GAWAT DARURAT UROLOGI
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Tata Kelola Gawat Darurat UROLOGI
Prof. DR. dr. H. Rifki Muslim, Sp. B, Sp. U
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Contoh :1. Batu Buli / uretra2. Striktur uretra3. Tumor buli4. Stolsel ( bekuan darah )5. Benda Asing6. Fimosis / Parafimosis7. Meatal Stenosis
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• Syaraf pada lengkung reflek miksi rusak.
Causa :o Trauma Col. Vertebralis.o Tumor Medula Spinaliso Diabetes Mellitus neuropathia
diabetica.
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Obat bisa memicu retensio urinae bila dipakai lama,
misalnya:1.Obat Hipertensi / jantung Jenis Beta Blocker Contoh nama generik : Propanolol2. Obat penenang Contoh nama generik : Imipramin3.Obat Asma Contoh : Efedrin4. Obat Flu / Batuk tertentu
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Pengelolaan Retensio Urinae
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1. Kateterisasi
Telentang bersihkan dengan bethadin
6 cc pelumkat + 4 cc lidokain campur masukkan kedalam uretra
Tutup m.u.e 3 – 5 menit Kateter no. 16 / lebih kecil masukkan. Urine keluar dorong lagi +/- 5 cm Isi balon 10 – 15 cc Urinae bag.
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• Kateter tidak bisa masuk1.Ada sumbatan ( batu , striktur ,
dll )2.Pasien mengejan
Bila tetap tidak bisa masuk :- Ulang sekali lagi
Tetap tidak masuk :1. Coba dengan mandrin2. Pungsi Suprapubik3. Sistostomi
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• Pasang cateter dengan mandrin
Urutan Kompetensi :1.Ahli Urologi2.Ahli badah3.Dokter Umum4.Perawat terlatih dibawah supervisi
dokter
Kateter yang bisa dipakai :No. 18 F atau lebih besarBahaya : salah arah ( False Route ) -- Kateter merobek uretra ---
berdarah.
• Pasang cateter dengan mandrin
Urutan Kompetensi :1.Ahli Urologi2.Ahli badah3.Dokter Umum4.Perawat terlatih dibawah supervisi
dokter
Kateter yang bisa dipakai :No. 18 F atau lebih besarBahaya : salah arah ( False Route ) -- Kateter merobek uretra ---
berdarah.
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2. Pungsi Suprapubik
Pasien terlentang Supra Pubik dibetadin Jarum tusukan di 2
cm cranial dari simfisis
Arah tegak lurus – sedikit miring mengarah ke caudal.
Urine disedot ---- buang berulang – ulang
Jarum cabut.
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3. Sistostomi
1. Operasi :- Standar- Permanen
2. Percutan : a. jarum plastik infus (mis.
Abbocath ) b. Sistostomi Set.
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* Sistostomi Percutan
• Pasien terlentang• Supra pubik di betadhin• Tusuk 2 cm di cranial simfisis di
linea mediana.• Arah tusukan tegak lurus /
miring kearah caudal.• Urinae keluar sambung
urine bag.
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1. R. U. Posterior oleh karena Fraktur Pelvis
2. R. U. Anterior oleh karena Straddle injury.
Gejala : - Retensio Urine- Meatal Bleeding- Hematoma perineal / suprapubik - Nyeri di perineum
Diagnosa : xfoto Uretragram retrogradTerapi : - Sistostomi - definitif
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Akibat dari: Kecelakaan
Kerja KLL
• Klinis : Jejas dipinggang Hematoma Sakit dipinggang Hematuria
Diagnosis :• USG• FPA/UIV• CT SCANTindakan : • Resusitasi napas, T,
N, Hb• Pasang Cateter
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Biasanya akibat operasi ginekologi
Klinis :Nyeri pinggangBiasa anuria
Diagnosis : FPA/UIVRPGUSG
Tindakan :Pasang cateterPersiapan Operasi.
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Akibat dari :
Trauma tumpul Luka tusuk Luka tembak Spoeling buli yang salah Endourologi Operasi
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Trauma buli…
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• Causa :1. Trauma G.U.B.U2. Tumor G.U.B.U3. Batu G.U.B4. Prostat hiperplasia5. Obat – obatan6. Penyakit hemofilia, dllDiagnosis : USG FPA/UIV CT SCANTindakan : Kateter 3 Way Definitif
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• Testis terpuntir pada funiculus Causa : Kelainan Funiculus Olah raga BeratKlinis : Umur Prepubertas Tiba – tiba sakit hebat scrotum Testis horisontal Lama – lama bengkak.Tindakan : Detorsi Cito operasi
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• Penis full ereksi tertekuk corpus cavernosum robek
• Klinis :- Tengah hubungan sexual- Sakit hebat- Hematoma penis penis hitam besar
( seperti penis kuda ??? )Diagnosa : xfoto cavernosografiTindakan : Pasang kateter Cito Operasi
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