Vesico Ureteral Junction Obstruction: Ardyansyah Can
Vesico Ureteral Junction Obstruction: Ardyansyah Can
Vesico Ureteral Junction Obstruction: Ardyansyah Can
JUNCTION
OBSTRUCTION
ARDYANSYAH CAN
PATOLOGI OBSTRUKSI
Gross
◦ 48 jam: dilatasi collecting system, tumpulnya papil ginjal,
peningkatan berat ginjal
◦ 72 jam: edema parenkim
◦ 12 hari: dilatasi collecting system semakin nyata
◦ 21 – 28 hari: jaringan korteks dan medulla ginjal menipis
◦ Pada 6 minggu pasca obstruksi: ginjal yang terkena akan terlihat
gambarannya kistik, membesar namun lebih ringan jika
dibandingkan dengan ginjal normal
Mikroskopik
◦ Dilatasi tubulus
◦ Infiltrasi sel inflamasi - penebalan interstitial space - fibrosis
◦ Fibrosis tubulointerstisial yang progresif
◦ Apoptosis sel tubulus ginjal
PATOLOGI OBSTRUKSI
DAMPAK KLINIS
◦ Hipertensi
◦ Compensatory contralateral renal growth
cellular hypertrophy
◦ Post-obstructive diuresis
◦ UO ≥ 200 ml/jam
◦ Bilateral tidak ada ginjal yang
mengkompensasi ANP ↑
◦ Unilateral kompensasi oleh ginjal
kontralateral
TERMINOLOGY
Hydronephrosis is the dilation of the renal pelvis or calyces.
It may be associated with obstruction but may be present in the
absence of obstruction
RENOGRAPHY
MAG-3 diff fn, diuresis renography
DTPA diff fn, diuresis renography (more
background activity in infants)
DMSA diff fn, renal scarring
Glucoheptonate diff fn, perfusion, renal scarring
(images not very sharp; substitute if DMSA
unavailable)
DIURETIC RENOGRAM
IV hydration; catheter in bladder
Differential function : calculated from uptake in first 2 minutes
Lasix give 1 mg/kg at 20 to 30 minutes; collecting system should be
full
Diff fn T½ management
(%) (minutes)
Hodges SJ, Werle D, McLorie G, Atala A. Megaureter. ScientificWorldJournal. 2010 Apr 13;10:603-12. doi: 10.1100/tsw.2010.54. PMID: 20419273; PMCID: PMC5763690.
SURGICAL INDICATION
Indikasi bedah:
- Simptomatik
- Kegagalan terapi non operatif
SURGICAL MANAGEMENT
Traditionally Open surgery, to excise the area of scarring
and re-connect the ureter to kidney
Minimally Invasive:
Endopyelotomy
Laparoscopic Pyeloplasty
SURGICAL MANAGEMENT
Prosedur reimplantasi ureter/ ureteroneosistostomi dapat dilakukan
secara intravesika, ekstravesika atau kombinasi keduanya
Kasus yang bilateral teknik intravesika.
Ureter yang berkelok-kelok perlu diluruskan tanpa
mengorbankan vaskularisasi ureter.
Ureter yang sangat lebar tapering atau plikasi mekanisme
antirefluks.