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    30 Juni 2019

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    Komet Rama Daud
    The document reports on emergency case reports from a hospital in Makassar on June 30th, 2019. It includes details of a 62-year-old male patient who presented with inability to urinate and was diagnosed with urine retention due to suspected urethral rupture and enlarged prostate. The patient underwent an open cystostomy procedure under spinal anesthesia to relieve the urinary retention.

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    30 Juni 2019

    Uploaded by

    Komet Rama Daud
    19 views20 pages
    The document reports on emergency case reports from a hospital in Makassar on June 30th, 2019. It includes details of a 62-year-old male patient who presented with inability to urinate and was diagnosed with urine retention due to suspected urethral rupture and enlarged prostate. The patient underwent an open cystostomy procedure under spinal anesthesia to relieve the urinary retention.

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    30 JUNI 2019

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    The document reports on emergency case reports from a hospital in Makassar on June 30th, 2019. It includes details of a 62-year-old male patient who presented with inability to urinate and was diagnosed with urine retention due to suspected urethral rupture and enlarged prostate. The patient underwent an open cystostomy procedure under spinal anesthesia to relieve the urinary retention.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    19 views20 pages

    30 Juni 2019

    Uploaded by

    Komet Rama Daud
    The document reports on emergency case reports from a hospital in Makassar on June 30th, 2019. It includes details of a 62-year-old male patient who presented with inability to urinate and was diagnosed with urine retention due to suspected urethral rupture and enlarged prostate. The patient underwent an open cystostomy procedure under spinal anesthesia to relieve the urinary retention.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 20

    EMERGENCY CASE REPORTS

    Sunday, June 30th 2019


    SURGERY DEPARTMENT

    EMERGENCY ROOM
    Wahidin Sudirohusodo General Hospital
    Makassar
    EMERGENCY CASE REPORT
    Sunday, June 30th 2019
    Ambulation : Patient
    Hospitalized
    : Patients

    Observation : Patient
    Operated : Patient
    Death : Patient
    Total : Patients
    Wahidin Sudirohusodo General Hospital
    Makassar
    Name : Mr. SN Age : 62 years
    RM : 887472 DPJP : dr. KK

    Chief complain : Cannot Micturition


    History taking : The condition has been apparent 1 day before admitted to the hospital. The
    patient also complain pain at lower abdomen, and seen lump at lower abdomen.
    The patient came to Takalar hospital and tried to be applied with urine catheher
    2 times by paramedic, but failed to insert and bloody discharge seen at the hole
    of penis without urine.
    There were history of hesitancy, weak stream, straining, feeling of incomplete
    bladder emptying, frequency, suddenly wokeup at night 3 times to micturation.
    There was no history of urgency micturation, no history of terminal dribbling
    There was no history of sand urinate
    There was no history of stone urinate
    There was no history of injury or trauma

    Defecation : Normal
    General Status
    Moderate illness / well nourish / conscious

    Vital Sign
    BP : 126/84 mmHg
    PR : 90 bpm, strong, reguler
    RR : 20 x/mnt, symmetric L= R,
    thoracoabdominal type.
    T : 36,6 °C
    PHYSICAL EXAMINATION

    Right Costovetebra
    I : Skin color is same with
    surrounding area
    Mass (-) Gibbus (-)
    P: Mass (-) ballotement (-)
    Pk : Tapping pain (-)
    Left Costovetebra
    I : Skin color is same with
    surrounding area
    Mass (-) Gibbus (-)
    P: Mass (-) ballotement (-)
    Pk : Tapping pain (-)
    PHYSICAL
    EXAMINATION
    Suprapubic Region :
    I : Bulging (+), no hematome
    P : Mass (+) Pain (+)
    Penis :
    I : circumcised, orifficium urethra
    externum at the tip of the penis, no
    hematoma
    P : No tenderness , no palpable mass
    Scotum :
    I : Skin color is darker compared with
    surrounding area
    P : Palpable 2 testes with normal size
    and consistency, no tumor mass
    PHYSICAL EXAMINATION

    Perineum Region :
    I : Skin color is darker compared to the
    surrounding area
    P : no palpable mass
    Rectal toucher :
    Spincter ani was tight, mucosa smooth,
    tumor(-) ampula filled with feces,
    prostate difficult to evaluate, handscoen
    feces (+) blood (-) slime (-)
    Clinical Diagnosis
    • Urine Retention due to suspicious urethral
    rupture
    • Suspicious Hypertrophy Prostate
    USG ABDOMEN
    Laboratory findings :
    • Hb : 13,5  PT : 10,3
    • Hct : 40  INR : 0,99
    • WBC : 14,8  APTT : 31,9
     PLT : 119
     Ur : 43
     Cr : 1,80
    WORKING : Urine retention due to suspicious
    DIAGNOSIS urethral rupture
    Hyperthropy Prostate grade I-II

    MANAGEMENT : • IVFD
    • Medicaments
    • Immediate Open Cystostomy
    Operating Procedure
    - The patient lie on supine position under spinal anesthesia
    - Drapping and disinfection procedure on suprapubic region
    - Incision at midline, 2 finger above symphisis pubic continuous 10cm to
    umbilicus, deeper the incision until anterior fascia rectus abdominis
    muscle.
    - Make two stitch at right and left vesicae wall
    - Continous with vesicae aspiration test by 5cc spouit, urine came out, and
    make incision at the point of aspiration, and continuous applying folley
    cathteter 18 Ch, and catheter balloon fill with aquades to expand
    - Stitching the operated incision layer by layer
    - operation is done
    Operating Finding
    POST OP : Urinary retention due to suspicious urethral
    DIAGNOSIS rupture
    Hyperthropy Prostate grade I-II

    FOLLOW UP : •Vital Sign


    •Urine production
    •Pro Bipolar Urethrocystography

    PROGNOSIS : Good
    THANK YOU
    ETIOLOGY URETHRAL INJURY
    1. From external injuries consist of :
    1. Blunt injuries
    1. Direct injury
    2. Indirect injury
    2. Penetrating injury
    1. Stab wound
    2. Gun shot
    3. Direct blunt injury : straddle injury
    4. Indirect bunt injuries : pelvic injury : pubic fracture, symphiolysis
    2. From internal injuries :
    1. Catheterization
    2. Bouginaton
    3. Endoscopy
    3. Following instrumenation, injury, is common of 3 sites :
    1. At the external meatus -> the narrowest position of the urethra
    2. At the bulbus urethra
    3. At the prostatic urethra
    Suprapubic Cystostomy is employed for:
    1. Relief of acute urinary obstruction where the
    urethral catheter can not be inserted into the
    bladder
    2. Relief of chronic urinary retention where the
    obstruction at or below the internal meatus of the
    bladder
    3. Relief of chronic retention in the neurogenic
    bladder
    4. Urethral rupture and urinary infiltrate

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