Referat

BLADDER TRAUMA

Rizal Trianto

Consultant:
Dr. dr. Besut Daryanto, Sp.B, Sp.U(K)
dr. Taufiq Nur Budaya Sp. U
 BACKGROUND

Trauma is one of the causes of death

(Gross et al., 1999; Laxminarayan et al., 2006; WHO,
2003; NEMC, 2011).

The incidence of trauma increases every

year (Soreide, 2009; Middleton, 2010).

Urogenital trauma accounts for 10% of all

trauma cases (McGeady dan Breyer, 2013)
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 PROBLEMS

1. What are the definitions and epidemiology of bladder

trauma?
2. What are the etiologies of bladder trauma?
3. What is the clinical symptoms of bladder trauma?
4. How do you diagnose bladder trauma?
5. What is the management for bladder trauma?
6. Knowing the complications and prognosis of bladder
trauma?
 AIMS
1. Knowing the definition and epidemiology of bladder
trauma
2. Knowing the etiology of bladder trauma
3. Knowing the clinical symptoms of bladder trauma
4. Knowing how to diagnose bladder trauma
5. Knowing the management of bladder trauma
6. Knowing the complications and prognosis of bladder
trauma
 BENEFITS

Theoritical Benefit
• Knowledge of
bladder trauma
Practical Benefit
• Reference about
bladder trauma
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 EPIDEMIOLOGY

Genitourinary Trauma (Aditya, 2016):

Urethral Trauma (37,9%)
Renal Trauma (29,5%)
Bladder Trauma (26,3%)
Genitalia Eksterna Trauma (6,31%)
ANATOMI OF BLADDER

(Drake, Vogl, dan Mitchell, 2012)

ANATOMI OF BLADDER

(Drake, Vogl, dan Mitchell, 2012)

 CLASSIFICATION OF
BLADDER TRAUMA
Grade Trauma Description

1 Contusion, intramural hematoma

2 Extraperitoneal bladder wall laceration < 2 cm

3 Extraperitoneal (>2 cm) or intraperitoneal (<2 cm) bladder wall laceration

4 Intraperitoneal bladder wall laceration > 2cm

Intraperitoneal or ekstraperitoneal bladder wall laceration extending into

5
bladder neck or ureteral orifice (trigone)

(Bryk dan Zhao, 2015)

 CLASSIFICATION OF
BLADDER TRAUMA
Mode of Action Trauma Description

Blunt
Trauma non-iatrogenik

Penetrating

Eksternal

Trauma Iatrogenik Internal

Corpus alienum

(Bryk dan Zhao, 2015)

 CAUSES OF BLADDER
TRAUMA
Type of Trauma Frequency per 1000 prosedure

Histerektomi Open Radical 14

Lap. Assisted Vaginal Hysterectomy 13.8

Histerektomi laparoskopi 10

Histerektomi vagina 9

Caesarean section 1.8

Herniorapi laparoskopi 1.6

Sling Mid Urethra 0.4

Persalinan pervaginam 0.1

(Kitrey et al., 2018)

 CAUSES OF BLADDER
TRAUMA
Prosedure Persentage (%)
Obstetry
Sectio Caesarean 0.0016-0.94
Ginekologi
Sterilisation Laparoscopic 0.02
Laparoskopic Diagnostic 0.01
Histerektomi vagina (benign) 0.6
Histerektomi Abdomen (benign) 0.9
Laparoskopic Hysterektomi 0.05-0.66

(Kitrey et al., 2018)

 CAUSES OF BLADDER
TRAUMA
Bedah Umum
Small/large bowel procedure 0.12-.0.14
Rektal Prosedure 0.27-0.41
Abdominal Sitoreductive Surgery 4.5
Urologi
Sling retropubik male 8.0-50
Sacrocolpopeksi laparoscopic 1.9
Colposuspensi Burch 1.0-1.2
Sling midurethral (rute transobturator) 0-2.4
Sling midurethral (rute retropubik) 3.2-8.5
sling pubovaginal 2.8
Mesh transvaginal surgery 1.5-3.5
Colporrhapi anterior 0.5
(Kitrey et al., 2018)
TURB 3.5-58
 CLINICAL SYMPTOMS 0F
BLADDER TRAUMA
Sign and Symptomp Remark
Hematuria
Inability to urinate
Visible = cardinal sign
Inflamation and abdominal pain
Suprapubik hematom
Abdominal distended
Scrotal edema, perineum,
In the case of urinary ascites
abdominal edema and/or femur
edema
Increases ureum and creatinine Ruptur intraperitoneal  reabsorpsi
value nitrogen urea dan kreatinin
Open wound on lower abdomen,
In the penetrating trauma
perineum or gluteus
(Aloi et al., 2010)
Logarithm of Bladder Trauma

(Wessels et al., 2003)

 DIAGNOSTIC OF BLADDER
TRAUMA
• Ultrasound
• Cystography
• CT cystography
• Cystoscopy

(Wu, 2011;Santucci dan Mcaninch, 2000; Summerton, 2015)

 BLADDER RUPTURE

INTRAPERITONEAL BLADDER EXTRAPERITONEAL BLADDER

RUPTURE RUPTURE
(Wu, 2011;Santucci dan Mcaninch, 2000)
 CT Cystography
• Type 1 : Bladder Contusio
• Type 2 : Intraperitoneal Bladder Rupture
• Type 3 : Intersisiel Bladder Rupture
• Type 4 : Extraperitoneal Bladder Rupture

(Wu, 2011;Santucci dan Mcaninch, 2000; Vaccaro dan Brody, 2000)

 Type 2 : Intraperitoneal
Bladder Rupture

Intraperitoneal Bladder Rupture

(Wu, 2011;Santucci dan Mcaninch, 2000)

 Type 4 : Extraperitoneal
Bladder Rupture

Ruptur Kandung Kemih ekstraperitoneal simple

(Vaccaro dan Brody, 2000)

 COMPLICATION OF
BLADDER TRAUMA
• Unknown urine extravasation
• The involvement of the bladder neck,
vagina and anus is not immediately
corrected
• Neurogenic Trauma
• Persistent Haematuria
• UTI
• Decrease of Bladder Capacity
(Gomez, et al. 2004)
 EMERGENCY TREATMENT
OF BLADDER TRAUMA
• Primary Surveilance
• Suprapubic Catether
• Diagnostic Radiography Examination

(Wessels et al., 2003).

 SURGERY TREATMENT OF
BLADDER TRAUMA
Indication :
• Open Fraktur Pelvis and Rectum
Perforation
• Clot Retention
• Laparotomy due to other abdominal
trauma
• Open reduction and internal fixation by
Orthopedic Specialist
(Wessels et al., 2003).
 Repair Extraperitoneal of
Bladder Trauma

(Wessels et al., 2003).

 Two layer Surgical Closure

(Wessels et al., 2003).

 PROGNOSIS

Dubia ad bonam

(Santucci, 2000).
 CONCLUSION

BLADDER BLADDER
EMERGENCY DIAGNOSTIC
TRAUMA RUPTURE

USG
Iatrogenik/non Extraperitoneal
Iatrogenik => Observation
Cystography
Primary
Surveilance
CT
Cystography
Blunt/ Intraperitoneal
Penetration => Surgery
Cystoscopy