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Urethral Trauma
1. PROGRAM PENDIDIKAN DOKTER SPESIALIS
PROGRAM STUDI BEDAH TORAKS, KARDIAK DANVASKULAR
ROTASI BEDAH DASAR – STASE UROLOGI (SEPTEMBER 2015)
2. Anatomy
• Chung BI, Sommer G, Brooks JD. Anatomy of the Lower Urinary Tract and Male Genitalia. Campbell-Walsh Urology. 10 ed: Elsevier Inc.; 2012. p. 52-5.
• Sobotta, Johannes, Putz R, Pabst R, Taylor. AN. Sobotta Atlas of Human Anatomy. 15 ed: Elsevier Inc; 1997.
3. Anatomy
• Chung BI, Sommer G, Brooks JD. Anatomy of the Lower Urinary Tract and Male Genitalia. Campbell-Walsh Urology. 10 ed: Elsevier Inc.; 2012. p. 52-5.
• Sobotta, Johannes, Putz R, Pabst R, Taylor. AN. Sobotta Atlas of Human Anatomy. 15 ed: Elsevier Inc; 1997.
4. • Chung BI, Sommer G, Brooks JD. Anatomy of the Lower Urinary Tract and Male Genitalia. Campbell-Walsh Urology. 10 ed: Elsevier Inc.; 2012. p. 52-5.
• Sobotta, Johannes, Putz R, Pabst R, Taylor. AN. Sobotta Atlas of Human Anatomy. 15 ed: Elsevier Inc; 1997.
5. Etiology Iatrogenic Cause
Martinez-Pineiro L, Djakovic N, Plas E, Mor Y, Santucci RA, Serafetinidis E, et al. EAU Guidelines on Urethral Trauma. European urology.
2010;57(5):791-803.
6. Etiology Non-Iatrogenic Cause
• Anterior Urethral Injury
• Posterior Urethral Injury
Martinez-Pineiro L, Djakovic N, Plas E, Mor Y, Santucci RA, Serafetinidis E, et al. EAU Guidelines on Urethral Trauma. European urology.
2010;57(5):791-803.
7. Martinez-Pineiro L, Djakovic N, Plas E, Mor Y, Santucci RA, Serafetinidis E, et al. EAU Guidelines on Urethral Trauma. European urology.
2010;57(5):791-803.
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15. Clinical Manifestation
Cardinal signs
• Urethral bleeding from meatus
• Bladder distention (from
retention reflex)
• Scrotal, perineal and/or penile
swelling, “butterfly haematoma”
• High riding prostate
• Difficulty to insert a catheter
Martinez-Pineiro L, Djakovic N, Plas E, Mor Y, Santucci RA, Serafetinidis E, et al. EAU Guidelines on Urethral Trauma. European urology.
2010;57(5):791-803.
18. Management
Urethral Trauma
Principles
Diversion
Endoscopic Realignment
Urethroplasty
• Immediate (less than 48hr)
• Delayed (2 days – 2 weeks)
• Deferred (more than 3 months)
Martinez-Pineiro L, Djakovic N, Plas E, Mor Y, Santucci RA, Serafetinidis E, et al. EAU Guidelines on Urethral Trauma. European urology.
2010;57(5):791-803.
Uretra prostatik, membranosa, dan spongiosa pada pria
Muara dari duktus ejakulatorius, prostatic utricle, pada bulb of penis muara kelenjar bulbouretral (cowper’s)
Pada wanita uretra ditopang oleh pubouretral ligamen dan suspensory clitoris ligament
2/3 distal pada uretra wanita dikelilingi serat otot (spinchter eksterna)
Uretra prostatik, membranosa, dan spongiosa pada pria
Muara dari duktus ejakulatorius, prostatic utricle, pada bulb of penis muara kelenjar bulbouretral (cowper’s)
Pada wanita uretra ditopang oleh pubouretral ligamen dan suspensory clitoris ligament
2/3 distal pada uretra wanita dikelilingi serat otot (spinchter eksterna)
Benturan
Straddle injury, kompresi bulbosa pada simfisis
luka tembus
instrumentasi
sexual intercourse
Risiko tertinggi straddle fracture with diastasis concomitant sendi sakroiliaka dan fraktur malgaigne
tidak mengancam nyawa namun sering fatal tempat lain pelvis, toraks, abdomen, tulang belakang
delayed: stricture, incontinence, disfungsi ereksi
In male immediate reconstruction is avoided
In female is encourage because urethral length is short 4 cm and scar tissue could make it difficult
Insisi perineum
Flexible cytoscope dimasukan hingga scar, insisi scar di distal
Dipisahkan dari korpus karvernosum
Tension free
anastomosis
Indication
Improve visualization in long distraction defects
Tension free in long defects
Excision at prostatic apex
Excision of fistulous tracts and cavities
Midline suprapubic incision
Diseksi anterior bila perlu pubic dipotong diberikan bone wax