Research Article

Sistem tunggal ureter ektopik dengan ginjal multikistik displastik di RSUP Sanglah, Bali, Indonesia: laporan kasus

Donny Oktavius , Gede Wirya Kusuma Duarsa

Donny Oktavius
Dokter umum, Fakultas Kedokteran Universitas Kristen Krida Wacana, Jakarta. Email: donnyokt@gmail.com

Gede Wirya Kusuma Duarsa
Spesialis Urologi, Divisi Urologi Rumah Sakit Umum Sanglah, Fakultas Kedokteran Universitas Udayana, Denpasar, Bali
Online First: March 26, 2020 | Cite this Article
Oktavius, D., Duarsa, G. 2020. Sistem tunggal ureter ektopik dengan ginjal multikistik displastik di RSUP Sanglah, Bali, Indonesia: laporan kasus. Intisari Sains Medis 11(1): 228-232. DOI:10.15562/ism.v11i1.551


Background: Ectopic ureter is a condition when the ureter does not enter the bladder properly. The occurrence of the ectopic ureter is 1:2.000 - 1:4.000 in general population with gender ratio 6:1 in favour of females. More than 80% of cases of ectopic ureters are generally associated with complete duplication of the pelvic-ureteric system. Still, the ectopic ureter can also occur in a single pelvic-ureteric system, which is typically dysplastic or poorly functioning, such as in multicystic dysplastic kidney. This study aims to evaluate the current management of a single ectopic ureteral system with dysplastic multicystic kidneys at Sanglah General Hospital, Bali, Indonesia.

Case Description: A 3-year-old girl was referred to the urology clinic of Sanglah General Hospital with chief complaint cloudy urinary since 1,5 years ago. Past medical history, the patient had a recurrent urinary tract infection with fever. Physical examination and laboratory findings were normal. However, an abdominal ultrasound showed a multicystic dysplastic kidney. VCUG showed vesicoureteral reflux grade V and ectopic ureter. Cystoscopy with retrograde pyelography and ureterorenoscopy showed an ectopic ureter opening was located in the proximal urethra above the external sphincter. Nephroureterectomy was performed. After the surgical procedure, the patient was treated and had no complaint. The patient was discharged from the hospital four days after surgery.

 Conclusion: The management of ectopic ureteral cases varies for each case. In this regard, the nephroureterectomy surgery performed in the case has provided good outcomes.



Latar Belakang: Ureter ektopik merupakan suatu kondisi dimana ureter tidak masuk ke buli-buli pada tempat yang seharusnya. Insiden ureter ektopik 1:2.000 - 1:4.000 kelahiran pada populasi secara umum dengan perbandingan jenis kelamin perempuan lebih banyak daripada laki-laki, yaitu 6:1. Lebih dari 80% kasus ureter ektopik umumnya berhubungan dengan duplikasi sistem pelvis-ureter yang lengkap. Tetapi ureter ektopik juga dapat terjadi pada sistem pelvis-ureter tunggal, yang pada umumnya displastik atau fungsinya buruk, seperti pada keadaan ginjal multikistik displastik. Studi ini bertujuan untuk mengevaluasi manajemen terkini pada sistem tunggal ureter ektopik dengan ginjal multikistik displastik di RSUP Sanglah, Bali, Indonesia.

Deskripsi Kasus: Seorang anak perempuan berusia 3 tahun dirujuk ke poliklinik urologi Rumah Sakit Sanglah dengan keluhan buang air kecil keruh sejak 1,5 tahun lalu. Riwayat penyakit dahulu, penderita mengalami infeksi saluran kemih berulang disertai demam. Hasil pemeriksaan fisik dan laboratorium normal. Hasil USG abdomen menunjukkan gambaran ginjal multikistik displastik, VCUG menunjukkan vesikoureteral refluks grade V dan ureter ektopik. Sistoskopi dengan retrograde pyelografi dan ureterorenoskopi menunjukkan muara ureter ektopik terletak di uretra proksimal di atas sfingter uretra eksterna. Lalu dilakukan tindakan nefroureterektomi. Setelah dioperasi, selama perawatan, pasien tidak memiliki keluhan. Pasien dipulangkan setelah empat hari perawatan.

Kesimpulan: Tatalaksana pada kasus ureter ektopik bervariasi untuk setiap kasus. Berkaitan dengan hal tersebut maka tindakan pembedahan nefrouretektomi yang dilakukan pada kasus tersebut telah memberikan luaran yang baik.

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