RENAL INJURY

(CEDERA GINJAL)

By
Dr. HARDY, SpB

RELEVANT OF ANATOMY

ETIOLOGI
- TRAUMA TUMPUL : KECELAKAAN LALU
LINTAS, OLAHRAGA, JATUH DARI
KETINGGIAN, PENGANIAYAAN
- TRAUMA TAJAM : STAB WOUND, GUN SHOT
WOUND
- IATROGENIC : PROSEDUR2
ENDOUROLOGI : ESWL, RENAL BIOPSI,
PCNL

GAMBARAN KLINIS
- RIWAYAT TRAUMA
- MEKANISME CEDERA
- SISTEM HEMODINAMIK : STABIL / TDK
STABIL
- NYERI DAERAH PINGGANG / ABDOMEN
BAGIAN ATAS
- GAMBARAN AKUT ABDOMEN : PERITONITIS
- MASSA RETROPERITONEAL : HEMATOM,
URINOMA (EXTRAVASASI URIN)
- JEJAS DI DAERAH PINGGANG : MEMAR,
EKIMOSIS
- FX TULANG KOSTA BAGIAN BAWAH

LABORATORIUM
DARAH LENGKAP : Hb MENURUN +/ URINALISA
- HEMATURIA (+): MIKROSKOPIS
ERITROSIT > 5 LPB, MAKROSKOPIS
HEMATURIA
- HEMATURIA (-)
DERAJAT KERUSAKAN GINJAL TDK
BERBANDING LURUS DENGAN ADA ATAU
TDKNYA HEMATURIA

RENAL INJURY SCALE

GRAD
E

TYPE

CONTUSIO
N
HEMATOM
A

MICROSCOPIC OR GROSS HEMATURIA, UROLOGIC

STUDIES NORMAL
SUBSCAPULAR, NONEXPANDING WITHOUT
PARENCHYMAL LACERATION

II

HEMATOM
A

NONEXPANDING PERIRENAL HEMATOMA

CONFINED TO RENAL RETROPERITONEUM
< 1 CM PARENCHYMAL DEPTH OF RENAL CORTEX
WITHOUT URINARY EXTRAVASATION

LACERATIO
N

DESCRIPTION

III

LACERATIO
N

> 1 CM PARENCHYMAL DEPTH OF RENAL CORTEX

WITHOUT COLLECTING SYSTEM RUPTURE OR
URINARY EXTRAVASATION

IV

LACERATIO
N

PARENCHYMAL LACERATION EXTENDING TROUGH

RENAL CORTEX, MEDULLA AND COLLECTING
SYSTEM
MAIN RENAL ARTERI OR VEIN INJURY WITH
COUNTAIN HEMORRHAGE

VASCULAR

RENAL INJURY
SCALE

IMAGING
IVP
USG
CT SCAN
ANGIOGRAFI
PENATALAKSANAAN
KONSERVATIF
OPERASI

KOMPLIKASI
KOMPLIKASI DINI
URINOMA
DELAYED
BLEEDING
URINARY FISTULA
ABCES
HIPERTENSI

KOMPLIKASI LANJUT
HIDRONEFROSIS
ARTERIO VENOUS
FISTULA
PYELONEFRITIS
CALCULUS
FORMATION
DELAYED
HYPERTENSION

URETERAL INJURY
(CEDERA URETER)
By
Dr. HARDY, SpB

RELEVANT OF ANATOMY

ETIOLOGI
EXTERNAL TRAUMA ARE RARE : BLUNT /
PENETRATING
IATROGENIK
- PROSEDUR BEDAH : DIGESTIF,
GINEKOLOGI, UROLOGI

GRADE OF URETERAL INJURY

GRAD
E

DESCRIPTION

CONTUSION OR HEMATOMA WITHOUT

DEVASCULARIZATION

II

LACERATION : < 50% TRANSECTION

III

LACERATION : > 50% TRANSECTION

IV

LACERATION : COMPLETE TRANSECTION WITH <

2CM DEVASCULARIZATION

LACERATION : AVULSION WITH > 2CM OF

DEVASCULARIZATION

GAMBARAN KLINIS
- NYERI ABDOMEN : EXTRAVASASI URIN
(URINOMA)
- URINOMA
- MASSA PD ABDOMEN / PINGGANG
- NYERI PD CVA
- GAMBARAN PERITONITIS
- KELUAR CAIRAN DR LUKA ATAU VAGINA

