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Kuliah Trauma Urogenital
Kuliah Trauma Urogenital
• Anatomi
– Ginjal
– Ureter
– Buli buli
– Uretra
TRAUMA UROGENITAL
• Anatomi
– Ginjal
– Ureter
– Buli buli
– Uretra
Ginjal
• Sepasang organ seperti kacang
• Terletak retroperitonel diregio
lumbal superior
• Dilapisi oleh 3 lapis jaringan
penunjang:
– kapsul ginjal
– kapsul adipose dan
– fasia renalis
Ureter
• Tubulus muscular yang
menghubungkan ginjal ke buli buli
• Terletak di belakang rongga
peritoneum (retroperitoneal)
• Panjang 25 – 30 cm
TRAUMA GINJAL
Trauma Ginjal
Sering
8-10% trauma tumpul / tajam abdomen
Separuh dari kejadian trauma urogenital
Di proteksi :
* Otot-otot lumbal
* Iga
* Vertebrae
Angka kesakitan / kematian ok
trauma ginjal tergantung :
– Derajat trauma
– Keterlibatan trauma organ lain
– Fasilitas penanggulangan trauma
Buli-buli
• Buli buli normal dapat menampung
350 – 450 mL urine
• Drainase kendung kemih bermuara ke
vena iliaca interna
Uretra
• Tabung yang menyalurkan urine ke
luar dari buli-buli
• Secara anatomis uretra dibagi
menjadi 2 bagian :
– Uretra posterior dan
– Uretra anterior
Mekanisme Trauma
Trauma tumpul -> penyebab trauma
Langsung, tidak langsung
Klasifikasi
* Ada beberapa macam
* Ditentukan oleh luas dan penatalaksanaan
Cedera Ginjal
* Minor
* Mayor
* Vaskuler
Cedera Minor
• 90% trauma ginjal
• Kontusio ginjal
• Laserasi parenkim superficial
Cedera Mayor
• Laserasi korteks, medula tanpa
ekstravasasi
• Laserasi korteks, medula dengan
ekstravasasi
Cedera Vaskuler
• Avulsi
• Trombosis
Berdasarkan AAST ( American for The Surgery of
Trauma )
Berdasarkan AAST
( American for The Surgery of Trauma )
Dibagi 5 derajat
Derajat 1
• Kontusio ginjal /subkapsularhematom
• Tidak meluas
• Hematuria dengan normal imaging
Derajat 2
• Hematom perineal
• Tdk meluas ke retroperitonium
• Laserasi superficial ( < 1cm )
• Tdk melibatkan collecting systim
Derajat 3
• Renal laserasi ( > 2cm )
• Sub capsular hematom
• Perinephric hematom
• Tdk melibatkan collecting systim
Derajat 4
• Laserasi yang meluas ke collecting
systim
• Extravasasi
• Trauma vasculer segmental
infark
Derajat 5
• Shattered kidney
• Devaskularisasi / oklusi / trombosis
arteri / vena utama
• Laserasi komplit
• Extravasasi
• UPJ avulsi
Pemeriksaan Radiologi
USG
* Melihat hemoperitoneum
* Tdk dianjurkan utk evaluasi trauma
ginjal
* Dengan color doppler melihat vaskuler
CT Scan
• Pemeriksaan yang sensitif dan spesifik
• Menentukan derajat trauma
• Tidak invasif
• Dpt mengevaluasi organ lain
( hepar , lien , aorta )
kontras non kontras
Angiografi
• Invasif
• Delayed renal bleeding-pseudo-aneurisma
IVP normal
USG ginjal normal
CT scan ginjal normal
Gambar 1. Kidney trauma. Absent nephrogram. Abdominal radiograph after
intravenous contrast administration in a patient with hypotension after a
motor vehicle collision shows absent right nephrogram
Gambar 2. Kidney trauma. Grade 3 renal laceration on
abdominal radiograph. Abdominal radiograph after
intravenous contrast administration shows very
diminished left nephrogram and no urinary contrast
extravasation
Gambar 3. Kidney trauma. Grade 5 renal injury. Shattered kidney with renal
vein thrombosis (incomplete). Abdominal radiograph after intravenous
contrast administration shows absent right nephrogram
Gambar 4 Kidney trauma. Grade 1 renal injury, contusion. Image from a
contrast-enhanced CT scan of the abdomen in a patient with hematuria after a
motor vehicle collision shows ill-defined area of hypoenhancement in the
medial right kidney.
