PEMERIKSAAN USG PADA KELAINAN TESTIS
Disusun oleh:
M FADLI FADLI SYA SYAHDEMA (1102012150) (1102012150 )
Preseptor:
dr H !sep SAA" Sp#$d
KEPANITERAAN KEPANITERAAN KLINIK STASE STASE ILMU RADIOLOGI PERIODE 6 FEBRUARI 2017 – 24 FEBRUARI 2017 FAKULTAS KEDOKTERAN UNIVERSITAS YARSI BAB I
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PENDAHULUAN
De%or&it$ De%or&it$ss %isi' %isi' p$d$ s$lur$n s$lur$n reprodu'si reprodu'si pri$ $d$l$h $d$n$ $d$n$ stru'tur stru'tur $n $*nor&$l $n d$p$t &erus$' d$n &enh$l$ni testis" epidid&is" du'tus se&in$lis $t$u prost$t d$n d$p$t &ene*$*'$n penurun$n 'esu*ur$n $n s$n$t sini%i'$n (Sinh (Sinh et $l" 2012) +el$in$n $t$upun $t$upun lesi p$d$ testis testis terdiri terdiri d$ri *er*$$i &$,$& pen$'it H$l terse*ut &en,$'up in%e'si" 'e$-$t$n" &$lin$nsi $t$upun 'el$in$n 'onenit$l .e*er$p$ h$l $n d$p$t &en/$di pene*$* ti&*uln$ lesi$ $d$l$h seperti tr$u&$ tr$u&$ testis testis $n $n &eni&* &eni&*ul' ul'$n $n torsio torsio"" he&$to& he&$to&$" $" 'el$in 'el$in$n $n 'oneni 'onenit$l t$l sepert sepertii hidro'el hidro'el d$n $ri'o'el" in%e'si seperti epidid&itis epidid&itis d$n or,hitis or,hitis sert$ sert$ 'e$n$s$n 'e$n$s$n seperti tr$u&$ testis (Hu$n et $l" 2015) el$h el$h diper' diper'ir$ ir$'$n '$n *$h-$ *$h-$ se'it$ se'it$rr 3 d$ri d$ri l$'i4l l$'i4l$'i $'i"" p$d$ usi$ usi$ reprod reprodu's u'sii &en$l$&i su*%ertilit$s $t$upun in%ertilit$s" &en$,u p$d$ testis" se*elu& testis d$n or$n setel$h testis +el$in$n eneti, *erper$n se*es$r 153 d$ri '$sus in%ertilit$s p$d$ pri$ .$h'$n 503 pri$ tid$' terdi$nosis &es'ipun $l$t4$l$t di$nosis sud$h *er'e&*$n se&$'in ,$nih (Lotti" 201) orsio orsio testis testis $d$l$h 'e$d$$n e&erensi e&erensi $n d$p$t &en$n,$& &en$n,$& in%ertili in%ertilit$s t$s d$n tr$u&$ psi'olois p$d$ pri$ !ntu' &en,e$h ne'rosis is'e&i'" pen$n$n$n h$rus dil$'u'$n seseer$ &un'in 6i'$ testis d$p$t ddit$n$ni d$l$& -$'tu 7 /$& p$s,$ tr$u&$ tr$u&$"" le*ih le*ih d$ri d$ri 803 p$sien p$sien d$p$t d$p$t ter*e* ter*e*$s $s d$ri d$ri 'o&pli 'o&pli'$s '$sii torsio torsio"" sed$n' sed$n'$n $n $p$*il$ dit$n$ni le*ih d$ri 7 /$& p$s,$ tr$u&$" h$n$ 9 103 $n d$p$t ter*e*$s d$ri 'o&pli'$si torsio terse*ut (Lee et $l" 2015) Sel$in torsio testis" $ri'o'el /u$ &en/$di pene*$* ut$&$ ter/$din$ in%ertilit$s p$d$ pri$ $ri'o'el $ri'o'el sendiri d$p$t tert$n$ni den$n*$i' Pen$n$n$n $n *$i' h$ru h$russ didu' didu'un un den$ den$n n dete' dete'si si $n $n *$i' *$i' terh terh$d$ $d$p p $ri' $ri'o' o'el el"" '$re '$ren$ n$ oper oper$s $sii $ri'o $ri'o'el 'el d$p$t d$p$t &e&*$nt &e&*$ntu u per*$i per*$i'$n '$n 'u$lit$ 'u$lit$ss se&en se&en d$ri d$ri pender penderit$ it$ Pen$n$ Pen$n$n$n n$n $ri'o'el p$d$ de-$s$ ini pun *er'e&*$n '$ren$ h$l itu ditun/$n oleh te'ni' pe&*ed$h$n d$n pen,itr$$n $n &ul$i &en$l$&i 'e&$/u$n $n pes$t (Seo" 201)
1
PENDAHULUAN
De%or&it$ De%or&it$ss %isi' %isi' p$d$ s$lur$n s$lur$n reprodu'si reprodu'si pri$ $d$l$h $d$n$ $d$n$ stru'tur stru'tur $n $*nor&$l $n d$p$t &erus$' d$n &enh$l$ni testis" epidid&is" du'tus se&in$lis $t$u prost$t d$n d$p$t &ene*$*'$n penurun$n 'esu*ur$n $n s$n$t sini%i'$n (Sinh (Sinh et $l" 2012) +el$in$n $t$upun $t$upun lesi p$d$ testis testis terdiri terdiri d$ri *er*$$i &$,$& pen$'it H$l terse*ut &en,$'up in%e'si" 'e$-$t$n" &$lin$nsi $t$upun 'el$in$n 'onenit$l .e*er$p$ h$l $n d$p$t &en/$di pene*$* ti&*uln$ lesi$ $d$l$h seperti tr$u&$ tr$u&$ testis testis $n $n &eni&* &eni&*ul' ul'$n $n torsio torsio"" he&$to& he&$to&$" $" 'el$in 'el$in$n $n 'oneni 'onenit$l t$l sepert sepertii hidro'el hidro'el d$n $ri'o'el" in%e'si seperti epidid&itis epidid&itis d$n or,hitis or,hitis sert$ sert$ 'e$n$s$n 'e$n$s$n seperti tr$u&$ testis (Hu$n et $l" 2015) el$h el$h diper' diper'ir$ ir$'$n '$n *$h-$ *$h-$ se'it$ se'it$rr 3 d$ri d$ri l$'i4l l$'i4l$'i $'i"" p$d$ usi$ usi$ reprod reprodu's u'sii &en$l$&i su*%ertilit$s $t$upun in%ertilit$s" &en$,u p$d$ testis" se*elu& testis d$n or$n setel$h testis +el$in$n eneti, *erper$n se*es$r 153 d$ri '$sus in%ertilit$s p$d$ pri$ .$h'$n 503 pri$ tid$' terdi$nosis &es'ipun $l$t4$l$t di$nosis sud$h *er'e&*$n se&$'in ,$nih (Lotti" 201) orsio orsio testis testis $d$l$h 'e$d$$n e&erensi e&erensi $n d$p$t &en$n,$& &en$n,$& in%ertili in%ertilit$s t$s d$n tr$u&$ psi'olois p$d$ pri$ !ntu' &en,e$h ne'rosis is'e&i'" pen$n$n$n h$rus dil$'u'$n seseer$ &un'in 6i'$ testis d$p$t ddit$n$ni d$l$& -$'tu 7 /$& p$s,$ tr$u&$ tr$u&$"" le*ih le*ih d$ri d$ri 803 p$sien p$sien d$p$t d$p$t ter*e* ter*e*$s $s d$ri d$ri 'o&pli 'o&pli'$s '$sii torsio torsio"" sed$n' sed$n'$n $n $p$*il$ dit$n$ni le*ih d$ri 7 /$& p$s,$ tr$u&$" h$n$ 9 103 $n d$p$t ter*e*$s d$ri 'o&pli'$si torsio terse*ut (Lee et $l" 2015) Sel$in torsio testis" $ri'o'el /u$ &en/$di pene*$* ut$&$ ter/$din$ in%ertilit$s p$d$ pri$ $ri'o'el $ri'o'el sendiri d$p$t tert$n$ni den$n*$i' Pen$n$n$n $n *$i' h$ru h$russ didu' didu'un un den$ den$n n dete' dete'si si $n $n *$i' *$i' terh terh$d$ $d$p p $ri' $ri'o' o'el el"" '$re '$ren$ n$ oper oper$s $sii $ri'o $ri'o'el 'el d$p$t d$p$t &e&*$nt &e&*$ntu u per*$i per*$i'$n '$n 'u$lit$ 'u$lit$ss se&en se&en d$ri d$ri pender penderit$ it$ Pen$n$ Pen$n$n$n n$n $ri'o'el p$d$ de-$s$ ini pun *er'e&*$n '$ren$ h$l itu ditun/$n oleh te'ni' pe&*ed$h$n d$n pen,itr$$n $n &ul$i &en$l$&i 'e&$/u$n $n pes$t (Seo" 201)
