is also advantageous for ureteral stones, especially those <8
mm in diameter.
a) Access to the ureter for ureteroscopy is greatly facilitated
by use of the ureteral access sheath.
Under fluoroscopy, the sheath is passed over a guide wire
into the proximal ureter. Passage of the sheath causes
ureteral dilation, and the sheath itself provides a
continuous working channel for the introduction of
endoscopes and instruments during ureteroscopic
procedures.
b) Lithotripsy techniques include US, electrohydraulic,
pneumatic, or laser lithotripsy. For ureteroscopic stone
fragmentation
c) Stone extraction of small stones may be accomplished by
a stone basket. The advent of rigid and more recently
flexible ureteroscopy has eliminated the need for blind or
radiologically guided basket extraction.
• (PCNL) is indicated for large stones >2 cm in size or for staghorn
calculi.
• With use of rigid and flexible nephroscopes and a variety of
fragmenting tools, approximately 85% of patients can be
rendered stone-free at 3 months
• Results are comparable with those of open surgery, although
many large stones will require staged procedures. Even full
staghorn calculi can be successfully removed with PCNL.
 Is virtually never required today, given the
advances in minimally invasive surgery and
ESWL.
 In the past, ureterolithotomy and open
nephrolithotomy (anatrophic nephrolithotomy)
were common urologic procedures, but today
they are rarely performed
pierce a, grace. neil r, borley . 2002 surgery at a glance, second edition, blackwell science ,pp 158
 In a patient with neurogenic bladder, kidney
stones generally are the result of infection 
untreated  the stones become the source
of persistent renal infection and eventual
renal loss

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