Download - SOE Medan 03 15 - Emergency in Urology
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Emergency in Urology
Dr Dhirajaya Dharma Kadar SpU
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Retensi Urin
Solusi : 1. Pemasangan kateter Retensi Urin Gawat
darurat Penyebab : • BPH dan Ca Prostat • Strikur urethra • ISK • Neurogenik bladder • Trauma
2. Supra pubic puncture
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Fournier’s gangrene
Fournier’s gangrene ??
Necrotizing fasitis polimicrobal of perineum and genetalia
Jean Alfred Fournier, 1974
* C.F. Heynes, P.D Theron
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• Striktur urethra
• Batu urethra
• Negleted kondom kateter
• Phimosis
Traktus urinarius
• Abses perianal
• Tumor recti
• Colitis dan divetikulitis
Traktus Digestivus
• Folikulitis
• Selulitis
• Pressure sore Kulit
Prinsip utama penanganan: - Resusitasi - Antibotik - Debridement
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Priapismus
Tediri atas : 1. low flow –venous-ischemic 2. high flow –arterial- non ischemic
Priapismus ?
Ereksi yang terjadi lebih dari 4 jam dan tidak berhubungan dengan stimulasi seksual
USG Doppler
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Penyebab : 50% idiopatik (Sickle cell anemia)
obat iv papaverin pentolamin alprostadil
Tindakan : 1. Tentukan jenis high atau low flow 2. Identifikasi dan penyebab 3. Aspirasi dan irigasi rujuk 4. Injeksi fenileprin 100-500µg 3-5 menit slm 1 jam 5. Shunt
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Scrotal Emergency
Torsio Testis Gangguan aliran darah yang disebabkan oleh “twisting “ arteri dan struktur sekitarnya
Gejala dan Pemeriksaan Fisik 1. Gejala akut 2. Nyeri menjalar ke perut bagian bawah 3. Tanpa nyeri BAK 4. Testis yang terkena lebih tinggi 5. Akut hirokel dan edema scrotum 6. Cremaster reflex negatif 7. Frehns test positif
6 JAM
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Prinsip penanganan : ATLSABCD
UROLOGY TRAUMA
Trauma ginjal
Trauma ureter
Trauma buli
Trauma urethra
Trauma gentalia eksterna
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Trauma Ginjal
MUST be suspected if?
Hematuria Sudden decelaration /Fall from height.
Lower (T8-12) rib fractures
Significant flank ecchymosis
Penetrating abdominal or flank injury
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Mekanisme :
1. External trauma penetrating trauma (rare), high velocity missiles
2. Surgical trauma ( Iatrogenik )
Trauma Ureter
Gejala: Demam, nyeri pinggang , jika bilateral dapat menyebabkan anuria Hidonefrosis Dapat menyebabkan peritonitis
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Trauma Buli
Penyebab :
- Iatrogenic injury
- Trauma tajam abdomen bawah
- Trauma tumpul – berhubungan dengan faktur pelvic
- Rapid deceleration injury—seat belt injury with full bladder
Trias of ruptur buli : Hematuria, Jejas dan nyeri pada suprasimpisis , tidak bisa ataupun sulit berkemih
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Urethral Trauma
Terbagi atas : • Posterior (membranosa & prostatika) fraktur pelvic
• Anterior (bulbosa & pendulosa) straddle type injury
The management goal minimize the chances for debilitating complications of incontinence, impotence & stricture
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Posterior urethral injuries
Gejala
– “Blood at the meatus”
– Inability to urinate
– Full bladder
– Floating prostate
– Srotal hematom
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Anterior Urethral Injury :
• Trauma Perineum / straddle injury
• Meatal bleeding
• Sleeve hematoma
• Butterfly sign
• Inability to void
NO FOLEY IF INJURY SUSPECTED