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Pen$'it l$in seperti sper&$to'el d$n hidro'el pun /u$ &e&ili'i 'o&pli'$si $n n$t$ p$d$ penderit$ .$h'$n setel$h dioper$si pun &$sih tet$p &e&ili'i 'o&pli'$si p$s,$ oper$si $n /u$ &en$r$h 'ep$d$ in%ertilit$s ;leh se*$* itu" dete'si dini den$n te'ni' pen,itr$$n $n *$i' d$p$t &e&*$ntu &endi$nosis '$sus terse*ut den$n ,ep$t (+lies,h" 201) +el$in$n +el$in$n p$d$ testis testis $n l$in $d$l$h '$n'er testis testis +$n'er testis testis s$n$t s$n$t /$r$n /$r$n ter/$di d$n insidenn$ h$n$ se'it$r 13 &$lin$nsi p$d$ pri$ et$pi untu' di'et$hui" '$n'er testis &erup$'$n '$n'er $n p$lin serin ter/$di p$d$ de-$s$ &ud$ di -il$$h Erop$ Insidensi d$ri '$n'er testis se,$r$ u&u& &en$l$&i penin'$t$n" &es' &es'ip ipun un &ort &ort$l $lit it$s $sn n$$ &enu &enuru run n di '$-$ '$-$s$ s$n n Erop Erop$ $ S$n$ S$n$tt pent pentin in untu untu' ' &enet$hui $ri$si p$d$ popul$si" *$i' $n *erhu*un$n den$n eneti, $t$upun %$'tor lin'un$n (Sh$n&u$lin$n et $l " 201<) +$n'er testis testis ter/$di ter/$di di$nt$r$n di$nt$r$n$$ rent$n rent$n usi$ p$lin p$lin *$n$' 1540 t$hun ren ren penin'$t$n '$n'er testis se,$r$ lo*$l *erhu*un$n den$n siste& pel$$n$n 'eseh$t$n $n 'ur$n *$i' '$ren$ proses di$nosis d$n pen$n$n$n $n terl$&*$t Di/el$s'$n pul$ *$h-$ present$se pene&*uh$n $n tini d$ri '$n'er testis di,$p$i den$n den$n pen$n$ pen$n$n$n n$n $n $n tep$t" tep$t" &enur &enur$ni $ni p$p$r$n p$p$r$n *$h$n *$h$n to'si' to'si' d$n e%ed e%ed d$ri d$ri terl$& terl$&*$t *$tn$ n$ pen$n$ pen$n$n$n n$n Inside Insidensi nsi tertin tertini i d$ri d$ri '$n'er '$n'er testis testis terd$p$ terd$p$tt di =e>e$l$nd ("?)" Austr$li$ (7"<)" S-eden (5"7)" !SA (5"2)" Pol$ndi$ ("8)" Sp$nol (<"?)" @hin$ (1"<)" Indi$ (0"5) per 100000 l$'i l$'i (Sh$n&u$lin$n" 2015) Sel$in pen$'it 'e$n$s$n" pen$'it seperti 'riptor'is&us /u$ 'er$p'$li di/u&p$i d$n serin serin &ener &ener$n $n *$i *$i Pre$l Pre$lens ensii p$d$ p$d$ *$i *$i pre&$t pre&$ture ure $d$l$h $d$l$h 84<03" 84<03" *$i *$i ,u'up *ul$n se'it$r <473" 1423 p$d$ *$i *erusi$ s$tu t$hun d$n 1 3 p$d$ usi$ pu*ert$s P$d$ se*$i$n *es$r '$sus" se'it$r 204<03 tid$' terp$lp$si d$n 0"53 *erusi$ 0 t$hun (#o&ero et $l" 201) !ltr$sonor$%i &erup$'$n te'ni' pen,itr$$n $n sensitie d$n $'ur$t untu' &ene$lu$si 'el$in$n p$d$ testis d$n diteri&$ se,$r$ lu$s se*$$i te'ni' pen,itr$$n lini lini pert$& pert$&$$ untu' untu' pen$'i pen$'itt testis testis $n $n serin serin ter/$d ter/$dii sert$ sert$ $n $n /$r$n /$r$n ter/$d ter/$di i
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!ltr$s !ltr$sono onor$ r$%i %i e%e'ti e%e'ti%% d$n &erup$ &erup$'$n '$n s$tu4s s$tu4s$tu $tun$ n$ pe&eri pe&eri's$ 's$$n $n $n $n dil$'u dil$'u'$n '$n untu' untu' persi$ persi$p$n p$n p$sien p$sien &eni' &eni'uti uti oper$s oper$sii (Hu$n (Hu$n et $l" 2015) 2015) +eters +etersedi edi$$n $$n $l$t $l$t ultr$sonor$%i $n le*ih *$i' d$n te'ni' pen,itr$$n l$inn$" &e&un'in'$n 'it$ untu' &enentu'$n di$nosis den$n ,ep$t d$n &en,e$h untu' pe&*ed$h$n d$n peno*$t$n $nti*ioti, $n tid$' perlu (+h$n" 2008) !ltr$sonor$%i den$n s'$l$ $*u4$*u $*u4$*u d$n Doppler Doppler d$p$t d$p$t &e&*er &e&*eri'$ i'$n n in%or& in%or&$si $si $n $n *$i' *$i' untu' untu' &enent &enentu'$n u'$n di$nosis terh$d$p 'el$in$n p$d$ tr$'tus enit$lis p$d$ pri$ .$h'$n ultr$sonor$%i Doppler sendiri sel$in d$p$t &enentu'$n 'el$in$n" /u$ d$p$t &endete'si $d$n$ &$lin$nsi sert$ in%e'si p$d$ or$n enit$l pri$ (Lotti" 201) Pentinn$ Pentinn$ per$n per$n d$ri te'ni' te'ni' pen,itr$$ pen,itr$$n n ultr$sono ultr$sonor$%i r$%i terse*ut terse*ut &en/$di &en/$di $l$s $l$s $n penulis untu' &en$n'$t te&$ 'el$in$n p$d$ testis d$n 'e&$&pu$n !SB" terut$&$ !SB !SB Dopp Dopple lerr d$l$ d$l$& & &ende &endete te's 'sii 'el$ 'el$in in$n $n ters terse* e*ut ut d$p$ d$p$tt &enur &enurun' un'$n $n $n'$ $n'$ &ort$lit$ &ort$lit$ss $t$upun $t$upun 'o&pli'$si 'o&pli'$si $n d$p$t diti&*ul' diti&*ul'$n $n Dete'si Dete'si dini *erpen$ruh *es$r terh$d$p 'e*erl$nsun$n reprodu'si d$n 'eseh$t$n &ent$l pri$ $n &en$l$&i pen$'it terse*ut
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BAB II TINJAUAN PUSTAKA
11 Ana!"# Sa$%&an R'(&!)%*+# $
An$to&i estis estis $d$l$h or$n enit$li$ pri$ $n p$d$ or$n nor&$l /u&l$hn$ $d$ du$ $n &$sin4&$sin terlet$' di d$l$& s'rotu& '$n$n d$n 'iri .entu'n$ ooid d$n p$d$ or$n de-$s$ u'ur$nnn$ $d$l$h C
Ga",a& 2-1 Ana!"# '+#+
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Ga",a& 2-2 P'n%&%nan '+#+
estis *er$d$ di d$l$& s'rotu& *ers$&$ epidid&is $itu '$ntun e'str$s'rotu& tep$t di *$-$h penis estis 'iri terlet$' le*ih rend$h d$rip$d$ $n '$n$n Dindin p$d$ ron$ $n &e&is$h'$n testis den$n epidid&is dise*ut tuni'$ $in$lis uni'$ $in$lis di*entu' d$ri peritoneu& intr$$*do&en $n *er&ir$si 'e d$l$& s'rotu& pri&itie sel$&$ per'e&*$n$n enit$li$ intern$ pri$" setel$h &ir$si 'e d$l$& s'rotu&" s$lur$n te&p$t turunn$ testis (pro,essus $in$lis) $'$n &enutup
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L$pis$n pe&*un'us testis : $ @utis * uni,$ d$rtos , F$s,i$ sper&$ti,$ e'stern$ (Aponeurosis M;AE) d Mus,ulus ,re&$steri,$ e F$s,i$ ,re&$steri,$ (Aponeurosis M;AI) % F$s,i$ sper&$ti,$ intern$ (Aponeurosis MA) uni,$ $in$lis propi$ (L$&in$ P$riet$lis d$n L$&in$ is,er$lis) h uni,$ $l*uine$
Ga",a& 2-. La(#+an '+#+
Se,$r$ histop$tolois" testis terdiri $t$s 'ur$n le*ih 250 lo*uli d$n ti$p lo*ules terdiri $t$s tu*uli se&ini%eri Di d$l$& tu*ulus se&ini%erous terd$p$t sel sper&$tooni$ d$n sel sertoli" sed$n'$n di $nt$r$ tu*uli se&ini%eri terd$p$t sel ledi
Sel
sper&$tooniu&
p$d$ proses sper&$toenesis
&en/$di sel
sper&$too$ Sel sertoli *er%unsi &e&*eri &$'$n p$d$ *$'$l sper&$"
