Download - Batu Saluran Kemih
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BATU SALURAN KEMIH
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BATU SALURAN KEMIH1. Batu parenchym ginjal2. Batu pylum Batu Staghorn3. a. Batu ureter prox. b. Batu ureter tengah c. Batu ureter distal d. Batu ureter intra mural4. Batu kandungan kemih
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JENIS BATU - Ca. oxalat 70-30% - Struvite (infeksi) - 21% - Urat ± - 5% - Cystine 3 - 4%
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E T I O L O G I Banyak faktor dan tak ada satu yang dominan Lebih tepat: faktor-faktor resiko berdasarkan patofisiologi Analisa batu: 80% Ca. oxalat-Ca. phosphat Lain-lain: urat, batu, cystine,campuran ca. ox-urat-phosphat, dll.
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Ca: Hipercalciuria: > 4 mg/kgBB/24jam 30-40% penderitaOxalat : belum dapat diperiksaph: bila makin tinggimemudahkan kristalisasiVol. Urine : banyakkristalkurangbanyak
minumAMPS: Acid Mucopolysaccharida—mucous di
urineGAGS: Zat kimiawi di urine yang merupakan
inhibitor kristalisasi Ca dan oxalat/PO4
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Asam urat: meningkat pengikatan AMPS/GAGS inhibisi kristalisasi
Hiperuricosuria: > 800 mg/24 jam ♂ > 750 mg/24 jam ♀
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K L I N I S Gejala :
1. Silent: -obstruksi
-tanpa kolik: batu besar2. Hematuria : gross, mikroskopis3. Batu intramural; hematuria, polakisuria,
disuria, menyerupai batu kandung kemih4. Nyeri pinggang
Kolik (+)
Kolik (-)
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Tanda : -kadang dgn. Gross hematuria -nyeri ketok/tekan di sudut iga
12/vertebra (costo-vertebra angle) -hidronefrosis: palpasi Ballotement x-ray -infeksi suhu tinggi -renal failure (akut/kronis)
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BATU URAT Infus Na HCO3, 84 mEo dalam 500 ml NaCl fis., 4-6 unit/hariSuntikan furosemide, 40-60 mg, 3-4/hrAllopurinol 300-400 mg/hr
Tindakan Pembedahan:Indikasi: (Buchanan,1979) -Obstruksi -Diameter> 6 mm, sukar keluar -Batu Staghorn
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TINDAK LANJUT Minum : banyak, vol. Urine 2 l/hr Spesifik :
Ca. Oxalat/fosfat:1. Low Ca diet, thiazide2. Low purine diet, allopurinal,
kombinasi thiazide + allopurinal3. Low oxalat diet
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T E R A P I Konservatif : Way & Frank :
-< 4 mm 82% -< 5 mm (sepertiga distal) 85% -5-10 mm 36% ->10 mm 2 dari 13
( dalam tempo satu tahun)
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Struvite : - acidifikasi urine - antibiotik sesuai sensitivitas - operatif
Urat : - low purine diet - allopurinal - alkalinisasi
Cystin : - alkalinisasi urine - penicillamine
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D I A G N O S I S1. Keluar batu dari urine2. X-photo3. Operatif dikeluarkan batu4. USG : sonodenseX-photo : 1.BNO (KBU) radio opaque, batu
urat tak kelihatan ok radiolucent. 2.IVP : obstruksi
ureter/rielum/calyces dgn. Hydro ureter/hydro pelvis/hidrocalyces.
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TERAPIBatu kecil : 0 < 5 mm, konservatif dengan force
diuresisMetode SesiaJam 07.00 : inj. Furosemide 40 mg 1.m 0800-09.00 : Minum 1 ltr air 09.00-10.00 : Minum 1 ltr air Suntikan prostigmin 10.00-11.00 : Minum 1 ltr air Suntik spasmolitik/analgetik 11.00-12.00 : Minum 1 ltr airProsedur diulang 1-2x/minggu hingga batu keluar
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Metoda Lain Tab. Furosemide 2x40 mg peroral 4 hr/mgg minum yang banyak Batu urat : idem, alkalinisasi urine dgn. NaHCO3, allopurinolBatu besar : operatif bedah urologiPencegahan : mutlak perlu analisa biokimiawiHipercalciuria :1. Diet rendah Ca, Na
2. Thiazide : -chlortalidon 25 mg/hr -HCT 25-50 mg/hr
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Hiperuricosuria :1. Diet rendah purine 2. Allopurinol 200-300
mg/hr.Batu Infeksi : Camp. Ca.mg. Ox.phosp. Urat=Struvite
- Berantas infeksi- Minum 2-3 ltr/hr
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FORCED DIURESISMetode Sesia: Batu 1 cm
jam 07.00 furosemide 08.00-09.00 minum 1 ltr air 09.00-10.00 minum 1 ltr air injeksi prostigmin 10.00-11.00 minum 1 ltr air inj. Spasmolytic 11.00-12.00 minum 1 ltr airLubis Dkk : Hasil : 73%
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Sidabutar, 1978 1x0,5 cm, tanpa obstruksi berat atau infeksiMetode : 1. Pagi:40-60 mg furosemide IV 2. Minum 4 ltr air, olahragaHasil : 10 hari: -46% hilang -27% turun -27% gagal
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TERAPI OPERATIFIndikasi :1. Batu besar: ø6 mm
2. Staghorn 3. Obstruksi
Lanjutan :-Preventif-Restrikasi : purine, alkohol, jengkol, petai?-Rajin : minum 2-3 ltr/hr, exercise, kontrol
urine
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ADVANCESSemi invasif : percutaneous nefrolito-
tripsi=PCN probeginjal/pyelum shock wave,lithotripsy
Non invasif : extra corporeal shock wave lithotripsy=ESWLKombinasi : PCN + ESWL, Operatif + ESWL batu besar + multiple.
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