Download - Radiologi urologi
![Page 1: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/1.jpg)
RADIOLOGI UROLOGI
Luh Ratna Oka Rastini
![Page 2: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/2.jpg)
OUTLINE
• IVP (tumor ren, nefroblastoma)• Cystography (cystitis, neurogenic bladder,
divertikulosis)• Urethrosystography (ruptur uretra)• VCUG (VUR pediatri)• APG
![Page 3: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/3.jpg)
INTRAVENOUS PYELOGRAPHY (IVP)
![Page 4: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/4.jpg)
IVPSyarat: Fungsi ginjal (ureum ,kreatinin) normal
• Memperlihatkan kaliks minor, kaliks mayor, pelvis renalis, ureter, vesica urinaria setelah injeksi zat kontras i.v
• Bersifat fungsional krn menilai fungsi ginjal.• Injeksi IV bahan kontras (Kontras media) mengandung: Iodium
non ionik (Omnopaque,Ultravist) dsb • Dilakukan foto serial
![Page 5: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/5.jpg)
Indikasi IVP
• Flank Pain• Hematuria• Frequency• Dysuria• Suspected renal calculus• Renal tumor
![Page 6: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/6.jpg)
Indikasi IVP
• Evaluasi massa abdomen, kista ginjal, tumor ginjal• Urolitiasis • Pielonefritis• Glomerulonefritis• Hidronefrosis• Trauma • Evaluasi preoperatif (fungsi, lokasi, ukuran, bentuk
ginjal dan ureter)• Hipertensi renal.
![Page 7: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/7.jpg)
Kontraindikasi IVP• Alergi bahan kontras• Asma• Anuria• Gagal ginjal• Penyakit kardiovaskuler
![Page 8: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/8.jpg)
Faktor-faktor yang mempengaruhi
• Feces atau udara di kolon• Aliran darah yang sedikit ke ginjal• Barium di saluran cerna dari prosedur
sebelumnya
![Page 9: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/9.jpg)
Prosedur pemeriksaan IVP
1. Prosedur px radiologi umum2. Pasien diminta mengosongkan kandung kemih3. Foto BNO4. Cek tensi, nadi, tes alergi5. Injeksi bahan kontras6. Perhatikan tanda-tanda alergi
Flushing, rasa asin di lidah, sakit kepala ringan, gatal, mual atau muntah
7. Foto serial dan penilaiannya
![Page 10: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/10.jpg)
FOTO SERIAL DAN PENILAIAN
a. Menit ke 5 fase nefrogram.b. Menit ke 15 SPC dan ureterc. Menit ke 30 traktus urinarius/ ureterovesicojunctiond. Menit ke 45 atau 60 VU penuhe. Foto paska miksi
![Page 11: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/11.jpg)
Komplikasi • Alergi zat kontras• Nefropati yang diinduksi zat kontras
![Page 12: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/12.jpg)
![Page 13: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/13.jpg)
![Page 14: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/14.jpg)
![Page 15: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/15.jpg)
![Page 16: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/16.jpg)
TUMOR GINJAL
• Pemeriksaan dengan IVP terlihat gambaran sistem pelvicocaliceal yang tidak teratur ( Wilm’s Tumor)
• Bayangan massa dapat tidak homogen,tidak ada kalsifikasi,mengandung banyak jaringan lunak (hipernefroma)
• Massa di daerah ginjal,batas tidak jelas,menutupi bayangan musculus psoas bagian atas (sarcoma ginjal)
![Page 17: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/17.jpg)
Renal cell carcinoma
![Page 18: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/18.jpg)
Tumor Wilm’s
![Page 19: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/19.jpg)
Wilm’s Tumor dengan IVP Tumor Grawitz
![Page 20: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/20.jpg)
Massa intrarenal : non-fungsional renal sinistra dgn gambaran massa tidak jelas pada pinggang kiri dengan hasil biopsi adanya tumor Wilms. CXR : metastase paru
![Page 21: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/21.jpg)
SISTOGRAFI
![Page 22: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/22.jpg)
DEFINISI
• Retrograde cystografi : pemeriksaan traktus urinarius yang dikhususkan untuk memeriksa bagian vesica urinaria dan uretra, dengan cara memasukan suatu bahan kontras yang dimasukan melalui uretra, dengan mengunakan kateter atau langsung menggunakan spuit.
