trauma daluran kemih-urologi

7/23/2019 Trauma Daluran Kemih-urologi

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Trauma saluran kemih

Ginjal berj!lah 2 bah"bera# $ 1%0 &r '12% (1)0 &r *a+a La,i-la,i"

11% ( 1%% &r *a+a*ere!*an/ *anjan& %( )"% !/ #ebal 2"% ( 3!.

Le#a, retroeritonealebelah dorsal !a"uma#dominale" *a+a*ii ber+iri le#a, &injal

,anan lebih ren+ah


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Anatomi $in%al

$in%al dilaisi & ela*ii ,r#e, &injal : 'asula

(#rosa

Se#elah a*la 4bra #er+a*a# )asiagerota.

An#ara 5aia &er#a #er+a*ar# rn&&a

*erirenal. Se#elah 4ia &er#a #er+a*a#

*eri#ne!" +an an#ra !ere,a#er+a*a# rn&&a *ararenal

n&i 5aia &er#a : eba&ai barier


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TRAUMA $IN*AL

Struktur gin%al &8ila +iba# irian !e!anjan&+ari !e+ial ,e la#eral #a!*a,+a ba&ian 9r#e ebelah lar

+an !e+lla ebelah +ala!

E*i+e!il&i :10 ; erin& #erja+i *a+a

#ra!a ab+!en.

E#il&i :


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Dera%at trauma gin%al

8era#


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Dera%at trauma gin%al

DERA*AT *ENIS KERUSAKAN

Deraja# I Kn#i &injal = he!a#!a *erirenal

Deraja#II

Laerai &injal #erba#a *a+a ,r#e,

Deraja#III Laerai &injal a!*ai !e+la &injal" !n&,in #er+a*a# #r!bia. e&!en#ali


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Diagnosis+ ANAMNESIS

1. a e+era &injal ji,a #er+a*a#:


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Management /tions 0or RenalTrauma

9le ber7a#in 8e+ re#

Serial He!&lbin

An#ibi#i i5 rinar> e#ra7aa#in Ra+i&ra*hi E!blia#in Urinar> Di7erin

Ure#eral S#en#in&

Ne*hr#!> Draina&e Sr&er>

Renal Breer7a#in = Ren#r#in

Ne*hre#!>


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Tatalaksana


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Tatalaksana

O*erair - n#, hen#i,an

*er+arahan. Selanj#,an>a la,,an +erbri+e!en"

re*arai &injal 'renra4=*en>a!bn&an7a,lar

Ne5re,#!i '*arial = ##al


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TRAUMA URETER

Caran& / 1 ; +ari elrh i+era #r.Ur&eni#al.


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Diagnosis !idera ureter

He!a#ri *aa #ra!a9i+era ia#r&eni, aa# *erai a#a

e#elah *e!be+ahan. ' ,ebran rin!elali *i*a +rainae *aa be+ah

Be!eri,aan re! +an ,rea#inin +ari*i*a +rainae.

IVU #a!*a, e,#ra7aai ,n#ra=,n#raberhen#i *+ +aerah lei = +e7iai re#er ,ela#eral ,arena he!a#!a a#a rin!a.

Hi+r-re#erne5ri ( i+era la!a.


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Ke!urigaan !edera ureteriatrogenik

Saatoerasi

Laangan oerasi #an1ak !airanHematuriaAnuria2oliguri %ika !edera #ilateral

Baa

be+ah

De!a!N>eri *in&&an& a,iba# b#r,iL,a *erai elal baahSa!*ai bebera*a hari airan +rainae

jernih +an ban>a,.

He!a#ri *eri#en +anhe!a#!a=rin!a +i ab+!en.i#la re#er,#an=4#lare#er7a&ina.


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Tindakan !idera ureter &

1. Anastomosis end to end (re#er alin&+ia!bn&.


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Tindakan !idera ureter &

2. In*lan#ai re#er ,e

bli-bli.3. Ure#er-,#ane#!i. Ne5r#!i%.


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TRAUMA BULI+BULI


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TRAUMA BULI+BULI+ eidemiologi &

F0 ; #ra!a #!*l bli-blia+alah a,iba# 5ra,#r *el7i.

Rbe,n>a bli-bli ,arena Deelerai *a+a #i#i, 4,ai 5aia

ber&era, *a+a arah berla?anan.

A,iba# 5ra&!en #lan& *el7i


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Klasi(kasi trauma #uli

INTRAPERIT/NEAL RUPTURE

2%-%; +ari elrh#ra!a bli.

an& #erii *enh. Urin !en&alir ,e rn&&a

*eri#neal ( ina!ai-in5e,i

E3TRAPERIT/NEALRUPTURE

%-60; +ari elrh

#ra!a bli. ra,#r *el7i '10;


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Diagnosis trauma #uli

Ana!nei : Ri?a>a# #ra!a ab+!en ba&ian ba?ah N>eri +aerah *ra i!4i i,i bera!*r +arah a#a #i+a, +a*a# !i,i.