IMAGING
URETEROSCOPY
KUB / IVP
CT SCAN
PENATALAKSANAAN
- PEMBEDAHAN

BLADDER INJURY
(CEDERA KANDUNG
KEMIH)
By
Dr. HARDY, SpB

RELEVANT OF ANATOMY

ETIOLOGI
- BLUNT INJURY (CEDERA TUMPUL) :
CEDERA DAERAH PELVIK
SERING DIIKUTI CEDERA ABDOMEN
- PENETRETING INJURY (CEDERA TAJAM)
LUKA TUSUK
LUKA TEMBAK
- IATROGENIK
PROSEDUR GYNECOLOGI : SC, HITEREKTOMY
PROSEDUR UROLOGI : TUR P / TUR BT
PROSEDUR ORTHOPEDI : PEMBEDAHAN
PADA TULANG PELVIK

KLASIFIKASI
- BLADDER CONTUSION : INCOMPLETE /
PARTIAL THICKNESS TEAR OF THE
BLADDER, HEMATOME
- EXTRAPERITONEAL BLADDER RUPTURE
- INTRAPERITONEAL BLADDER RUPTURE
- KOMBINASI : INTRA / EXTRA PERITONEAL
BLADDER RUPTURE

GRADE OF BLADDER INJURY

GRAD
E

DESCRIPTION

HEMATOME / INTRAMURAL HEMATOME

PARTIAL THICKNESS LACERATION

II

LACERATION : EXTRAPERITONEAL BLADDER WALL

LACERATION <2CM

III

LACERATION : EXTRAPERITONEAL (>2CM) OR

INTRA-PERITONEAL (<2CM) BLADDER WALL
LACERATIONS

IV

LACERATION : INTRAPERITONEAL BLADDER WALL

LACERATION >2CM

LACERATION EXTENDING INTO BLADDER NECK OR

URETERAL ORIFICE (TRIGONE)

BLADDER CONTUSSION
PATOFISIOLOGI

INCOMPLETE / PARTIAL THICKNESS TEAR OF THE

BLADDER
HEMATOME

KLINIS

LOWER ABDOMINAL PAIN / SUPRA PUBIC PAIN

GROSS HEMATURIA

LABORATORIUM
IMAGING

CYSTOGRAFI

PENATALAKSANAAN SELF LIMITING

NO SPECIFIC THERAPY
PEMASANGAN KATETER

EXTRA PERITONEAL BLADDER RUPTURE

PATOFISIOLOGI

ASSOCIATED WITH ANTERIOR PUBIC ARC PELVIC

FRACTURE
DIRECT PERFORATION BY BONY FRAGMENT OR
DISRUPTION OF THE PELVIC GIRDL &
PUBOPROSTATIC LIGAMENT
BURST INJURY

DERAJAT
KERUSAKAN

DIRECTLY RELATED TO THE SEVERITY OF THE

FRACTURE.

KLINIS

LOWER ABDOMINAL PAIN / SUPRA PUBIC PAIN

GROSS HEMATURIA
INABILITY OF VOIDING

KLINIS TAMBAHAN

HEMATOME / SWELLING : PERINEUM,

SKROTUM,
ABDOMINAL WALL

LABORATORIUM
IMAGING

CYSTOGRAFI : EXTRAVASATION CONTRAST

CT SCAN : EXTRAVASATION CONTRAST
EXTRAVASASI KE DINDING ABDOMEN,
PERINEUM, SKROTUM

INTRA PERITONEAL BLADDER RUPTURE

PATOFISIOLOGI

TEARS IN THE BLADDER DOME

FULL BLADDER
COMMON IN SEAT BELT & STEERING WHEEL
INJURY AND
IN CHRONIC ALCHOOL

KLINIS

LOWER ABDOMINAL PAIN / SUPRA PUBIC PAIN

GROSS HEMATURIA
INABILITY OF VOIDING
GAMBARAN PERITONITIS, URINARY ASCITES
KADANG2 : SILENT / LATE PRESENTATIONS :
UREMIA,
METABOLIC ACIDOSIS