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sed$n'$n sel ledi $t$u dise*ut sel interstisi$l testis *er%unsi d$l$& &enh$sil'$n hor&one testosterone (Purno&o" 2011) Sel sper&$too$ $n diprodu'si di tu*ulus se&ini%erous testis disi&p$n d$n &en$l$&i pe&$t$n$n&$tur$si di epidid&is Setel$h de-$s$" sel sper&$too$ *ers$&$4s$&$ den$n et$h d$ri epidid&is d$n $s de%erens dis$lur'$n &enu/u $&pul$ $s de%erens Sel itu *er,$&pur den$n ,$ir$n d$ri epidid&is" $s de%erens" esi'ul$ se&in$lis" sert$ ,$ir$n prost$t &e&*entu' ,$ir$n se&en $t$u &$ni (Purno&o" 2011) estis dipers$r$%i oleh ser$*ut s$r$% d$ri ple'sus ner$,us testi,ul$ris Ple'sus ini di*entu' oleh nerus thor$,$lis I4II estis &end$p$t'$n d$r$h d$ri *e*er$p$ ,$*$n $rteri" $itu (1) $rteri sper&$ti'$ intern$ $n &erup$'$n ,$*$n d$ri $ort$" (2) $rteri de%erensi$lis ,$*$n d$ri $rteri esi'$lis in%erior" d$n (<) $rteri 're&$steri'$ $n &erup$'$n ,$*$n d$ri $rteri epi$stri'$ Pe&*uluh en$ $n &enin$l'$n testis *er'u&pul &e&*entu' ple'sus p$&pini%or&is Ple'sus ini p$d$ *e*er$p$ or$n &en$l$&i dil$t$si d$n di'en$l se*$$i $ri'o'el (Purno&o" 2011) *
An$to&i Epididi&is Epididi&is $d$l$h or$n $n *er*entu' seperti sosis terdiri $t$s '$put" 'orpus" d$n '$ud$ epidid&is +orpus epidid&is dihu*un'$n den$n testis &el$lui du'tuli e%erentes $s'ul$ris$si epidid&is *er$s$l d$ri $rteri testi'ul$ris d$n $rteri de%erensi$lis Di se*el$h '$ud$l" epidid&is *erhu*un$n den$n $s$ de%erens (Purno&o" 2011) Sel sper&$too$ setel$h diprodu'si di d$l$& testis" di$lir'$n 'e epidid&is Disini sper&$too$ &en$ll$&i &$tur$si sehin$ &en/$di &otil (d$p$t *erer$') d$n disi&p$n di d$l$& '$ud$ epidid&is se*elu& di$lir'$n 'e $s de%erens (Purno&o" 2011)
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Ga",a& 2-4 Ana!"# '+#+/ '(#)#)"#+/ )%%+ ''&'n'+
1-2 T'*n#* P'"'&#*+aan USG Pa)a T'+#+
e'ni' Pen,itr$$n !SB estis :
a. P$sien dilet$''$n d$l$& posisi supin$si d$n let$''$n h$n du' $n terlip$t di$nt$r$ '$'i p$sien untu' &en$n'$t s'rotu& b. Penis dilet$''$n di $t$s reio supr$pu*i' p$sien d$n t$h$n den$n h$ndu' 'edu$ c. Pe&*$,$$n $-$l &enun$'$n %re'uensi tini (5412 MH) den$n $r$h linier d. +$sus $n &en$nd$'$n $d$n$ pe&*en'$'$n s'rotu&" tr$nsdu,er $rr$ 'ur$ linier den$n %re'uensi tini &enin'$t'$n l$p$n p$nd$n" sehin$ d$p$t &elih$t te&u$n di lu$r testis B$&*$r$n seri$l tr$nsers$l d$n s$itt$l d$ri ti$p
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testis d$n epididi&is diperoleh den$n &en$&*$h'$n &ini&$l s$tu $&*$r $n &enun/u''$n 'edu$ testis untu' per*$ndin$n se,$r$ l$nsun terh$d$p e'oenisit$s d$ri testis" te'stur d$n 'ete*$l$n testis e. P$sien den$n lesi s'rotu& $n terp$lp$si" $&*$r t$&*$h$n di*utuh'$n untu' &enel$r$s'$n den$n te&u$n %isi' P$sien $n &er$s$'$n neri p$d$ *$i$n s'rotu&n$" d$p$t &enun/u''$n lo'$si $t$u te&p$t $n s$'it sehin$ d$p$t dite&u'$n p$d$ te&u$n us f. !SB Doppler untu' &enentu'$n $lir$n d$r$h di epididi&is d$n testis g. Penun$$n !SB Doppler den$n sensitiit$s tertini d$p$t &enun/u''$n den$n ,ep$t lo'$lis$si pe&*uluh d$r$h d$n isu$lis$si $lir$n d$r$h $n *er*ed$ d$ri 'edu$ testis 1-. Ga",a&an T'+#+ N!&"a$
B$&*$r G E'oenisit$s testis $n ho&oen d$n te'stur e'oi' B$&*$r G Per*$ndin$n testis nor&$l
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($t$n$*e" 200) B$&*$r G !SB Doppler r$nsers$l &en$&*$r'$n e'oenisit$s ser$$& d$n $lir$n &enu/u testis
($t$n$*e" 200) B$&*$r G B$&*$r$n !SB Doppler r$nsers$l $n &enun/u''$n e'oenisit$s d$n $lir$n $n si&etris
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($t$n$*e" 200) B$&*$r G estis d$n epididi&is nor&$l !SB Doppler lonitudin$l &enun/u''$n $&*$r$n $lir$n $n nor&$l d$n di%us testis d$n epididi&is
A orsio estis P$d$ 'ondisi ini" %uni'ulus sper&$ti'us terpluntir sehin$ ter/$di rot$si testis $n &enh$sil'$n is'e&i' p$d$ testis D$p$t ter/$di p$d$ se$l$ usi$ tet$pi 'e*$n$'$n ter/$di p$d$ t$hun pert$&$ usi$ *er$n/$' de-$s$" 'eti'$ testis se,$r$ ,ep$t &ele*$r P$d$ &$s$ /$nin d$n neon$tes" l$pis$n $n &ene&pel p$d$ &us'ulus d$rtos &$sih *elu& *$n$' /$rin$n pen$n$n$ sehin$ testis" epidid&is d$n tuni'$ $in$lis &ud$h se'$li *erer$' d$n &e&un'in'$n untu' terpeluntir p$d$ su&*u %uni'ulus sper&$ti'us erpeluntirn$ testis p$d$ 'e$d$$n ini dise*ut torsio testis e'str$$in$l er/$din$ torsio testis p$d$ re&$/$ di'$it'$n den$n 'el$in$n sste& pen$n$ testis uni'$ $in$lis $n seh$rusn$ &enelilini se*$i$n d$ri testis p$d$ per&u'$$n $nterior d$n l$ter$l testis" p$d$ 'e$d$$n ini tuni'$ &enelilini seluruh per&u'$$n testis sehin$ &en,e$h insersi epidid&is 'e
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dindin s'rotu& +e$d$$n ini &ene*$*'$n testis d$n epidid&is den$n &ud$hn$ *erer$' di '$ntun tuni'$ $in$lis d$n &en$ntun p$d$ %uni'ulus sper&$ti'us +e$d$$n ini di'en$l se*$$i $no&$l *ell ,l$pper $n &ene*$*'$n testis &ud$h &en$l$&i torsio intr$$in$l (S/$&suhid$/$t" 2010) Be/$l$ d$ri torsio testis $n pert$&$ $d$l$h h$&pir sel$lu neri Be/$l$ ini *is$ ti&*ul &end$d$' $t$u *er$nsur4$nsur" tet$pi *i$s$n$ &enin'$t &enurut der$/$t 'el$in$n #i-$$t tr$u&$ did$p$t'$n d$ri 203 p$sien" d$n le*ih d$ri seperti$ p$sien &en$l$&i episode neri testis $n *erul$n se&purn$ Der$/$t neri testis u&un$ *er$ri$si d$n tid$' *erhu*un$n den$n lu$sn$ sert$ l$&$n$ 'e/$di$n Pe&*en'$'$n d$n erite&$ *er$nsur4$nsur &un,ul" d$n d$p$t pul$ disert$i n$use$" o&itin" '$d$n disert$i de&$& rin$n" sert$ ter/$di pe&*en'$'$n testis =eri /u$ ter'$d$n dir$s$'$n di inuin$l d$n $*do&in$l 6i'$ testis $n &en$l$&i torsio $d$l$h &$ldesensus testis" &$'$ e/$l$ $n ti&*ul &enerup$i herni$ inuin$lis str$nul$si (S/$&suhid$/$t" 2010) P$d$ %$se $'ut" $&*$r$n ultr$sonor$%i &un'in nor&$l $t$u &enun/u''$n $d$n$ testis $n &e&*en'$' den$n $&*$r$n p$t,h $t$u hipoe'oi' di%us Epididi&is &un'in *is$ /u$ &e&*en'$' d$n &en$l$&i $ne'oi' .is$ /u$ disert$i $&*$r$n hidro'el re$'ti% d$n 'ulit s'rotu& &ene*$l sert$ ter/$di ede&$ !ltr$sonor$%i Doppler &e&*u'ti'$n *$h-$ $l$t ini d$p$t &ene$''$n di$nosis torsio testis ?53 den$n $&*$r$n penurun$n $s'ul$ris$si di se'it$r testis (tid$' $d$ $t$u *uru'n$ $lir$n -$rn$" &enurun'$n 'e'e,ep$t$n pun,$' sistoli') di*$ndin'$n den$n testis $n tid$' ter'en$ Ad$n$ %$lse4positie (se*$$i ,ontoh $itu is'e&i' $n *erhu*un$n den$n or,hido4epididi&itis $n p$r$h) d$n %$lse4ne$tie (&en$,u p$d$ sulitn$ &enentu'$n $lir$n -$rn$ $n $de'u$t" si%$t inter&itten d$ri torsio" dll) d$n &$sih terd$p$t 'ontroersi terh$d$p prosedur pe&eri's$$n pen$n$n$n p$sien den$n '$sus ini Ap$'$h h$rus &el$'u'$n !SB terle*ih d$hulu $n d$p$t &enund$ pe&*ed$h$n $t$u'$h &el$'u'$n pe&*ed$h$n terle*ih d$hulu t$np$ &el'u'$n !SB +$ren$ penund$$n pe&*ed$h$n untu'
12
&el$'u'$n !SB /u$ *erpen$ruh terh$d$p pronosis d$ri torsio testis (Sutton" 200<) Apendi's testis d$p$t *er'e&*$n &en/$di torsio testis H$l ini *er'$it$n den$n neri $'ut s'rotu& d$n pe&*en'$'$n d$n neri lo,$l P$d$ pe&eri's$$n ultr$sonor$%i dite&u'$n $d$n$ &$ss$ /$rin$n lun$' p$d$ *$i$n $t$s d$ri epidid&is $n heteroen den$n hipoe'oi' d$n *erhu*un$n pul$ den$n hidro'el Mun'in slouh o%% d$n ter'$lsi%i'$si sehin$ ter/$di penin'$t$n *$$n$n e'oi' $nt$r$ l$pis$n d$ri tuni'$ $in$lis (Sutton" 200<)
(Sutton" 200<) B$&*$r G B$&*$r$n ultr$sonor$%i Ad$n$ $&*$r$n hipoe'oi' di d$l$& su*st$n,e testis Ad/$,ent epidid&is &en$l$&i pe&*en'$'$n
(Sutton" 200<) B$&*$r G !ltr$sonor$%i &enun/u''$n $&*$r$n e'oi' d$ri s'rotu& den$n *$$n$n $'usti' dist$l d$n hidro'el 'e,il
13
($t$n$*e" 200) B$&*$r G orsio estis !SB Doppler lonitudin$l &enun/u''$n tid$' $d$n$ $lir$n p$d$ testis d$n pele*$r$n d$ri epididi&is d$n %uni'ulus sper&$ti'us" $n /u$ &enun/u''$n tid$' $d$n$ $s'ul$ris$si
($t$n$*e" 200) B$&*$r G orsio estis !SB Doppler lonitudin$l testis sinistr$ t$np$ dite&u'$n $d$n$ $lir$n
14
($t$n$*e" 200) B$&*$r G orsio testis !SB Doppler tr$nsers$l 'edu$ $&*$r &enun/u''$n pe&*es$r$n" sedi'it penurun$n e'oenisit$s d$n tid$' $d$n$ $lir$n di se*el$h 'iri
. u&or estis u&or testis &erup$'$n 'e$n$s$n ter*$n$' p$d$ pri$ $n *erusi$ di$nt$r$ 154 <5 t$hun" d$n &erup$'$n 1423 se&u$ neopl$s&$ p$d$ pri$ A'hir4$'hir ini terd$p$t per*$i'$n usi$ h$r$p$n hidup p$sien $n &end$p$t'$n ter$pi di*$ndin'$n den$n <0 t$hun l$lu" '$ren$ s$r$n$ di$nosis le*ih *$i'" di'ete&u'$n pen$nd$ tu&or" di'ete&u'$n rei&en 'e&oter$pi d$n r$di$si" sert$ te'ni' pe&*ed$h$n $n le*ih *$i' An'$ &ort$lit$s &enurun d$ri 503 &en/$di 53 (Purno&o" 2011) P$sien *i$s$n$ &eneluh $d$n$ pe&*es$r$n testis $n serin'$li tid$' neri =$&un <03 &eneluh neri d$n ter$s$ *er$t p$d$ '$ntun s'rotu&" sed$n 103 &eneluh neri $'ut p$d$ s'rotu& id$' /$r$n p$sien &eneluh '$ren$ &er$s$ $d$ &$ss$ di perut se*el$h $t$s (103) '$ren$ pe&*es$r$n 'elen/$r p$d$ $ort$" *en/ol$n p$d$ 'elen/$r leher" d$n 53 p$sien &eneluh $d$n$ ine'o&$sti$ Bine'o&$sti$ $d$l$h &$ni%est$si d$ri *ered$rn$ '$d$r .4H@B di d$l$& sir'ul$si siste&i' $n *$n$' terd$p$t 'orio'$rsino&$ (Purno&o" 2011) P$d$ pe&eri's$$n %isi' testis terd$p$t *en/ol$n p$d$t 'er$s" tid$' neri p$d$ p$lp$si" d$n tid$' &enun/u''$n t$nd$ tr$nsilu&in$si Diperh$ti'$n $d$n$ in%iltr$si
15
tu&or p$d$ %uni'ulus $t$u epididi&is Perlu di,$ri 'e&un'in$n $d$n$ &$ss$ di $*do&en" *en/ol$n 'elen/$r supr$'l$i'uler" $t$upun ine'o&$sti$ (Purno&o" 2011) Pe&eri's$$n !SB d$p$t &e&*ed$'$n den$n /el$s lesi intr$ $t$u e'str$testi'uler d$n &$ss$ p$d$t $t$u 'isti' =$&un !SB tid$' d$p$t &e&perlih$t'$n tuni'$ $l*uine$" sehin$ tid$' d$p$t dip$'$i untu' &enentu'$n pender$/$t$n tu&or testis (Purno&o" 2011) 4 Se&ino&$ Se&ino&$ &erup$'$n '$n'er testis $n serin ter/$di p$d$ popul$si or$n tu$" $itu *er/u&l$h <54503 den$n r$t$4r$t$ usi$ $n ter'en$ $d$l$h 05 t$hun Se,$r$ histoloi" se&ino&$ ter*entu' $t$s susun$n sel den$n $&*$r$n tid$' dite&u'$nn$ sitopl$s&$ d$n $d$n$ in%iltr$te li&%onodus P$d$ $&*$r$n !SB" se&ino&$ &un,ul den$n $&*$r$n &$ss$ ho&oen *entu' *ul$t den$n p$ntul$n ,$h$$ $n rend$h t$np$ '$lsi%i'$si di d$l$& &$ss$ tu&or P$d$ $&*$r$n @D!S" dite&u'$n $d$n$ $s'ul$ris$si di d$l$& lesi B$&*$r$n @E!S &enun/u''$n $d$n$ penin'$t$n ,ep$t p$d$ *en/ol$n (le*ih *es$r d$ri p$ren'i& testis nor&$l dise'it$rn$) d$n hil$nn$ *entu'$n $s'uler linier (Hu$n" 2012)
16
B$&*$rG ($) Menun/u''$n $d$n$ lesi %o'$l $n 'e,il (p$n$h) *eru'ur$n 7&&" den$n p$ntul$n $lir$n $n ser$$& (*) !SB doppler &en$&*$r'$n $s'ul$ris$si intern$l di d$l$& *en/ol$n 'e,il (p$n$h) (,) Lesi &un,ul den$n /el$s p$d$ el$stor$%i /$rin$n (di$&*$r'$n den$n $re$ *iru) (d) !ltr$sonor$%i den$n 'ontr$s &enun/u''$n $d$n$ penin'$t$n hil$nn$ $&*$r$n nor&$l pol$ $s'uler
17
4 =on4'$rsino&$ testis Did$p$t'$n d$t$ *$h-$ 803 non '$rsino&$ sel terdiri d$ri sel tu&or $n /in$' u&or ini *i$s$n$ u'ur$nn$ 'e,il d$n 'e*$n$'$n di'et$hui se,$r$ tid$' sen$/$ u&or ini serin terd$p$t p$d$ p$sien *erusi$ 20450 t$hun B$&*$r$n !SB &enun/u''$n lesi $n &un,ul ho&oen *entu' *ul$t den$n lesi hipoe'oi'
B$&*$rG u&or Sel Ledi ($) B$&*$r$n !SB &enun/u''$n lesi hipoe'oi' (t$nd$ p$n$h) (*) !SB Doppler &enun/u''$n penin'$t$n $s'ul$ris$si di d$l$& lesi (p$n$h) (,) El$stor$%i /$rin$n &enun/u''$n lesi 'e,il $n /el$s (d$er$h ,$&pur$n -$rn$