![Page 23: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/23.jpg)
INDIKASI
• Benigna Prostatica Hyperplasia • Bladder calculi/vesico lithiasis• Polinephritis• Hidronefrosis• Hipertensi ginjal (renal hypertension)• Obstruksi ginjal (renal obstruction)• Penyakit ginjal polikistik (polycystic kidney disease)• Cystitis
![Page 24: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/24.jpg)
KONTRAINDIKASI• Hipersensitif terhadap media kontras• Tumor ganas• Gangguan pada hepar• Gagal jantung• Anemia• Gagal ginjal akut maupun kronik• Diabetes, khususnya diabetes mellitus• Pheochrocytoma• Multiple myeloma• Anuria (tidak adanya ekskresi dari urine)• Perforasi ureter
![Page 25: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/25.jpg)
CYSTITIS
![Page 26: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/26.jpg)
NEUROGENIC BLADDER
Christmas tree appearance
![Page 27: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/27.jpg)
DIVERTICULOSIS
Retrograde cystogram, AP, divertikula kecil mutliple (additional defect) (panah) pada pasien 6h th dengan keluhan 1,5 tahun disuria dan urgensi.
![Page 28: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/28.jpg)
URETEROSISTOGRAFI RETROGRAD
![Page 29: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/29.jpg)
DEFINISI
• Merupakan pemeriksaan radiologi yang menggunakan zat kontras untuk menilai keadaan uretra dan vesica urinaria.
• Zat kontras diinjeksikan secara retrograd melalui orifisium uretra eksternus.
• Kombinasi px uretrografi retrograd dan sistografi retrograd.
![Page 30: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/30.jpg)
INDIKASI• Ruptur uretra• Striktur uretra• Kelainan kongenital• Abses periuretra atau abses prostat• Fistula yang berhubungan dengan uretra• Divertikula uretra• Obstruksi uretra• Hematuria dengan kecurigaan ruptur uretra• ISK berulang• Aliran urin yg menurun• Tumor pada uretra
![Page 31: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/31.jpg)
KONTRAINDIKASI
• Infeksi saluran kemih yang akut
![Page 32: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/32.jpg)
PROSEDUR & KOMPLIKASI
• Sama dengan prosedur px uretrografi retrograd
• Zat kontras dimasukkan sampai VU• Komplikasi serupa dengan pada 2 px tsb.
![Page 33: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/33.jpg)
Urethrocystography normal
![Page 34: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/34.jpg)
TRAUMA URETRA
• Uretra laki-laki lebih panjang dari wanita• Dihubungkan dgn trauma daerah pelvis yg cukup
berat
Etiologi• Trauma tumpul• Trauma tembus• Iatrogenik
![Page 35: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/35.jpg)
Anatomi• Uretra posterior
* uretra prostatika* uretra membranosa
• Uretra anterior 3 segmen : * pars bulosa
* pars pendulans * pars glanularis
sampai ke meatus uretra externa
![Page 36: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/36.jpg)
Diagnosa
• Berdasarkan gejala klinik• Pemeriksaan penunjang radiologi
RUG ( Retrograde Uretrografi )
Klasifikasi trauma uretra Hasil RUGKlasifikasi Gold Man yaitu :“Berdasarkan Kerusakan Anatomi “
![Page 37: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/37.jpg)
TRAUMA URETRA
SECARA ANATOMI TERDIRI DARI :• TRAUMA URETRA POSTERIOR• TRAUMA URETRA ANTERIOR
![Page 38: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/38.jpg)
Prostatic
Membranous
Bulbous
Pendulous
![Page 39: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/39.jpg)
RUPTUR URETRA POSTERIOR
• RUPTUR URETRA PARS PROSTATO – MEMBRANASEA.
• TERBANYAK DISEBABKAN FRAKTUR TULANG PELVIS.
• ROBEKNYA LIGAMEN PUBO - PROSTATIKUM
![Page 40: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/40.jpg)
KLASIFIKASICOLAPINTO DAN Mc COLLUM ( 1976 ) :• 1. STRETCHING (TEREGANG). TIDAK ADA
EKSTRAVASASI.• 2. URETRA PUTUS DIATAS PROSTATO
MEMBRANASEA. DIAPHRAGMA UROGENITAL UTUH. EKSTRAVASASI TERBATAS PADA DIAPHRAGMA UROGENITAL.
• 3. URETRA POSTERIOR,DIAPH.UROGENITAL & URETRA PARS BULBOSA PROKSIMAL RUSAK. EKSTRAVASASI SAMPAI PERINEUM
![Page 41: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/41.jpg)
![Page 42: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/42.jpg)
DIAGNOSISGAMBARAN KHAS :• 1. PERDARAHAN PERURETRA• 2. RETENSI URINE • 3. RT : FLOATING PROSTAT.
URETROGRAFI : • EKSTRAVASASI KONTRAS PD PARS PROSTATO
MEMBRANASEA• FRAKTUR PELVIS.