Gambar. 5. Kidney trauma. Grade 1 renal injury, subcapsular
hematoma. CT scan of the abdomen with intravenous contrast in a
patient after a motor vehicle collision shows crescentic high-density
fluid collection around the left kidney. Note the well-defined outer
margin
Gambar 6. Kidney trauma. Grade 1 renal injury, subcapsular hematoma. CT
scan of the abdomen with intravenous contrast in a patient after a motor
vehicle collision; shows crescentic high-density fluid collection around the
left kidney. Note the well-defined outer margin and the mild deformity of the
renal parenchyma
Derajat II dan III
Gambar 17. Kidney trauma. Grade 5 renal injury. Shattered kidney. Contrast-
enhanced CT scan of the abdomen in a patient with hematuria and hypotension
after a motor vehicle collision shows transection of the right kidney with a large
hematoma around and between the 2 halves of the kidney. The 2 halves are both
perfused because there were 2 renal arteries Delayed images show urinary
contrast extravasation
Gambar 18. Kidney trauma. Grade 5 renal injury. Shattered kidney. Contrast-
enhanced CT scan of the abdomen in a patient with hematuria and hypotension
after a motor vehicle collision shows transection of the right kidney with a large
hematoma around and between the 2 halves of the kidney. The 2 halves are both
perfused because there were 2 renal arteries. Delayed images show urinary
contrast extravasation
Gambar 19 Kidney trauma. Grade 5 renal injury. Shattered kidney. Contrast-enhanced
CT scan of the abdomen in a patient with hematuria and hypotension after a motor
vehicle collision shows transection of the right kidney with a large hematoma around
and between the 2 halves of the kidney. The 2 halves are both perfused because there
were 2 renal arteries Delayed images show urinary contrast extravasation
Gambar 20. Kidney trauma. Grade 5 renal injury. Shattered kidney. Contrast-
enhanced CT scan of the abdomen in a patient with hematuria and
hypotension after a motor vehicle collision shows transection of the right
kidney with a large hematoma around and between the 2 halves of the
kidney. The 2 halves are both perfused because there were 2 renal arteries.
Delayed images show urinary contrast extravasation
Gambar 21. Kidney trauma. Grade 5 renal injury. Shattered kidney with renal vein
thrombosis (incomplete). CT scan of the abdomen with intravenous contrast
administration shattered right kidney and renal vein thrombus extending slightly
into the inferior vena cava
Gambar 22. Kidney trauma. Normal ultrasound with grade 5 renal injury.
Ultrasound gray-scale image of a patient involved in a motor vehicle
collision shows what appears to be a normal right kidney
Gambar 23 Kidney trauma. Grade 5 renal injury. Color Doppler ultrasound of
same motor vehicle collision patient as in Image 4 shows no blood flow within
the right kidney.
4.Arteriografy
• Trauma Luar
a. Tajam
b. Tumpul
• Iatrogenik
a. Ginekologis
b. Pembedahan rektum
c. Endoskopi
Pemeriksaan Radiologi
Pemeriksaan :
• Sistografi
• CT scan abdomen - pelvis
Kontusio Vesika Urinaria
• Normal
• Tear Drop
• Mudah sembuh
Etiologi
• Trauma tumpul
• Trauma tembus
• Iatrogenik
Anatomi
• Uretra posterior
* uretra prostatika
* uretra membranosa
• Uretra anterior
3 segmen : * pars bulosa
* pars pendulans
* pars glanularis
sampai ke meatus uretra externa
Diagnosa
Tipe 1