LABORATORIUM
IMAGING

CYSTOGRAFI : EXTRAVASASI URIN KE RONGGA

PERITONEAL
CT SCAN : EXTRAVASASI URIN KE RONGGA
PERITONEAL

PENATALAKSANAAN PEMASANGAN KATETER

REPAIR

KOMPLIKASI
- SEPSIS
- PELVIC INFECTION
- INCONTINENCE URINE
- SMALL CAPACITY BLADDER
- HEMAORRAGE
- URINE ASCITES
PEMASANGAN KATETER DI
KONTRAINDIKASIKAN PD CEDERA / FRAKTUR
PELVIK JIKA DI JUMPAI BLOOD DISCHARGE
PADA MEATUS URETRA EXTERNA

CEDERA URETRA
By
Dr. HARDY, SpB

RELEVANT OF ANATOMY

ETIOLOGI
- BLUNT INJURY
- PENETRATING INJURY
- IATROGENIK
KLASIFIKASI
- CEDERA URETRA ANTERIOR
- CEDERA URETRA POSTERIOR

GRADE OF URETHRAL INJURY

GRAD
E

INJURY
TYPE

DESCRIPTION

CONTUSIO BLOOD AT URETHRAL MEATUS; RETROGRAPHY

N
NORMAL

II

STRETCH
INJURY

III

PARTIAL
EXTRAVASATION OF URETHROGRAPHY CONTRAST
DISRUPTIO AT INJURY SITE WITH VISUALIZATION IN THE
N
BLADDER

IV

COMPLETE EXTRAVASATION OF URETHROGRAPHY CONTRAST

DISRUPTIO AT INJURY SITE WITHOUT VISUALIZATION IN THE
N
BLADDER; <2CM OF URETHRA SEPERATION

COMPLETE COMPLETE TRANSACTION WITH >2 CM

DISRUPTIO URETHRAL SEPARATION, OR EXTENSION INTO THE
N
PROSTATE OR VAGINA

ELONGATION OF URETHRA WITHOUT

EXTRAVASATION ON URETHROGRAPHY

CEDERA URETRA ANTERIOR

BLUNT INJURY
SERING MENGENAI PARS BULBOSA
STRADDLE TYPE INJURY
- KECELAKAAN PADA SAAT MENGENDERAI
SEPEDA / SEPEDA MOTOR
- TENDANGAN DAERAH PERINEUM
TERDAPAT TEKANAN BERLAWANAN
ANTARA RAMI PUBIK INFERIOR DENGAN
URETRA PARS BULBOSA KONTUSIO ATAU
LACERASI URETRA
FRAKTUR PENIS : SAAT EREKSI

CEDERA TAJAM / PENETRATING

- MUTILASI : DIRI SENDIRI, PASANGAN
PENILE AMPUTATION
- GIGITAN
- LUKA TUSUK
- LUKA TEMBAK
- BENDA ASING
IATROGENIK
- TERPOTONG SAAT SIRKUMSISI
- PEMASANGAN KATETER
- PROSEDUR2 UROLOGI

GAMBARAN KLINIS
- JARANG DISERTAI CEDERA PD ORGAN LAIN
- KDG TAMPAK RINGAN : TTP BBRP BLN KMDN
PENDEITA DATANG TLH MENGALAMI STRIKTUR
URETRA
- KDG DISERTAI FX PENIS (PEROBEKAN PD TUNIKA
ALBUGINEA, CORPUS SPONGIOSUM): PD SAAT
EREKSI
- SAKIT BAK, SULIT BAK DAN TDK BISA BAK
- DARAH PD MEATUS URETRA EKSTERNA
- HEMATOM PD PENIS, PERINEUM : JK CEDERA
MEROBEK FASCIA BUCKS & FASCIA COLLES
MEMBERIKAN GAMBARAN BUTTERFLY HEMATOME

CEDERA URETRA POSTERIOR

- SERING DISERTAI TRAUMA + FX PD PELVIK
- STRADDLE INJURY
- PD PARS MEMBRANOUS & PARS
PROSTATIKA
GAMBARAN KLINIS
- DARAH PD MEATUS URETRA EKSTERNA
- HEMATOM PD PERINEUM
- KETDK MAMPUAN BERKEMIH
- RT : FLOATING PROSTAT

IMAGING
- RETROGRADE URETROGRAPHY
- CT SCAN / MRI
PENATALAKSANAAN
- KONSERVATIF
- OPERATIF