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*iru&ud$" p$n$h) (d) Den$n !SB 'ontr$s lesi &enun/uu''$n $d$n$ penin'$t$n $-$l" se*u$h '$r$'teristi' $n d$p$t &e&*ed$'$nn$ d$ri tu&or l$in @ M$ss$ s'rotu& Funsi ut$&$ AS d$l$& di$nosis &$ss$ testis $d$l$h untu' &e&*ed$'$n intr$testi,ul$r d$ri lo'$si eCtr$testi,ul$r '$ren$ &$orit$s &$ss$ eCtr$testi,ul$r $d$l$h /in$'" t$pi $n intr$testi,ul$r $n$s (5) AS tid$' &en$-$r'$n di$nosis histolois Br$4s,$le AS s$n$t sensiti% untu' &endete'si &$ss$ testis
B$&*$r < $4, Lonitudin$l -$rn$ Doppler ultr$sonor$%i $&*$r ($) seor$n pri$ 554t$hun den$n pen$nd$ tu&or ne$ti% d$n non p$lp$*le" 'ist$ $$' 'o&ple's d$l$& testis '$n$n Se*u$h 'ist$ ter&$su' sept$tions" terlet$' di se*el$h &edi$stinu&" &un'in $'i*$t d$ri stri'tur di retetestis d$ri tr$u&$ se*elu&n$ $t$u per$d$n$n Se*u$h 'ist$ d$l$& testis u&u&n$ &e&enuhi 'riteri$ d$ri seti$p 'ist$ sederh$n$:
19
'ontur h$lus" $ne,hoi, pus$t t$np$ unsur p$d$t" d$n penin'$t$n &el$lui tr$ns&isi D$l$& '$sus ini" tu&or seperti ter$to&$ $t$u sper&$to,ele intr$testi,ul$r h$rus d$l$& di$nosis di%erensi$l 6u$ perh$ti'$n hidro'el &ini&$l d$n $rteri tr$ns&edi$stin$l (p$n$h)" $n dilih$t se,$r$ sepih$' p$d$ 503 '$sus d$n *il$ter$l di 253" $n &enert$i en$ tr$ns&edi$stin$l (p$n$h)" $n terlih$t d$l$& 253 '$sus" &el$lui &edi$stinu& d$l$& testis Lonitudin$l ,itr$ ultr$sonor$%i r$4s,$le (*) seor$n pri$ <74t$hun den$n 'ist$ sederh$n$ di e'or epididi&is $n tep$t d$n %i*rosis d$ri testis Se*u$h 'ist$ 'e,il terdete'si di e'or epididi&is (p$n$h)" 'onsisten den$n $*, epididi&is 'ist$ sederh$n$ *u'$n sper&$to,ele ('ist$ $n &en$ndun p$rti'el &eniru'$n *uni sper&$ &$tiJ d$n terlet$' di 'ep$l$ epididi&is u&u&n$ dise*ut se*$$i sper&$to,ele ) 'ist$ epididi&is sederh$n$ d$p$t tun$l $t$u $nd$" s$n$t 'e,il" d$n terlet$' di seti$p *$i$n d$ri epididi&is 6u$ perh$ti'$n stri$tions hpoe,hoi, di testis p$ren'i& (p$n$h) &e&$n,$r 'e $r$h &edi$stinu& (tid$' p$d$ *id$n $&*$r)" 'onsisten den$n %i*rosis +ondisi ini *is$ s$l$h didi$nos$ se*$$i tu&or /i'$ d$er$h ini &en/$di le*ih teri&pit Pe&ind$i$n pes$-$t l$in $'$n &en$t$si per$n'$p ini Seor$n pri$ <5 t$hun den$n nodul ter$*$ perus$h$$n 'e,il $n *erer$' den$n testis sel$&$ pe&eri's$$n %isi' di he&is,rotu& '$n$n (,) r$pesiu&" -$rn$ &e&*u/ur Doppler ,itr$ ultr$sonor$%i &enun'$p'$n 'e,il" soliter unilo,ul$r 'ist$ sederh$n$ di tuni'$ p$d$ testis (p$n$h) Mes'ipun 'ete$s$n" d$p$t di$*$i'$n Etioloi tid$' /el$s (*$-$$n $t$u diperoleh" tr$u&$ $t$u in%e'si)
4 +ist$ d$n lesi 'ist$ seperti
u*ul$r e,t$si$ d$ri rete testis $d$l$h 'ondisi /in$' d$n dilih$t se*$$i
stru'tur tu*ul$r %luid%illed p$d$ tin'$t &edi$stinu& +ist$ retensi Intr$testi,ul$r /u$ terlet$' di de'$t &edi$stinu& (B$&*$r <$) Mes'ipun 'ist$ retensi intr$testi,ul$r d$n intr$testi,ul$r sper&$to,eles tid$' d$p$t di*ed$'$n d$ri ultr$sonor$%i" intr$testi,ul$r sper&$to,ele *er'o&uni'$si den$n tu*ulus se&ini%erus" ini tid$' seperti 'ist$ l$in $t$u e,t$si$ d$ri rete testis" $n tid$' *er'o&uni'$si se,$r$ l$nsun den$n tu*ulus se&ini%erus p$d$ histop$toloi
(7) +ist$ Sper&$to,ele d$n sederh$n$ d$l$&
epididi&is $n dite&ui di 'e*$n$'$n or$n de-$s$ (B$&*$r <*) Sper&$to,ele
20
&irip den$n 'ist$ di te&p$t l$in" t$pi &en$ndun e&$ tin'$t rend$h $t$u d$p$t sept$ted
Se,$r$ 'linis" di%erensi$si d$ri 'edu$ entit$s tid$' pentin P$d$ '$sus
tertentu" 'ist$ epider&oid &enun/u''$n '$r$'teristi' pol$ l$pis$n 'onsentris ,in,in Pus$t ini *en$r4*en$r $$s,ul$r"
d$n seti$p $s'ul$ris$si d$l$& lesi ter&$su'
di$nosis $pi ini tid$' sel$lu di$&$ti Sel$n/utn$" 'ist$ epider&oid $n p$lin $d$l$h lesi intr$testi,ul$r p$d$ pri$ &ud$ he true $l$s$n &enen$li lesi pr$ oper$si $d$l$h *$h-$ d$l$& '$sus terse*ut" testis4he&$t
oper$si (&enun$'$n *$ntu$n
!SB intr$oper$ti%) h$rus diperti&*$n'$n se*$$i pilih$n peno*$t$n +ist$ d$ri tuni'$ $l*uine$ &un'in ton/ol$n 'e d$l$& testis $t$u 'elu$r 'e ru$n p$r$testi,ul$r (B$&*$r <,) neopl$s&$ Intr$testi,ul$r Lesi intr$testi,ul$r p$lin $&*l$n $d$l$h neopl$s&$" d$n lesi $n p$lin nonp$lp$*le ( 1 ,&) tid$' neopl$s&$ Lesi le*ih 'e,il d$ri 1 ,& &un'in neopl$s&$ nonp$lp$*le $t$u lesi /in$' (B$&*$r ) +eh$dir$n $*nor&$l penin'$t$n $lir$n d$l$& neopl$s&$ testis ter$ntun p$d$ u'ur$n &ere'$ d$rip$d$ /enis sel &ere'$ Mis$ $n le*ih *es$r d$ri 1"5 ,& le*ih &un'in untu' &e&ili'i di*u'ti'$n () Se,$r$ u&u&" -$rn$ $t$u *erdenut Doppler tid$' diperlu'$n untu' &endete'si tu&or intr$testi,ul$r Distorsi d$ri 'ursus '$p$l nor&$l le*ih &un'in dite&u'$n p$d$ neopl$s&$ di*$ndin'$n per$d$n$n =eopl$s&$ Intr$testi,ul$r d$p$t di*$i &en/$di tu&or pri&er sel *enih" tu&or pri&er l$inn$" d$n tu&or se'under u&or $n$s sel er&in$l &erup$'$n 803 s$&p$i 853 d$ri neopl$s&$ pri&er intr$testi,ul$r u&or sel er&in$l di*$i &en/$di se&ino&$ (B$&*$r 2%) d$n tu&or nonse&ino&$tous" ter&$su' *urnedout tu&or sel er&in$l (B$&*$r 5$) u&or sel er&in$l .urnedout ter/$di se'under terh$d$p pertu&*uh$n tu&or ,ep$t" &en$'i*$t'$n o'lusi supl$i d$r$h d$n reresi tu&or *eri'utn$ +eti'$ h$dir" nod$l &et$st$sis &e&*$ntu &en'on%ir&$si 'e*er$d$$n d$n t$h$p tu&or Seti$p '$li $denop$ti retroperitone$l terdete'si p$d$ l$'i4l$'i de-$s$" tu&or testis o'ultis&e h$rus diperti&*$n'$n" s,$n testis h$rus dil$'u'$n untu' &en,$ri tu&or o'ultis&e intr$testi,ul$r l$inn$ neopl$s&$ $d$l$h li&%o&$" leu'e&i$" tu&or su&su& se's4 stro&$" tu&or &esen,h&$l" $deno'$rsino&$ rete testis" '$rsinoid" pl$s&$,to&$" &et$st$se ('e*$n$'$n d$ri prost$t)" d$n proli%er$si *erser$t /in$' Sepuluh persen
21
d$ri neopl$s&$ testis h$dir den$n e/$l$ $'ut (&is$ln$ neri) *i$s$n$ dise*$*'$n oleh perd$r$h$n 'e d$l$& lesi" 103 d$ri neopl$s&$ h$dir setel$h tr$u&$ s'rotu&" d$n 103 d$ri neopl$s&$ h$dir den$n &et$st$sis (?)
