Trauma Urogenitalia

TRAUMA UG - DMS - 2001 1

Trauma Urogenitalia

• Ginjal
• Ureter
• Buli-buli
• Urethra
• Genitalia eksterna

TRAUMA UG - DMS - 2001 2

Trauma Urogenitalia

• Ginjal
• klinis
• mekanisme trauma
• klasifikasi
• evaluasi dan diagnosa
• terapi

TRAUMA UG - DMS - 2001 3

Trauma Urogenitalia

• Ginjal
• klinis:
– anamnesa : mode of injury
– pem.fisik : jejas
– urinalisis : hematuria
• mekanisme trauma: tr.tajam, tr.tumpul

TRAUMA UG - DMS - 2001 4

Trauma Urogenitalia

• Ginjal
• klasifikasi (Moore dkk 1989)
• 1. Trauma ginjal minor (85% kasus)
– grade I & II
• 2. Trauma ginjal mayor (15% kasus)
– grade III, IV, & V
• 3. Trauma vaskular

TRAUMA UG - DMS - 2001 5

Trauma Urogenitalia

• Ginjal
• evaluasi dan diagnosa
– anamnesa
– jejas
– urin keluar? Warna?
– hati2 trauma organ lain: costae, abdomen
• IVP (harus dilakukan, terutama untuk melihat ginjal
kontralateral)
• USG, arteriografi (angiography) bila perlu

TRAUMA UG - DMS - 2001 6

Trauma Urogenitalia

• Ginjal
• evaluasi dan diagnosa

Riwayat trauma +

atau Hematuria

Ax: trauma lumbal

deselerasi mendadak +/-
Fx: hematoma lumbal
luka penetrasi

TRAUMA UG - DMS - 2001 7

Trauma Urogenitalia

• Ginjal
• terapi: prinsip konservatif
• indikasi bedah:
– perdarahan tak dapat diatasi
– injury renovascular
– parenkhim tidak viable
– ektravasasi urin luas
– pembedahan: laparotomi eksplorasi, repair, k/p
nefrektomi
TRAUMA UG - DMS - 2001 8
Trauma Urogenitalia

• Ginjal
• terapi: prinsip konservatif
– observasi:
• tanda2 vital: T/N/t
• masa lumbal
• warna urine serial
• tanda anemis / Hb serial

TRAUMA UG - DMS - 2001 9

 Trauma Urogenitalia
Renal injury scale of The American Association for The Surgery of trauma

Grade Description

I Contusion Micros/gross hematuria, urologic studies normal

II Hematoma Subcapsular, non expanding without parenchymal laceration
Non expanding perirenal hematoma confined to renal peritoneum
III Laceration <1 cm parenchymal depth of renal cortex w/o urinary extravasation
IV Laceration >1 cm parenchymal depth of renal cortex w/o collecting system
rupture or urinary extravasation
Laceration parencymal laceration extending through the renal cortex, medulla, &
collecting system
V Vascular main renal artery or vein injury with contained hemorrhage
Laceration completely shattered kidney
Vascular Avulsion of renal hilum, which devascularizes kidney
TRAUMA UG - DMS - 2001 10
Trauma Urogenitalia

• Ureter
– paling jarang, ok. mobil & kaliber kecil
– kausa:
• trauma eksterna
• trauma iatrogenik: operasi ob-gin
– diagnosis:
• Ax
• hematuria
• klinis, IVP, RPG
TRAUMA UG - DMS - 2001 11
Trauma Urogenitalia

• Buli-buli
• anamnesa
• pem. fisik
• urinalisis
• radiologik
• terapi

TRAUMA UG - DMS - 2001 12

Trauma Urogenitalia

• Buli-buli
• anamnesa
– trauma langsung
• tumpul
• tajam / penetrasi
– deselerasi mendadak
– hematuria / retensi urin

TRAUMA UG - DMS - 2001 13

Trauma Urogenitalia

• Buli-buli
• pem. fisik:
– jejas suprapubik
– nyeri suprapubik
– akut abdomen
– gross hematuria hebat
– shock hemoragik

TRAUMA UG - DMS - 2001 14

Trauma Urogenitalia

• Buli-buli
• laboratorik:
– sering perlu kateter (kecuali bl ada bloody discharge)
– makroskopik hematuria

TRAUMA UG - DMS - 2001 15

Trauma Urogenitalia

• Buli-buli
• radiologik
– sistografi: ekstravasasi urin
– IVP bila perlu
– bedakan ruptura ekstra atau intra
peritoneal
– lihat adakah fraktura pelvis

TRAUMA UG - DMS - 2001 16

Trauma Urogenitalia

• Buli-buli
• terapi:
– eksplorasi
– repair
– k.p. sitostomi

TRAUMA UG - DMS - 2001 17

Trauma Urogenitalia

• Uretra
• klinis
• pem. fisik
• radiologik dan klasifikasi
• terapi

TRAUMA UG - DMS - 2001 18

Trauma Urogenitalia

• Uretra
• klinis
• kausa
– trauma eksternal:
– trauma tumpul kecepatan tinggi
– crush injury
– saddle back injury

TRAUMA UG - DMS - 2001 19

Trauma Urogenitalia

• Uretra
• klinis
• pem. fisik:
• 3 gejala utama (trias)
– retensi urin
– bloody discharge
– prostat melayang (RT)

TRAUMA UG - DMS - 2001 20

Trauma Urogenitalia

• Uretra
• radiologik
– urethrogram retrograd
– extravasasi uretra posterior atau anterior

TRAUMA UG - DMS - 2001 21

Trauma Urogenitalia

• Uretra
• terapi
– ruptura u. posterior: sistostomi
– ruptura u. anterior: repair primer (dalam 6 jam
pasca kejadian) atau sistostomi

TRAUMA UG - DMS - 2001 22

Trauma Urogenitalia

• Genitalia eksterna
• penis
• testis
• skrotum
• vas deferens & epididimis

TRAUMA UG - DMS - 2001 23

Trauma Urogenitalia

• Genitalia eksterna
• penis
– fraktura penis: kavernosografi
– amputasi penis traumatika

TRAUMA UG - DMS - 2001 24