UROLOGIC TRAUMA

dr. Cut Rosnani SpRad

Renal trauma
Ureteral injury
Bladder injury
Urethral injury
Injury to external genitalia
Plain foto (BOF LLD)
USG Abdomen
CT Scan Abdomen
Angiografi
Foto dengan contrast bila perlu
Initial dalam evaluasi trauma abdomen
Pemeriksaan BOF meliputi diaphragma
s/d. cavum pelvis.
Penting bila waktu ada KU pasien baik
dilakukan diaphragma foto (tegak) atau
LLD (20 menit).
Melihat udara bebas
Cairan bebas (floating intestine)
Kelainan tulang (fraktur) terutama coste-
coste kanan
Perubahan countur organ
Melihat struktur intestine (bowel pattern)
Keuntungan :
Non invasif dan
dapat dilakukan
dengan cepat
Evaluasi cairan
bebas di empat
kuadran
Evaluasi organ
padat, hepat, lien,
ginjal.
Kerugian :
Personal
dependent
Bila KU penderita
menurun maka
waktu pemeriksaan
relatif singkat
Px. Sulit
dimobilisasi, bila
KU menurun
Sering terganggu
bayangan gas usus
Dilakukan bila dicurigai trauma pada
organ padat atau berongga
Tanpa persiapan dengan pemasangan
sonde lambung
Dilakukan dengan injeksi zat contrast
media 50 100 cc
Back up anestesi bila pasien gelisah
Irisan mulai diaphragma s/d. daerah
yang dicurigai cavum pelvis
Mayoritas kasus grade 1
Dicurigai
Significant flank ecchymosis / hematuria
Fractur Lower rib (T8-12)
Hematom (soft tissue swelling) pada
daerah abdomen sisi lateral (flank area)
Hematuria
Nausea vomitus


Non Invasif :
Plain foto (BNO)
USG
Invasif :
IVP
CT Scan Abdomen
Angiografi










Grade 1,2 : minor trauma
Grade 3,4,5 : major trauma
Contusion
Hematuria (micro
or gross)
Urologic studies N

Hematoma
Subcapsular
Non expanding
Parenchyma N
Hematoma
Perirenal
Nonexpanding

Laceration
< 1.0 cm
Renal cortex only
No urinary
extravasation

Laceration
> 1.0 cm
Renal cortex only
No urinary
extravasation
Intact collecting
system
Laceration
Renal cortex
Renal medulla
Collecting system

Vascular
Main renal
artery/vein injury
with contained
hemorrage.
Completely
shattered kidney.

Avulsion of renal
hilum (pedicule)
which
devascularizes
kidney.
Kennon et al. Radiographic assessment of renal trauma: our 15-year
experience. The Journal of Trauma, 154: 353-355; August 1995.
Mechanism :
1. External trauma

2. Surgical trauma

Symptoms : fever, flank and lower quadrant
pain, if bilateral anuria
Signs : acute hydronephrosis, sign &
symptoms of acute peritonitis may be (+)
Imaging : IVU, RPG, CT
86% due to blunt abdominal trauma
90% assoc with pelvic fx
60% extraperitoneal, 30% intraperitoneal,
10 12% combined injuries
Mechanism of injury :
- intraperitoneal
- extraperitoneal

Hematuria
Pelvic or lower abdominal pain
Imaging :
- cystography
- CT cystography

location
Anterior urethra:
bulbous & pendulous
Posterior urethra:
membrano - prostatic
Prostatic
Membranous
Bulbous
Pendulous
73% is complete, 27% partial
Rare in women
Mechanism: pelvic fracture
Triad:
Blood at the meatus
Inability to urinate
Full bladder

From McAnich JW. In Tanagho EA, McAninch JW, editors: Smiths general urology, ed 14, Norwalk, Conn, 1995, Appleton & Lange.
Retrograde urethrogram:
Contrast extravasation + Contrast in bladder



Contrast extravasation only
PARTIAL Tear
COMPLETE Tear
Scrotal injuries
Penile fracture
Testis rupture