B$&*$r Seor$n pri$ 54t$hun den$n lipo&$ di testis 'iri @itr$ ultr$sonor$%i r$4s,$le
&elint$n
&enun'$p'$n
'e*etul$n
dite&u'$n"
4&&"
n$t$
hpere,hoi," lesi p$d$t *er*$t$s te$s dip$ren'i& (p$n$h) Itu tid$' ter$*$" d$n pen$nd$ tu&or $n ne$ti% @olor Doppler pe&eri's$$n (tid$' dit$&pil'$n) &enun'$p'$n sedi'it pe&*uluh d$r$h ,odin di pinir$n lesi (#" '$n$n testis" L" testis 'iri)
neopl$s&$ ECtr$testi,ul$r 6i'$ lesi ter*$t$s p$d$ epididi&is" di%erensi$si d$p$t den$n &ud$h *e&$de $pi" /i'$ lesi *er$s$l d$ri tuni'$ p$d$ testis" di%erensi$si *is$ sulit (5* B*r)
'e*$n$'$n eCtr$testi,ul$r neopl$s&$
$d$l$h tu&or /in$'
$deno&$toid (8) L$inn$ &$ss$ eCtr$testi,ul$r l$n'$ lipo&$ lipos$r,o&$" pseudotu&or *erser$t" p$piler &esothelio&$ /in$'" d$n r$nulo&$ sper&$
22
B$&*$r 5 $" * u&or testis @itr$ AS d$ri seor$n pri$ 2?4t$hun den$n *iopsi4 ter*u'ti retroperitone$l eCtr$on$d$l sel *enih &et$st$sis nod$l d$n tu&or ter*$'$r di testis 'iri" s'rotu& &er$s$ *i$s$ p$d$ pe&eri's$$n %isi' ($) r$pesiu&" ,itr$ AS r$4s,$le &enun'$p'$n ,luster '$lsi%i'$si 'e,il den$n ri& hpoe,hoeni, di testis (p$n$h) Perh$ti'$n /u$ &ini& hidro'el er*$'$r h$*is tu&or sel er&in$l ter/$di se'under untu' pertu&*uh$n tu&or $n ,ep$t d$n h$sil d$l$& o'lusi supl$i d$r$h sendiri d$n reresi tu&or *eri'utn$ @itr$ AS d$ri seor$n pri$ 5 t$hun den$n ri-$$t one&onth &$ss$ s'rotu& '$n$n (*) @itr$ AS r$4s,$le &elint$n &enun'$p'$n ho&oen" hpoe,hoi," 8 K 5< && lesi p$d$t p$d$ per&u'$$n $nterior testis ($nt$r$ '$liper) (#" testis '$n$n) Lesi pe&*ed$h$n ter*u'ti &en/$di tu&or $deno&$toid d$ri tuni'$ $in$lis Asosi$si &$ss$ den$n testis d$p$t ditentu'$n den$n &ene'$n testis sel$&$ pe&eri's$$n re$l4ti&e D$l$& situ$si ini" &$ss$ $'$n tet$p di lo'$si $slin$ se&ent$r$ testis terse*ut dipind$h'$n
D r$u&$ estis r$u&$ testis serin dise*$*'$n oleh tr$u&$ tu&pul" penetr$si" $t$upun deloin Le*ih d$ri seten$h '$sus d$ri tr$u&$ testis dise*$*'$n oleh tr$u&$ tu&pul r$u&$ tu&pul $n serin ter/$di p$d$ $tlet" p$d$ t$*r$'$n seped$ &otor d$n pen$ni$$$n ter/$di se'it$r 8413 Me'$nis&e l$in seperti penetr$si" tr$u&$ ter&$l Deloin" s$n$t /$r$n ter/$di r$u&$ penetr$si *i$s$n$ dise*$*'$n oleh te&*$'$n d$ri sen/$t$ $pi" penusu'$n" iit$n he-$n r$u&$ $n &ene*$*'$n deloin
23
serin'$l$i 'ulit s'rotu& hil$n sehin$ diperlu'$n tind$'$n s'in r$%t (=i,ol$ et $l" 201) 4 #uptur testis uni,$ $l*uine$ $n nor&$l &un,ul den$n $&*$r$n hipere'oi' p$d$ $ris $n &e&*$t$si testis Ad$n$ dis'ontinuit$s p$d$ tuni,$ $l*uine$ &enindi'$si'$n $d$n$ rupture testis $n &ene*$*'$n e'trusi d$ri p$ren'i& testis" $n di$&*$r'$n den$n 'ontur $*nor&$l di d$l$& s'rotu& B$&*$r$ disrupsi tuni,$ $l*uine$ s$/$ &e&ili'i sensitiit$s d$n spesi%it$s 503 d$n 53 untu' ,eder$ p$d$ testis +$ren$ $d$n$ rupture p$d$ tuni,$ $l*uine$" &ene*$*'$n ,eder$ p$d$ p$ren'i& testis" $n &un,ul den$n $&*$r$n heteroen di d$l$& testis P$d$ disrupsi tuni,$ $s,ulos$" $n *er$d$ di *$-$h tuni,$ $l*uine$d$n &enusun '$osul$ $rteri di d$l$& testis" &erup$'$n t$nd$ t$' l$nsun $d$n$ rupture tuni,$ $l*uine$ Ad$n$ $&*$r$n heteroen di d$l$& testis" $*nor&$lit$s 'ontur testis $'i*$t disrupsi tuni,$ $l*uine$" d$n reion $$s,ul$r $n &enindi'$si'$n $d$n$ sensitiit$s d$n spesi%isit$s tini d$ri rupture testis (=i,ol$ et $l" 201) Le*ih d$ri ?03 rupture d$p$t dit$n$ni d$n disel$&$t'$n /i'$ dit$n$ni d$l$& 2 /$& p$s,$ 'e/$di$n tr$u&$ .i$s$n$ rupture testis *ersi%$t unil$ter$l =$&un p$d$ '$sus $n /$r$n ter/$di" se'it$r 153 *ersi%$t *il$ter$l P$d$ '$sus $n s$n$t /$r$n ter/$di" rupture testis d$p$t disert$i den$n rupture epididi&is sehin$ sulit untu' di*ed$'$n &enun$'$n !SB (=i,ol$ et $l" 201)
24
B$&*$r
GG
B$&*$r $n &enun/u''$n $d$n$ rupture s'rotu& (A) !SB lonitudin$l d$ri testis '$n$n &enun/u''$n $d$n$ 'erus$'$n tuni'$ $l*uine$ (p$n$h lurus) $n &ene*$*'$n 'onturn$ tid$' nor&$l (*int$n) d$n $d$n$ he&$to&$ %o'$l (p$n$h den$n 'ur$) (.) !SB Doppler &enun/u''$n penurun$n $s'ul$ris$si di d$l$& *$i$n testis $n rupture (&$t$ p$n$h) d$n tid$' $d$n$ $s'ul$ris$si di d$l$& he&$to&$ %o'$l (p$n$h) (=i,ole et $l" 201) 4 He&$to&$ He&$to&$ intr$testi'ul$r &erup$'$n '$sus $n p$lin serin dite&u'$n p$d$ tr$u&$ tu&pul testis B$&*$r$n !SB &enun/u''$n $d$n$ he&$to&$ ter$ntun d$ri -$'tu d$ri ter/$din$ tr$u&$ hin$ pel$'s$n$$n !SB He&$to&$ $'ut d$n hiper$'ut ter'$d$n sulit untu' dite&u'$n '$ren$ *i$s$n$ &un,ul den$n $&*$r$n isoe'oi' /i'$ di*$ndin'$n den$n /$rin$n di se'it$r testis $t$u &un'in &un,ul den$n $&*$r$n heteroen $n lu$s !ntu' $l$s$n inil$h" he&$to&$ $'ut die$lu$si untu' 'edu$ '$lin$ 1242 /$& setel$h pe&eri's$$n !SB $n pert$&$ untu' &elih$t peru*$h$n p$d$ e'oenisit$sn$
25
B$&*$rG (A) !SB lonitudin$l testis &enun/u''$n $d$n$
d$er$h hipoe'oi' p$d$
intr$testi'ul$r (p$n$h) $n &enindi'$si'$n $d$n$ he&$to&$ intr$testi'ul$r (.) !SB Doppler &enun/u''$n tid$' $d$n$ $s'ul$ris$si di d$l$& he&$to&$ (p$n$h) 4 He&$to'elhe&$to,eleHe&$to&$ s'rotu& E'str$testi'ul$r he&$to'el $t$u $d$n$ penu&pu'$n d$r$h di tuni,$ $in$lis" &erup$'$n te&u$n terserin d$ri s'rotu& setel$h ter'en$ tr$u&$ *end$ tu&pul 6$rin$n lun$' e'str$testi'uler $nt$r$ l$in dindin s'rotu&" tuni,$ $l*uine$ d$n epididi&is /u$ ter&$su' $&pil$n !SB p$d$ he&$to'el $t$u he&$to&$ lesin$ *er$ri$si ter$ntun usi$ (=i,ol$ et $l" 201) He&$to,ele $'ut $&*$r$nn$ e'oi'" sed$n'$n he&$to,ele 'roni' le*ih $ne'oi'" sept$ d$n lo'ul$si d$p$t *er'e&*$n +e&udi$n d$p$t &en/$di ter'$lsi%i'$si d$n &enerup$i &$ss$ ter'$lsi%i'$si di testis (=i,ol$ et $l" 201)