Bh>ial i&n: Ab+!inal *ain Ab+!inal #en+erne Ab+!inal briin& Ure#hral a#he#er +e n# re#rn rine Dela>e+

e7er N rine #*# Beri#neal i&n 8UN = 9rea#inine


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Pemeriksaanen!itraan &

Si#&ra4 Ha!*ir 100; a,ra# : Be!berian ,n#ra eban>a, 3%0

-00 !l #an*a #e,anan !elali

,a#e#er *er-re#ra!. Draina&e 4l!

Saa# bli #erii ,n#ra 'AB Obli, ah # 4l!

Un+er4llin& '2%0 aia#e+?i#h 5ale ne&a#i7e


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Terai

INTRAPERIT/NEALRUPTURE

Sr&ial re*air'e,*lraila*ar#!i

enari rbe,an bli+an r&an lain.

Rbe,an jahi# 2 la*i. Lal *aan& ,a#e#er

i##!i

EKSTRAPERI/NEALRUPTURE

Ka#e#er +rainae

ela!a )-10 hari $an#ibi#i,. Sr&ial re*air in

ele#e+ ae : A# an#erir #ein#ei

5 *el7i 5ra#re Injr> 5 bla++er ne,

9n!i#an# 7a&inalinjr>

ai7e r*#r


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TRAUMA URETRA

Banjan& re#ra la,i-la,i +e?aa e,i#ar1@ !" +en&an*erban+in&an re#ra*#erir 3 ! +anre#ra an#erir 1%! :

Ure#ra*#erir Ure#ra *ar *r#a#i,a

Ure#ra *ar!e!branaea

Ure#ra an#erir Ure#ra *ar blba

Ure#ra *ar*en+la

a na7ilare )


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TRAUMA URETRA

ETI/L/$I &'idera dari luar

Iatrogenik Ga!baran ,lini

Kelar +arah +ari!ea# re#rae,#ern! e#elah#ra!a.

8e+a,an +en&an

he!a#ria.


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Rutura uretra osterior

Karena 5r. Bel7i"!en&enai ra! a#ai!4i *bi +an

!eni!bl,an ,era,aninin *el7i.

Da*a# #erja+i he!a#!>an& la +i ,a7! re#i

ehin&&a ji,a li&. Bb-*r#a#i,! i,# rbe,"*r#a# +an bli-bli a,an#eran&,a# ,e ,ranial.


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Klasi(kasi

Dari &a!baran re#r&ra!" la*in# +an 9ll!'1F)6 !e!ba&i +erajar i+era re#ra !enja+i 3 jeni :

*enis

Kondisi 0oto uretrogram

1 Ure#ra *#erir !aih #h"han>a !en&ala!i #re#hin&'*ere&an&an.

an&!aih #erba#a +ia#a+ia5ra!a r&eni#alia.

3 Ure#ra *#erir" +ia5ra&!a

r&eni#al" +an re#ra *arblba *r,i!al i,# ra,.

E,#ra7aai ,n#ra !ela

hin&&a ba?ah +ia5ra&!ar&eni#al a!*ai *erine!.


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TINDAKAN

Kea+aan a,# : Si##!i n#, +i7eri rin.

Kea+aan #abil. Lal la,,anprimaryendoscopic realigment >ai# !e!aan&,a#e#er re#ra eba&ai *lin# +en&anre#r,*i.


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RUPTUR URETRAANTERI/R

E#il&i : Straddle injury 'e+era elan&,an&an

>ai# re#ra #erje*i# +ian#ara #lan&*el7i +an ben+a #!*l.

Ceni ,era,an : ,n#i +in+in& re#ra

R*#r *arial R*#r ##al +in+in& re#ra.


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Ba#l&i : Ure#ra an#erir #erbn&, +i+ala! ,r*

*n&i!. Kr* *n&i!$,r*ra

,a7erna *n&i! +ibn&, leh 5aiab, +an 5aia lle.

Ci,a


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RUPTUR URETRA


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DIAGNOSIS : Be!eri,aan re#r&ra4 re#r&ra+

Kn#i re#ra : #i+a, !ennj,,an a+an>ae,#ra7aai ,n#ra

R*#r re#ra : a+an>a e,#ra7aai ,n#ra*a+a *ar blba.

RUPTUR URETRA


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THANK 4/U,,-

trauma daluran kemih-urologi

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