TIMING OF SURGERY

ANOMALI
UROGENITAL ANAK
Bustanul Arifin Nawas, Erjan Fikri
Divisi Bedah Anak
FK UNPAD / RS Hasan
timing of surgery

pendahuluan
timing of surgery krusial

derajat urgensi tindakan:

1. immediate group
2. intermediate group
3. elective group
timing of surgery

phymosis
stenosis preputial ring
non retractable

paraphymosis
retraksi preputial ring
proksimal sulcus coronarius

sirkumsisi segera setelah diagnosis

phymosis
paraphymosis
timing of surgery

synechia vulva
iritasi pada vulva
(infeksi, hygiene, kelembaban urin)
estrogen cream
surgical separation

release synechia setelah diagnosis

synechia vulva
timing of surgery

imperforate hymen
1 : 2000 bayi perempuan
penonjolan dari dalam vagina
hidrokolpos/hematokolpos

insisi hymen segera setelah diagnosis

imperforate hymen
timing of surgery

hypospadia
gangguan perkembangan urethra
chordee, preputial hood, ventral meatus
koreksi untuk bentuk dan fungsi yang normal

chordee tanpa hypospadia

varian hypospadia
penis lengkung, meatus pada tip glans

repair hypospadia : 6-18 bulan

Hypospadia
chordee tanpa hypospadia..
timing of surgery

hydrokel skrotum
patensi prosesus vaginalis
transillumination
observasi sampai usia 2 thn

high ligation : usia 2 tahun

hydrokel skrotum
timing of surgery

varikokel
dilatasi, tortuisity pleksus pampiniformis
inkompetensi valvula
terapi: surgical ligation

timing of surgery: grade III

Varikokel
timing of surgery

torsio testis
peak incidence 14 16 yo
dingin, trauma, undescensus testis
lebih 24 jam: testicular salvage < 10%

detorsio testis : 4 6 jam

torsio testis
timing of surgery

prune belly syndrome

defisiensi muskulatur ddg. perut
undescensus testis bilateral
dilatasi renal collecting system

timing of surgery: tgt berat/ringan kelainan

prune belly syndrome
timing of surgery

patent urachus
kegagalan obliterasi urachus
wet umbillicus, discharge urine
VCUG, fistulogram

eksisi urachus setelah diagnosis

patent urachus
timing of surgery

ekstrofi buli
1 dari 50.000 bayi baru lahir
gangguan migrasi mesoderm
ekstrofi-epispadia kompleks

timing of surgery:
bladder closure 24 48 jam pertama
repair epispadia 12 18 bln
rekonstruksi bladder neck 4-5 thn
ekstrofi buli
timing of surgery

agenesis penis
anomali sangat jarang
kegagalan perkembangan genital tubercle
female gender assignment
terapi estrogen pada pubertas

orchidectomy dini segera setelah lahir

rekonstruksi urogenital
agenesis penis
timing of surgery

refluks vesiko-ureter
infeksi saluran kencing, scarring ginjal
terapi medikal
indikasi operasi:
pielonefritis berulang, break through infeksi,
button hole ureteral meatus

reimplantasi ureter: bila indikasi +

refluks vesiko-ureter
timing of surgery

megaureter
primer, sekunder
obstruktif, refluxing
hydronefrosis, ggn fungsi ginjal

reimplantasi ureter: setelah diagnosis

megaureter