26
P$d$ %$se $'ut" he&$to,ele $n *es$r d$p$t &ene*$*'$n 'o&presi dise'it$r pe&*uluh
d$r$h
d$n
&enur$ni $lir$n d$r$h" &enerup$i torsio p$rti$l'o&plit
B$&*$rG
27
!SB tr$nsers$l &enun/u''$n testis 'iri $n &en$l$&i he&$to&$ d$n he&$to,ele (*int$n)
B$&*$rG !SB &enun/u''$n $d$n$ pene*$l$n dindin s'rotu& $n heteroen (p$n$h) $'i*$t se'under terh$d$p perd$r$h$n d$n he&$to'el 'e,il (&$t$ p$n$h)
E Epididi&itis Epididi&itis $d$l$h re$'si in%l$&$si $n ter/$di p$d$ epididi&is $n d$p$t ter/$di se,$r$ $'ut $t$u 'ronis Den$n peno*$t$n $n tep$t pen$'it ini d$p$t se&*uh se&purn$" tet$pi /i'$ tid$' dit$n$ni den$n *$i' d$p$t &enul$r 'e testis sehin$
&eni&*ul'$n
ort'itis"
$*ses
testis"
neri
'ronis
p$d$
s'rotu&
*er'ep$n/$n$n" d$n in%ertilit$s (Purno&o" 2011) P$sien serin'$li &eneluh neri &end$d$' p$d$ d$er$h s'rotu&" dii'uti den$n *en'$' p$d$ '$ud$ hin$ '$put epididi&is id$' /$r$n disert$i de&$&" &$l$ise" d$n neri dir$s$'$n hin$ 'e pin$n (Purno&o" 2011)
28
Pe&eri's$$n &enun/u''$n pe&*en'$'$n p$d$ he&is'rotu& d$n '$d$n'$l$ p$d$ p$lp$si sulit untu' &e&is$h'$n $nt$r$ epididi&is den$n testis Mun'in disert$i den$n hidro'el se'under $'i*$t re$'si in%l$&$si p$d$ epididi&is #e$'si in%l$&$si d$p$t &en/$l$r 'e %uni'ulus sper&$ti/us di d$er$h inuin$l Be/$l$ 'linis epidid&itis $'ut sulit di*ed$'$n den$n torsio testis $n serin ter/$di p$d$ usi$ 10420 t$hun P$d$ epidid&itis $'ut /i'$ dil$'u'$n ele$si (pen$n'$t$n) testis" neri $'$n *er'ur$n h$l ini *er*ed$ den$n torsio testis (Purno&o" 2011) Pe&eri's$$n urin$lisis d$n d$r$h len'$p d$p$t &e&*u'ti'$n $d$n*$ proses in%l$&$si Pe&eri's$$n den$n !SB Doppler d$n stetos'op Doppler d$p$t &endete'si penin'$t$n $lir$n d$r$h di d$er$h epididi&is (Purno&o" 2011)
B$&*$r G
29
!ltr$sonor$%i d$ri epidid&itis $'ti% $n &enun/u''$n &$ss$ heteroen den$n $re$ hipo d$n hipere'oi' *erde'$t$n den$n *$i$n *$-$h d$ri testis
(Lun et $l" 2012) B$&*$rG Ad$n$ $&*$r$n epidid&itis p$r$h (t$nd$ p$n$h p$n/$n) dit$nd$i den$n pene*$l$n epididi&is d$n dindin s'rotu& .ul$t$n sentr$l $*nor&$l
terlih$t
Did$p$t'$n pul$ *$t$s $n 'ur$n /el$s$*nor&$l (p$n$h 'e,il4'e,il)
F ;r,hitis In%l$&$si d$ri testis itu sendiri &un'in d$p$t terlih$t p$d$ in%e'si irus siste&i' (seperti &u&ps)
$t$u
30
*erhu*un$n den$n epidid&itis *$,teri$l Le*ih d$ri 253 l$'i4l$'i post4pu*ert$s den$n &u&ps &enderit$ &u&ps den$n der$/$t tertentu" *i$s$n$ d$l$& 410 h$ri setel$h &en$l$&i p$rotitis Diper'ir$'$n se'it$r du$ perti$ '$sus $n ter/$di *ersi%$t unil$ter$l irus l$in $n *is$ &ene*$*'$n h$l itu $nt$r$ l$in e,ho irus" $r*oirus" d$n ,horio&eninitis irus P$d$ %$se $'ut" ultr$sonor$%i $'$n &enun/u''$n pe&*en'$'$n testis den$n $&*$r$n p$t,h $t$u hipoe'oi' di%us #esolusi p$d$ '$sus ini" testis n$ntin$ $'$n 'e&*$li nor&$l =$&un p$d$ 'e$d$$n or,hitis $n s$n$t p$r$h $'$n ter/$di $tro%i den$n penur$n$n u'ur$n d$n hipoe'oi'" *i$s$n$ &un,ul setel$h 7 *ul$n p$s,$ ser$n$n $'ut (Sutton" 200<)
B$&*$r B$&*$r$n ultr$sonor$%i or,hitis p$r$h .$i$n ter*es$r testis &enun/u''$n $&*$r$n hipoe'oi' di%us Are$ heteroen p$d$ *$i$n *$-$h &enun/u''$n $*ses $n &ul$i *er'e&*$n
31
!ltr$sonor$%i Doppler &enun/u''$n $d$n$ is'e&i' d$n in%$r' den$n $&*$r$n $s'ul$ris$si $n &enurun P$d$ *e*er$p$ or,hitis p$r$h" $re$ heteroen $'$n *er'e&*$n d$n *erpotensi &e&*entu' $*ses intr$testi,ul$r(=i,ol$ et $l" 201)
B$&*$rG ($) !SB lonitudin$l &enun/u''$n $&*$r$n heteroen *er*entu' p$t,h $n terlih$t di d$l$& testis (p$n$h p$n/$n) d$n pele*$r$n d$ri epididi&is (p$n$h pende') (*) Ad$ t$nd$ penin'$t$n $s'ul$ris$si di d$l$& testis p$d$ $&*$r$n !SB Doppler (Hu$n et $l" 2012)
B Hidro'el Se*u$h hidro'el $d$l$h 'ole'si nor&$l *es$r ,$ir$n $nt$r$ l$pis$n tuni'$ $in$lis d$n &erup$'$n pene*$* p$lin u&u& d$ri r$s$ s$'it pe&*en'$'$n s'rotu&
32
S$&p$i s$$t ini" e%e' hidro'el p$d$ testis 'ur$n dip$h$&i i$ *erpi'ir *$h-$ hidro'el diperlu'$n $d$ peno*$t$n 'e,u$li untu' $l$s$n 'os&eti' $t$u p$sien per&int$$n t$pi idiop$ti' hidro'el d$p$t &ene*$*'$n pe&*es$r$n testis d$n &enin'$t'$n resistensi pe&*uluh d$r$h di $rteri intr$testi,ul$r (B$&*$r 7) ;leh '$ren$ itu" &un'in *erhu*un$n den$n in%ertilit$s den$n &en$nu sper&$toenesis Penin'$t$n olu&e testis d$n penin'$t$n resistensi pe&*uluh d$r$h di/el$s'$n oleh penin'$t$n i&ped$nsi en$ d$n li&%$ti' $lir$n (10)
33
B$&*$r 7 $" * Hidro'el Doppler $&*$r AS ($" *) d$ri seor$n pri$ 54t$hun den$n hidro'el $n tep$t Doppler ,itr$ AS p$d$ testis se*elu& hdro,ele,to& ($) &enun/u''$n inde's resisti% (#I) nil$i 0" Doppler AS p$d$ testis $n s$&$ *ul$n setel$h hdro,ele,to& (*) &en$&pil'$n &enurun #I (05) Sel$in itu" olu&e testis &enurun setel$h hdro,ele,to& (se*elu& oper$si" 20" ,&<" p$s,$ oper$si" 15" ,&<) (tid$' dit$&pil'$n)
H In%ertilit$s !ltr$sonor$%i diun$'$n untu' &ene$lu$si Lo'$si testis (B$&*$r $)" u'ur$n d$n pen$&pil$n testis p$ren'i&" 'el$in$n 'ontur (B$&*$r *) d$n epididi&is (B$&*$r ," d)" $d$n$ $ri'o'el $-$l (intr$4$t$u eCtr$testi,ul$r) (B$&*$r e" %)" d$n 'o&pli'$si p$s,$ oper$si (B$&*$r ) Aenesis $t$u se*$i$n $enesis epididi&is d$n du'tus de%erens d$p$t die$lu$si den$n !SB D$l$& '$sus terse*ut" pen,itr$$n t$&*$h$n