![Page 43: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/43.jpg)
Floating Prostat
![Page 44: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/44.jpg)
Uretrografi
![Page 45: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/45.jpg)
Ruptur Parsial
![Page 46: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/46.jpg)
Ruptur total
![Page 47: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/47.jpg)
RUPTUR URETRA ANTERIOR
• PENYEBAB TERSERING : STRADDLE INJURY ( CEDERA SELANGKANGAN )
JENIS KERUSAKAN :• KONTUSIO DDG URETRA• RUPTUR PARSIAL• RUPTUR TOTAL
![Page 48: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/48.jpg)
DIAGNOSISKLINIS :• PERDARAHAN PERURETRA/HEMATURI• HEMATOM / BUTTERFLY HEMATOM• KDG RETENSI URINE
KONTUSIO : EKSTRAVASASI –RUPTUR : EKSTRAVASASI + BULBOSA
![Page 49: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/49.jpg)
Sleeve Hematom
![Page 50: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/50.jpg)
![Page 51: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/51.jpg)
Butterfly Hematom
![Page 52: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/52.jpg)
Ada 5 tipe
Tipe 1
. Ruptur ligamentum puboprostatika
. Prostate bergeser ke posterior
. Uretra tetap intak
. Tdk ada extra vasasi zat kontras
![Page 53: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/53.jpg)
Tipe 2
• Trauma uretra posterior & diafragma urogenital• Terlihat extravasasi kontras dlm pelvis extra
peritoneal• Zat kontras tdk ada dalam perineum
![Page 54: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/54.jpg)
Tipe 3
• Tipe yang sering• Kerusakan meluas• Terlihat extravasasi kontras pada rongga
pelvis extra peritoneal dan perineum
![Page 55: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/55.jpg)
Tipe 4
• Terjadi dekat buli-buli meluas ke uretra proximal
• Extravasasi kontras pada pelvis extra peritoneal & sekitar proximal uretra
• Dapat merusak sfingter uretra interna
![Page 56: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/56.jpg)
Tipe 5
• Terjadi di uretra anterior• Terlihat extravasasi kontras bagian
inferior diafragma urogenital
![Page 57: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/57.jpg)
![Page 58: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/58.jpg)
![Page 59: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/59.jpg)
![Page 60: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/60.jpg)
![Page 61: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/61.jpg)
![Page 62: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/62.jpg)
![Page 63: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/63.jpg)
VCUG
![Page 64: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/64.jpg)
• Atau: micturating cystourethrography• Untuk menilai katup vesicoureter• Indikasi: – Kecurigaan refluks vesicoureter– Mencari faktor predisposisi ISK berulang anak– Menilai uretra saat miksi– Stress incontinence– Hidronefrosis
• Kontraindikasi: ISK akut
![Page 65: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/65.jpg)
PROSEDUR
• Prosedur px radiologi umum• Pasang kateter• Hubungkan dg infus set berisi bahan kontras• Fluoroskopi: perhatikan adanya refluks• Ambil foto posisi: AP, RPO, LPO, foto spot• Minta pasien miksi/ anak: dirangsang miksi• Perhatikan refluks.• Ambil foto posisi: AP, RPO, LPO, spot. • Refluks mencapai ginjal kosongkan VU
![Page 66: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/66.jpg)
![Page 67: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/67.jpg)
Vesicoureteral reflux (VUR)
![Page 68: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/68.jpg)
APG
![Page 69: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/69.jpg)
DEFINISI
- Pemeriksaan non fungsional untuk menilai traktus urinarius dengan memasukkan zat kontras secara antegrad (searah dengan arah urin) ke sistem pelvikokalises melalui kateter nefrostomi.
- Bersifat non fungsional
![Page 70: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/70.jpg)
INDIKASI• Memperlihatkan lokasi dari suatu obstruksi• Memperkirakan penyebab obstruksi• Memperlihatkan sistem pelvikokalises jika
tidak dapat dilakukan dengan urografi intravena, pielografi retrograd, modalitas lain.
• Sebagai bagian dari pemeriksaan nefrostomi perkutan.
![Page 71: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/71.jpg)
KONTRAINDIKASI
• Infeksi akut traktus urinarius• Alergi zat kontras• Ibu hamil• Diastasis hemoragika• Kemungkinan penyakit ginjal hidatidosa
![Page 72: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/72.jpg)
PROSEDUR • Ambil foto AP sebelum pemberian zat kontras• Injeksi zat kontras dengan panduan fluoroskopi• Zat kontras dimasukkan ke dalam selang nefrostomi.• Jumlah zat kontras yang diberikan tergantung pada
derajat hidronefrosis. • Foto dengan berbagai posisi– AP, RPO, LPO, Lateral.
![Page 73: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/73.jpg)
KOMPLIKASI- Alergi zat kontras (< daripada i.v)- Pielitis kimiawi- Perdarahan perirenal dan intrarenal- Hematuria- Pneumothoraks- Infeksi - Nyeri- Urinoma- Fistula arteriovena- Trauma iatrogenik pada traktus urinarius
![Page 74: Radiologi urologi](https://reader031.vdocuments.pub/reader031/viewer/2022020709/56d6bfb81a28ab3016976a65/html5/thumbnails/74.jpg)