Ruptur buli &

Ruptur Uretra

Putu Chika Radeanty

Dibimbing oleh
dr. Triana D.C.,Sp.Rad, M.Sc
Rupture Uretra
 Definisi

 Trauma uretra sebagian besar hasil dari trauma tumpul, dengan penetrating injuries.
Uretra pria secara anatomis terbagi menjadi segmen anterior dan posterior setinggi
diafragma urogenital. Trauma uretra posterior biasanya terjadi di dekat sfingter uretra
eksternal yang menyebabkan fraktur pelvis dan gangguan melalui membran uretra.
 Ruptur uretra adalah kerusakan kontinuitas uretra yang disebabkan dari luar (patah
tulang panggul atau straddle injury) atau dari dalam (kateterisasi, tindakan-tindakan
melalui uretra)
 Epidemiologi


Trauma uretra mencakup 4% dari seluruh trauma saluran
kemih, terutama disebabkan fraktur pelvis pada kecelakaan lalu
lintas dan kasus jatuh dari ketinggian.


Sejumlah 65% kasus merupakan ruptur komplit dan 35%
inkomplit.
Etiologi
Klasifikasi
 Manifestasi Klinis

 Tidak dapat berkemih/ retensio urin  ruptur uretra

posterior
 Nyeri pada perineum/ genitalia  ruptur uretra anterior
 Hematome atau udem pada skrotum, perineum, penis 
ruptur uretra anterior
Pemeriksaan Penunjang Pada Ruptur Urethra
Radiologi
1. Urethrography retrograde 🡪 menilai keadaan
urethra dengan memasukan zat kontras secara
langsung dari uretra bagian distal ke proksimal 🡪
Gold Standard
2. CT Sistografi 🡪 dapat dilakukan, namun
pemeriksaan ini kurang spesifik untuk trauma
uretra.
Retrograde Urethrography (RUG)

Type 1
Membranous urethra is stretched
without rupture
Retrograde Urethrography (RUG)

Type 2
Complete rupture of
the membranous urethra with
intact urogenital diaphragm.
Extravasation extends into
the pelvis only
Retrograde Urethrography (RUG)

Type 3
Complete rupture of the
membranous urethra with
disrupted urogenital diaphragm
and injury to the proximal
bulbous urethra. Extravasation
extends into the pelvis as well as
into the perineum
Cedera uretra tipe IV. a. Gambar Retrograde cystographic menunjukkan kebocoran
kontras di sekitar uretra prostat (panah). Perhatikan juga fraktur rami pubis superior
bilateral (kepala panah). b. Gambar sistografi CT sagital menunjukkan laserasi
leher kandung kemih dengan ekstensi ke uretra proksimal serta ekstravasasi kontras
(panah)
Cedera uretra tipe V. Gambar uretrografi retrograde menunjukkan
transeksi uretra parsial dan ekstravasasi kontras pada proksimal bulbous
uretra (panah)
CT Sistografi Pada Ruptur Urethra
 Ekstravasasi
kontras pada
gambaran CT
Sistografi
Rupture Buli
Ruptur buli
DEFINISI
Cedera yang terjadi akibat
adanya hantaman langsung
terhadap bui yang
ETIOLOGI
 Kecelakaan saat mengendarai
kendaraa bermotor  umumnya
sepeda motor
 Iatrogenik  tindakan ginekologi

tetrdistensi, high energy dan bedah colorectal, prosedur

urologis, dan pemasangan kateter
injury yang menyebabkan Foley
gangguan pada pelvis, dan  Keganasan
cedera akibat tusukan serta  Infeksi

iatrogenic.  Retensi urin

Ruptur buli
PATOFISIOLOGI
 EPIDEMIOLOGI 
 Pada kandung kemih yang terdistensi
 1,6% pasien dengan akan lebih rentan cedera dikarenakan
melebihi pelvis.
trauma abdomen akibat  Ruptur spontan dan iatorgenik biasanya
benda tumpul mengalami intraperitoneal sedangkan rupture akibat
cedera kandung kemih. trauma cenderung extaperitoneal.
 Intraperitoneal  rupture terjadi di
 Extraperitoneal 60%, bladder dome dan di atas peritoneal
reflection
Intraperitoneal 30%, dan  Extraperitoneal  rupture terjadi di aspek
10% campuran keduanya. anterior/lateral kandung kemih dan di
bawah peritoneal reflection
Klasifikasi Rupture Buli-buli

Bagian terlemah dari buli-buli adalah pada kubah peritoneum buli-buli.

