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Hidronefrosis
Sagiran
Bagian Bedah FK UMY
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PENGERTIAN
• Hydronephrosis is distention and dilation of the renal pelvis, usually caused by obstruction of the free flow of urine from the kidney.
• Hydronephrosis is a condition that occurs with a disease and is not a disease itself.
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ETIOLOGI
• acute bilateral obstructive uropathy
• chronic bilateral obstructive uropathy
• vesicoureteric reflux • uteropelvic junction
obstruction • posterior ureteral valves • neurogenic bladder • bladder outlet obstruction • prune belly syndrome
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PENYEBAB
JEPITAN
BATU DI MUARA URETER
SUBPELVIC STENOSIS
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DERAJAT
• CUPPING• FLATTENING• CLUBING• BALOONING
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GEJALA
• Flank pain • Abdominal mass • Nausea and vomiting • Urinary tract infection • Fever • Dysuria • Increased urinary frequency • Increased urinary urgency
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PEMERIKSAAN IMAGE
• Intravenous pyelogram (IVP)
• Isotope renography (radio-isotope scan of the kidneys)
• Ultrasound of the kidneys or abdomen
• CT scan of the kidneys or abdomen
• Abdominal MRI
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TERAPI
• A ureteral stent (tube that allows the ureter to drain into the bladder)
• A nephrostomy tube (allows the blocked urine to drain through the back)
• Antibiotics for infections
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Contoh KasusHidronefrosis karena batu ureter
• Tn. Sudarto, 50 tahun, NRM 297-42-89, MRS 6-12-2005• ANAMNESIS• Perut kiri bagian bawah terasa nyeri sejak 1,5 bulan , hilang timbul,
menjalar. riwayat hematuria (+) 1,5 bulan yang lalu.riwayat nyeri pinggang kiri (+) 2,5 bulan yang lalu hilang timbul, passing stone (-), badan panas (-). BAK nyeri (-). DM (-), HT (-)
• PEMERIKSAAN FISIK• Pada pemeriksaan fisik : keadaan baik, komposmentis, gizi baik, TD 120/80
mmHg, N 80 x/mnt, R 20 x/mnt, S 36 0C konjungtiva tak pucat, sklera tak ikterik. Paru sonor, bronkovesikuler, ronkhi tidak ada. Bunyi jantung I-II murni murmur tidak ada, gallop tidak ada. Abdomen tak membuncit, lemas, Nyeri (-), bising usus (+) Normal. Ekstremitas edema tidak ada.
• Status urologi : sudut kostovertebra kanan tidak ada massa, nyeri tekan, dan nyeri ketok, sudut kostovertebra kiri tidak ada massa, nyeri tekan, dan nyeri ketok, Supra simfisis : tidak teraba massa, tidak ada nyeri tekan, kesan buli-buli kosong, GE : oue tidak sempit, indurasi(-), Discharge (-), prostat teraba simetris, kenyal, nodul (-), TBP 20 gram, Scrotum: kedua testis teraba normal.
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Kasus (lanjutan)• PEMERIKSAAN TAMBAHAN• Laboratorium: Hemoglobin 14,3 g/dL; Hematokrit 41%; Lekosit 9100
/L; Trombosit 263.000/L; Ureum 26 mg/dL; kreatinin 1,7 mg/dL;Asam urat 7 mg/dL Urinalisis: BJ 1.025, PH 5.0, Leukosit 2-4 /LPB, Eritrosit 0-1/LPB, Bakteri (-). Epitel(+), kultur (-)
• BNO : tampak bayangan radioopaque di pelvis minor kiri uk 3x5mm• IVP : delayed function bilateral, HN kiri• USG : bayangan batu di pole atau ginjal kiri• DIAGNOSIS• Batu ureter distal kiri + delayed function ginjal bilateral +
Hidronefrosis kiri• PENATALAKSANAAN• Pada 8-12-2005 dilakukan URS dan pasang DJ stent kiri. Pasien
pulang tanggal 9-12-2005 dan disarankan BNO kontrol 1 minggu lagi dan kontrol di Poliklinik Urologi, pasien direncanakan untuk aff DJ stent 1 bulan pasca operasi.