Urethral Trauma
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A brief information about urethral trauma
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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.
- 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.
- 16. Evaluation Modality • Retrograde Urethrography • Ultrasonography • CT Scan and MRI • Cystoscopy
- 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.
- 30. Thank You For Your Attention
Editor's Notes
- 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