Rupture spontan/iatrogenic biasanya terjadi pada kubah, sedangkan
pada kasus traumatis, akan terjadi diluar bagian peritoneal

1. Jika rupture buli bukan pada kubah buli🡪ekstravasasi akan ke luar

peritoneal (extraperitoneal) 🡪60%
2. Jika rupture buli berada di kubah🡪ekstravasasi akan ke daerah
peritoneal (intraperitoneal) 🡪30%
3. Rupture dapat berupa extraperitoneal maupun intraperitoneal (10%)

(Simon, et al., 2021)

Ruptur buli
Ruptur buli
Ruptur buli
MANIFESTASI KLINIS  Peritoneal signs 
 Hematuria rigiditas dan nyeri rebound
 Nyeri pelvis pada abdomen
 Nyeri abdomen bawah
 Kesulitan berkemih
 Fraktur pelvis
Ruptur buli extraperitoneal
 PELVIS X-RAY
 Urinary catheter in situ.
Left superior and inferior
pubic rami fractures and
widening of the left
sacroiliac joint. 
Ruptur buli extraperitoneal
 INTRAVENOUS
UROGRAPHY (IVU)
 One image from an IVU
shows a flame-shaped
density adjacent to
right lateral wall of bladder
representing extra-
peritoneal contrast from a
bladder rupture 
Ruptur buli extraperitoneal
 CYSTOGRAPHY
 Postvoid film shows a
flame-shaped density
adjacent to lateral walls of
bladder representing extra-
peritoneal contrast from a
bladder rupture.
Ruptur buli extraperitoneal
 ULTRASONOGRAPHY
 The bladder is thick-walled
with a poorly defined anterior
wall
Ruptur buli extraperitoneal
 CT CYSTOGRAM
 200 ml of 2% Urograffin was instilled
via the urinary catheter, and the
timing of acquisition was
approximately 10 minutes following
the intravenous contrast. There is leak
of contrast anteriorly from the bladder
wall into the soft tissues of the pelvis,
but not into the peritoneal space. The
"molar tooth sign" is observed.
 Incidental finding of duplex right
ureter.
Ruptur buli intraperitoneal
INTRAVENOUS
UROGRAPHY (IVU)
Contrast instilled into the
urinary bladder extends
outside the dome of the
bladder (black arrow) and
outlines the outside of the
loops of bowel in the lower
abdomen (white arrows)
Ruptur buli intraperitoneal
INTRAVENOUS UROGRAPHY
(IVU)
Note the extraluminal contrast (red
arrows) outside the confines of the
normal bladder and spreading into the
peritoneal cavity. There is contrast in
the left paracolic gutter (yellow
arrow), not within the bowel. The
intrarenal collecting systems and
ureters are visualized because the
patient had a contrast enhanced CT
done moments earlier
RUPTUR BULI INTRAPERITONEAL

 CYSTOGRAPHY
 150 ml of Isovue 300 was infused
through the patient's indwelling Foley
catheter. 
 The bladder partially distended and
the bladder wall appeared irregular.
There was resistance to hand
injection of contrast, likely due to
chronic blood products adherent to
the catheter. With a small adjustment,
contrast then began to flow freely
into the bladder and began to leak
into the intraperitoneal space,
outlining bowel loops.
Ruptur buli intraperitoneal
 VOIDING CYSTOURETHROGRAPHY
(VCUG)
 shows extravasation of contrast media from
the urinary bladder into the intraperitoneal
space. Contrast extravasation is seen
throughout the peritoneal cavity, not within
the bowel loops. 
 Fractures through the right iliopectineal
line, acetabular roof and greater sciatic
notch causing protrusio acetabuli and high
riding femur.
 Fracture line also is seen at the left superior
pubic ramus
Ruptur buli intraperitoneal
 ULTRASONOGRAPHY
 Discontinuity in wall of
urinary bladder at its dome
with gross ascites.
Foley catheter is in situ.
RUPTUR BULI INTRAPERITONEAL

 CT CONTRAST
 Renal excretory phase
reveals extravasation of
intra-venous administered
contrast into the peritoneal
cavity through a  rupture of
the urinary bladder dome.
The contrast-stained fluid is
seen in the right para-colic
gutter and in between small
bowel loops, confirming its
intraperitoneal location.
Kidneys and ureters are
unremarkable. No pelvic
fractures were seen.
Daftar Pustaka
 Chapple CR. Urethral injury. BJU international. 2000 Aug;86(3):318-26.

 Rosenstein DI, Alsikafi NF. Diagnosis and classification of urethral injuries. Urologic Clinics. 2006 Feb
1;33(1):73-85.

 Kusumajaya C. Diagnosis dan Tatalaksana Ruptur Uretra. Cermin Dunia Kedokteran. 2018 May
1;45(5):340-2.
 Simon LV, Sajjad H, Lopez RA, et al. Bladder Rupture. [Updated 2021 Feb 14]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK470226/
 Gill C Bradley. Bladder Trauma: Medscape. 2019. Available from:
https://emedicine.medscape.com/article/441124-workup#c4