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Gambaran neurogenic bladder pada pemeriksaan voiding cystourethrography: serial kasus



Abstract

Latar Belakang: Neurogenic bladder (kandung kemih neurogenik) adalah suatu kelainan pada kandung kemih yang disebabkan karena terdapat kerusakan maupun penyakit yang menyerang sistem saraf pada daerah inervasi saluran kemih bagian bawah. Neurogenic bladder merupakan suatu proses yang kompleks di mana diperlukan suatu proses anamnesis, pemeriksaan fisik dan pemeriksaan penunjang yang seksama dalam menentukan diagnosis penyakit tersebut. Voiding Cystouretrography (VCUG) merupakan salah satu pemeriksaan radiologi yang memiliki peran penting dalam menegakan diagnosis neurogenic bladder serta penentuan terapi dan pencegahan komplikasi lebih lanjut. Serial kasus ini akan membahas tiga kasus neurogenic bladder berdasarkan pemeriksaan voiding cystourethrography serta beberapa etiologi dan komplikasi yang dapat menyertainya.

Kasus: Pasien pertama yaitu wanita usia 13 tahun dengan klinis neurogenic bladder dan vesicoureteric reflux (VUR). Pada pemeriksaan VCUG didapatkan neurogenic bladder tipe UMN dengan gambaran cystitis kronis, vesicoureteric reflux (VUR) kiri grade V, parsial obstruksi pada ureter kiri 1/3 distal setinggi UVJ, spina bifida pada corpus vertebra L4, dan sacralisasi pada L5. Pasien kedua adalah laki-laki usia 7 bulan dengan manifestasi klinis infeksi saluran kemih. Hasil pemeriksaan VCUG didapatkan gambaran neurogenic bladder tipe UMN dengan posterior urethral valve disertai dengan cystitis dan divertikulosis. Pasien ketiga merupakan laki-laki usia 34 tahun dengan gambaran klinis striktur uretra. Pada pemeriksaan VCUG didapatkan striktur total urethra pars membranacea, neurogenic bladder tipe UMN dengan cystitis dan divertikel dinding posterior buli serta vesicolithiasis multipel.

Simpulan: Pemerikasan VCUG memegang peranan penting dalam mendiagnosis neurogenic bladderbeserta beberapa etiologi dan komplikasi yang dapat menyertainya, sehingga penatalaksanaan pasien optimal dan prognosis pasien menjadi lebih baik.


Background: Neurogenic bladder is a bladder disorder caused by any damage or disease that attacks the nervous system in the lower urinary tract. Neurogenic bladder is a complex process that requires thorough history taking, physical examination, and supporting radiology examination in determining the diagnosis of the disease. The voiding cystourethrography (VCUG) is radiological imaging that has an essential role in establishing the diagnosis of the neurogenic bladder. It also helps in determining therapy and preventing further complications. This case series aims to elaborate on three neurogenic bladder patients focusing on voiding cystourethrography and the etiology and complications concerning the disease.

Cases: The first patient was a 13-year-old girl with clinical neurogenic bladder and vesicoureteral reflux (VUR). The radiograph from VCUG examination revealed UMN type neurogenic bladder with chronic cystitis, left vesicoureteral reflux (VUR) grade V, partial obstruction in the left 1/3 distal ureter at UVJ level, spina bifida in the L4 vertebral body, and sacralization at L5. The second patient was a 7-month-old boy with clinical manifestations of urinary tract infection. The results of the VCUG examination found a neurogenic bladder of the UMN type with a posterior urethral valve accompanied by cystitis and diverticulosis. The third patient was a 34-year-old man with clinical features of urethral stricture. On VCUG examination, total stricture of the urethra pars membranacea, neurogenic bladder UMN type with cystitis and posterior bladder wall diverticula, and multiple vesicolithiasis were found.

Conclusion: VCUG examination plays an important role in diagnosing neurogenic bladder and several etiologies and complications that can accompany it. In addition, optimal patient management and better prognosis can be achieved.

Keywords: kandung kemih neurogenic bladder sistem saraf radiologi

References

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How to Cite

Kurniawan, K. I. S., Laksminingsih, N. S., & Sitanggang, F. P. (2021). Gambaran neurogenic bladder pada pemeriksaan voiding cystourethrography: serial kasus. Intisari Sains Medis, 12(3), 763–767. https://doi.org/10.15562/ism.v12i3.1144
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Kadek Ieke Sugeng Kurniawan
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Nyoman Srie Laksminingsih
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Firman Parulian Sitanggang
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