URETEROLITHIASI

S
Kusvandita Giopratiwi 1610211047
Definisi
■ Ureterolithiasis adalah terdapatnya kaklulus/batu di dalam ureter.
■ Batu uretra biasanya berasal dari batu ginjal/batu ureter yang turun ke vesika urinaria,
kemudian masuk ke uretra.
Epidemiologi
■ Angka kejadian batu uretra ini tidak lebih 1% dari seluruh batu saluran kemih
■ Lebih banyak terjadi pada laki-laki(19%) daripada perempuan (9%)
■ Prevalensi lebih sering terjadi pada kulit gelap(50%) daripada kulit putih
■ Pada laki-laki sering terjadi pada usia 40 tahun dan pada perempuan sering terjadi pada
usia 30 tahun
Etiologi

■ A low fluid intake, with a subsequent low volume of urine production, produces high
concentrations of stone-forming solutes in the urine.
■ Hypercalciuria is the most common metabolic abnormality. Some cases of
hypercalciuria are related to increased intestinal absorption of calcium (associated with
excess dietary calcium and/or overactive calcium absorption mechanisms), some are
related to excess resorption of calcium from bone (ie, hyperparathyroidism), and some
are related to an inability of the renal tubules to properly reclaim calcium in the
glomerular filtrate (renal-leak hypercalciuria)
■ Magnesium and especially citrate are important inhibitors of stone formation in the
urinary tract. Decreased levels of these in the urine predispose to stone formation.
Gejala

■ Miksi tiba-tiba berhenti —> terjadi retensi urine

■ Biasanya didahului dengan nyeri pinggang
■ Jika batu berasal dari ureter yang turun ke vesika urinaria kemudian ke uretra, biasanya
pasien mengeluh nyeri pinggang sebelum mengeluh kesulitan miksi. 
■ Batu yang berada di uretra anterior seringkali dapat diraba oleh pasien berupa benjolan
keras di uretra pars bulbosa kadang tampak di metus uretra eksterna.Batu yang berada
pada uretra posterior, nyeri dirasakan di perineum atau rektum.
■ Nyeri pada glans penis atau pada tempat batu berada.
There are two common presentations for individuals with an
acute stone event: renal colic and painless gross hematuria.
Renal colic is a pain typically does not subside completely;
rather, it varies in intensity. When a stone moves into the
ureter, the discomfort often begins with a sudden onset of
unilateral flank pain. The intensity of the pain can increase
rapidly, and there are no alleviating factors. This pain, which
is accompanied often by nausea and occasionally by
vomiting, may radiate, depending on the location of the
stone.
Stone

■ There are four main chemical types of renal calculi :

– Calcium stones
– Struvite (magnesium ammonium phosphate) stones
– Uric acid stones
– Cystine stones
Diagnosis
■ Anamnesis
■ Physical examination
■ Laboratory tests :
– Urinary sediment/dipstick test: To demonstrate blood cells, with a test for
bacteriuria (nitrite) and urine culture in case of a positive reaction
– Serum creatinine level: To measure renal function
– Serum electrolyte assessment in vomiting patients (eg, sodium, potassium, calcium,
PTH, phosphorus)
– Serum and urinary pH level: May provide insight regarding patient’s renal function
and type of calculus (eg, calcium oxalate, uric acid, cystine), respectively
– Microscopic urinalysis
– 24-Hour urine profile
■Noncontrast abdominopelvic CT scan: The imaging modality of choice for
assessment of urinary tract disease, especially acute renal colic
■Renal ultrasonography: To determine presence of a renal stone
■Plain abdominal radiograph : To assess total stone burden, as well as size, shape,
composition, location of urinary calculi
Tatalaksana
■ Tindakan untuk mengeluarkan batu tergantung pada posisi, ukuran, dan bentuk batu.
Seringkali batu yang ukurannya tidak terlalu besar dapat keluar spontan asalkan tidak
ada kelainan atau penyempitan pada uretra.
■ Batu pada meatus uretra eksternum atau fossa navikularis dapat diambil dengan forsep
setelah terlebih dahulu dilakukan pelebaran meatus uretra (meatotomi), sedangkan batu
kecil di uretra anterior dapat dicoba dikeluarkan dengan melakukan lubrikasi terlebih
dahulu dengan memasukkan campuran jelly dan lidokain 2% intrauretra dengan harapan
batu dapat keluar spontan.
■ Batu yang masih cukup besar dan berada uretra posterior didorong dahulu ke vesika
urinaria kemudian dilakukan litotripsi.
■ Untuk batu yang besar dan menempel di uretra sehingga sulit berpindah tempat
meskipun telah dilubrikasi, mungkin perlu dilakukan uretrolitotomi atau dihancurkan
dengan pemecah batu transuretra.
Prognosis

■ Early recognition and immediate surgical drainage are necessary in these situations.
■ Medical therapy is generally effective at delaying (but perhaps not completely stopping)
the tendency for stone formation. The most important aspect of medical therapy is
maintaining a high fluid intake and subsequent high urinary volume. Without an
adequate urinary volume, no amount of medical or dietary therapy is likely to be
successful in preventing stone formation.
■ According to estimates, merely increasing fluid intake and regularly visiting a physician
who advises increased fluids and dietary moderation can cut the stone recurrence rate by
60%.
Referensi

■ Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Jameson, Joseph
Loscalzo : Harrison's Principles of Internal Medicine. 2 vols.-McGraw-Hill
Professional,19th ed. (2015)
■ Jack W. McAnnich, Tom F. Lue – Smith and Tanagho’s General Urology (2012
McGraw-Hill Medical)
■ Basuki B Purnomo : Dasar-Dasar Urologi Edisi Kedua,2003