High Riding

Prostate

Latar Belakang  ATLS mengajarkan DRE (digital rectal examination) penting pada pasien trauma :“a finger or tube in every orifice”. Jafri SM. Rozycki GS. Gamelli RL. Esposito TJ. Ingraham A. Sears BW. Traumatic urethral injuries: does the digital rectal examination really help us? Injury.  ATLS edisi 8 merekomendasikan DRE sebelum memasang kateter  DRE jarang merubah arah manajemen pasien trauma urethra (0 to 4% of cases)  DRE bukanlah skrining bermakna pada pasien trauma urethra (detects <1 in 4 significant injuries) Ball CG.40(9):984-6. Poulakidas SJ. PMID: 19535063. no useful additional information. Wyrzykowski AD. Davis KA. J Trauma. Santaniello JM. Epub 2009 Jun 16. Kirkpatrick AW. Feliciano DV. 2005 . Rajani RR. Luchette FA. 2009 Sep. Reasons to omit digital rectal exam in trauma patients: no fingers. no rectum.

Santaniello JM. Esposito TJ. Kirkpatrick AW. Jafri SM. Feliciano DV. Luchette FA. Davis KA. 2009 Sep. Rajani RR. Traumatic urethral injuries: does the digital rectal examination really help us? Injury. RATIONALE FOR DRE IN TRAUMA  rectal hemorrhage  rectal mucosal injury or wall defects  loss of anal tone suggesting spinal cord injury  palpable pelvic fractures or hematoma  a high riding prostate suggestive of posterior urethral disruption  tenderness from ruptured viscus or intraperitoneal hemorrhage Ball CG. Sears BW. Rozycki GS. Gamelli RL.40(9):984-6. 2005 . no useful additional information. Wyrzykowski AD. Epub 2009 Jun 16. Reasons to omit digital rectal exam in trauma patients: no fingers. no rectum. PMID: 19535063. J Trauma. Poulakidas SJ. Ingraham A.

Poulakidas SJ. Davis KA. Esposito TJ. Jafri SM. no useful additional information. Epub 2009 Jun 16. Luchette FA. 2005 . 2009 Sep. DRE FINDINGS ARE OFTEN UNRELIABLE  Shlamovitz et al (2007) found high rates of falsely negative DREs:  63% for decreased anal sphincter tone  94% for the presence of gross rectal blood  67% for disruption of the rectal wall integrity  100% for palpation of bony fragments  80% for abnormal position of the prostate Ball CG. Wyrzykowski AD. Kirkpatrick AW. Rajani RR. Ingraham A. J Trauma.40(9):984-6. Feliciano DV. Sears BW. Santaniello JM. Traumatic urethral injuries: does the digital rectal examination really help us? Injury. PMID: 19535063. Reasons to omit digital rectal exam in trauma patients: no fingers. no rectum. Gamelli RL. Rozycki GS.

POSTERIOR URETHRAL INJURY  Abnormal prostate position is near useless for detecting posterior urethral injury  60% of the time there there were no clinical signs prior to urinary catheter insertion  blood at the urethral meatus (20% sensitivity)  gross hematuria prior to catheter insertion (17% sensitivity)  abnormal prostate position (2% sensitivity)  scrotal or perineal echymosis  inability to void .

Wyrzykowski AD. Jafri SM. Rozycki GS. J Trauma. 2009 Sep.40(9):984-6. no rectum. Ingraham A. PMID: 19535063. Practice points  Consider posterior urethral disruption if a pelvic fracture is present (95% are associated with fractures)  Suspect posterior urethral disruption if there is hematuria on IDC insertion or if the IDC doesn’t pass easily. Feliciano DV.  Perform a retrograde urethrogram to confirm posterior urethral disruption Ball CG. Sears BW. Reasons to omit digital rectal exam in trauma patients: no fingers. Davis KA. Traumatic urethral injuries: does the digital rectal examination really help us? Injury. Poulakidas SJ. 2005 . Luchette FA. Kirkpatrick AW. Rajani RR. no useful additional information. Gamelli RL. Esposito TJ. Epub 2009 Jun 16. Santaniello JM.

 Skandalakis' Surgical Anatomy  2004 .

Ruptur Urethra Posterior  Ruptur pada ligamen puboprostat  Skandalakis' Surgical Anatomy  2004 .

 Skandalakis' Surgical Anatomy 2004 .

tidak bisa BAK. 1989) Wein: Campbell-Walsh Urology. Ruptur urethra ditandai dengan triad: darah di meatus. 9th ed. Copyright © 2007 Saunders. buli teraba penuh  Because these and other classic findings such as a “high-riding” prostate or a “butterfly” perineal hematoma may frequently be absent (Sandler and Corriere. An Imprint of Elsevier .

 Ruptur urethra sering dicurigai ketika kateter urethra tidak bisa dimasukkan oleh IGD. Copyright © 2007 Saunders. resulting in a misdiagnosis of impalpable prostate (Koraitim et al. Wein: Campbell-Walsh Urology. 1996). atau ketika salah masuk ke hematoma pelvis. An Imprint of Elsevier .  Pelvic hematoma often obscures the prostatic contour. 9th ed.

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 Pada DRE. The value of digital rectal examination in assessing for pelvic fracture-associated urethral injury: what defines a high-riding or nonpalpable prostate? J Trauma Acute Care Surg. et al.75(5):913-5. pemeriksaan prostat melayang bernilai high false positive rate  Johnson MH. 2013 Nov. .