d$ri
ureteroesi,$l"
esi'ul$ d$n
in/$l
se&in$lis" s$n$t
prost$t" pentin
'$ndun untu'
'e&ih"
e$lu$si
persi&p$n$n
penuh
'el$in$n
per'e&*$n$n Se'it$r ?03 d$ri testis $n tid$' turun terlet$' d$l$& '$n$lis inuin$lis Sonor$%i s$n$t *erun$ untu' &enidenti%i'$si testis di '$n$lis inuin$lis E$lu$si &edi$stinu& '$d$n4'$d$n pentin untu' &e&*ed$'$n testis d$ri 'elen/$r et$h *enin estis intr$$*do&in$l ter/$di di retroperitoneu& d$ri tin'$t in/$l untu' ,in,in inuin$lis intern$ (11) M$neti, reson$n,e i&$in d$p$t &e&*$ntu d$l$& dete'si testis intr$ $*do&in$l 6i'$ or,hiopeC tid$' dil$'u'$n di &$s$ 'e,il (&un'in se*elu& 5 t$hun usi$" d$n tentu s$/$ se*elu& pu*ert$s)" testis tid$' turun *i$s$n$ steril $t$u hposper&i, d$n $tro%i (12) Insiden 'e$n$s$n" se*$i$n se&ino&$" $d$l$h 2"54? '$li le*ih *es$r d$l$& testis $n tid$' turun seperti p$d$ popul$si u&u& (penin'$t$n $n le*ih *es$r den$n penin'$t$n /$r$' d$ri s'rotu&) (12) +$ren$ penin'$t$n risi'o 'e$n$s$n p$d$ testis $n tid$' turun" *$h'$n setel$h or,hiopeC d$n di testis 'ontr$l$ter$l" $'$n &$su' $'$l untu' &enun$'$n AS se*$$i tes s'rinin" &es'ipun dete'si tu&or '$d$n4'$d$n *is$ sulit d$l$& testis hipopl$si$ '$ren$ isoe,hoeni,it (lesi hpoe,hoi, di testis
34
hpoe,hoi,)
6in$'
testis
lo*ul$tion
&un'in
&erup$'$n
$ri$n
idiop$ti'
e&*roloi, (1<) $t$u &un'in *er'e&*$n setel$h or,hiopeC se*$$i 'onse'uensi d$ri %i*rosis (1) Se*u$h 'ontur 'el$in$n p$d$ pe&eri's$$n %isi' tid$' sel$lu &enun/u''$n 'e$n$s$n D$l$& situ$si ini" sonor$%i s$n$t &e&*$ntu untu' lesi ter&$su' testis $ri'o'el &un'in eCtr$testi,ul$r $t$u intr$testi,ul$r" $ri'o'el intr$testi,ul$r /$r$n d$n *i$s$n$ dite&u'$n den$n eCtr$testi,ul$r $ri'o'el (15" 17) !'ur$n pe&*uluh d$r$h di $ri'o'el diu'ur s$$t istir$h$t d$n sel$&$ &$nuer $ls$$ +riteri$ AS untu' di$nosis $ri'o'el $d$l$h ter*es$r ple'sus en$ p$&pini%or&is diu'ur le*ih d$ri 2 && d$l$& terlent$n posisi $t$u le*ih d$ri < && d$l$& per%or&$ posisi se&iere,t d$n $t$u le*ih d$ri 1 && 'en$i'$n d$l$& u'ur$n d$ri en$ ter*es$r sel$&$ $ls$$ p$d$ pe&eri's$$n s'$l$ $*u4$*u d$n $t$u le*ih d$ri 24s retror$de $lir$n sel$&$ &$nuer $ls$$ p$d$ -$rn$ Doppler AS () +o&*in$si pert$&$ d$n 'edu$ $t$u pert$&$ d$n 'riteri$ 'eti$ $n diun$'$n =$&un" 'eh$dir$n re%lu's en$ h$rus ditentu'$n den$n -$rn$ Doppler AS (re%lu's d$l$& hitun$n deti') $ri'o'el /u$ d$p$t dinil$i se*$$i *eri'ut: 'el$s 1" sedi'it re%lu's (92 s) sel$&$ $ls$$" 'el$s 2" re%lu's ( 2 s) sel$&$ $ls$$" t$pi tid$' $d$ re%lu's terus &enerus sel$&$ &$nuer" d$n 'el$s <" re%lu's p$d$ istir$h$t sel$&$ $n nor&$l respir$si $t$u terus4&enerus sel$&$ seluruh &$nuer $ls$$ () +$&*uhn$ $ri'o'el didi$nosis den$n $d$n$ re%lu's p$d$ -$rn$ Doppler AS D$l$& tu$" $d$l$h pentin untu' &en,$ri $ri,o,ele se'under (se'under untu' proses pen$'it retroperitone$l)" terut$&$ p$d$ pri$ den$n *$ru *er'e&*$n $ri,o,ele
35
B$&*$r $4e Pene*$* in%ertilit$s r$pesiu&" &e&*u/ur d$$ Doppler !S $&*$r ($) d$ri seor$n pri$ 204t$hun den$n undes,ended testis 'iri" testis terlih$t se*el$h intern$l inuin$l ,in,in" $nterior 'e se&en pro'si&$l pe&*uluh ili$'$ e'stern$l estis 'e,il d$n hpoe,hoeni, d$l$& pen$&pil$n den$n sedi'it per%usi (p$n$h) p$d$ 'e'u$s$$n sonor$%i Doppler (sisi *erl$-$n$n $d$l$h nor&$l d$n tid$' dit$&pil'$n) (EIA" $rteri ili$'$ e'stern$l" EI" en$ ili$'$ e'stern$l) $rn$ Doppler ,itr$ AS (*) d$ri seor$n pri$ <04e$rold den$n 'ontur 'el$in$n &en$'it'$n (/in$' testis lo*ul$tion) d$ri testis 'iri Lonitudin$l -$rn$ Doppler ,itr$ AS p$d$ testis &enun'$p'$n 'ontur lo*ul$ted (p$n$h) p$d$ $spe' superior testis" t$pi pen$&pil$n
36
din$t$'$n nor&$l Distri*usi $s'ul$r Si&etris terdete'si p$d$ 'edu$ testis p$d$ -$rn$ Doppler i&$in (tid$' dit$&pil'$n) P$sien &e&ili'i ri-$$t or,hiopeC di &$s$ 'e,iln$ Seor$n pri$ 2?4t$hun &en,$ri peno*$t$n untu' in%ertilit$s setel$h < t$hun hu*un$n se'su$l $n nor&$l (den$n epididi&is 'iri hipopl$si$) (," d) Lonitudin$l $&*$r r$s,$le AS (," d) epididi&is di 'edu$ sisi =or&$l
e
epididi&is '$n$n (,) d$n epididi&is 'iri se*$i$n hpopl$sti, (e'or) (d) Epididi&is +$n$n &e&ili'i 'ep$l$ (p$n$h te*$l)" tu*uh (p$n$h tipis)" d$n e'or (p$n$h) isoe,hoi, p$d$ testis" terlet$' p$d$ $spe' unul d$n posterol$ter$l testis $pi epididi&is 'iri terdiri d$ri 'ep$l$ (p$n$h te*$l)" d$n tu*uh (p$n$h tipis) +edu$ *$i$n $n isoe,hoi, d$n terlet$' p$d$ $spe' unul d$n posterol$ter$l testis E'or (lo*us 'e,il) d$ri epididi&is 'iri tid$' h$dir (t$nd$ *int$n) B$&*$r AS seor$n pri$ <14t$hun den$n intr$testi,ul$r $ri'o'el" &en,$ri peno*$t$n untu' in%ertilit$s setel$h 2 t$hun hu*un$n se'su$l $n nor&$l (e" %) r$pesiu&" &e&*u/ur r$4s,$le ,itr$ AS (e) &enun/u''$n dil$t$si stru'tur tu*ul$r intr$testi,ul$r de'$t &edi$stinu& (p$n$h) d$n di *$i$n tepi testis
37
B$&*$r (l$n/ut$n) %4 r$pesiu& -$rn$ Doppler !S $&*$r (%) &en$&pil'$n ini $d$l$h '$p$l intr$testi,ul$r" &e&*en$r'$n $ri'o'el d$rip$d$ tu*ul$r e,t$si$ d$ri rete testis Doppler &ene$s'$n di$nosis (tid$' dit$&pil'$n) Seor$n pri$ <4t$hun den$n 'iri neri s'rotu& d$n in%$r' %o'us p$d$ testis setel$h $ri,o,ele,to& () Lonitudin$l tr$pesiu& d$$ Doppler AS &enun/u''$n d$er$h in%$r' di *$i$n $nterosuperior p$d$ testis $n hpoe,hoi, t$np$ per%usi (p$n$h) Fo,$l in%$r' *u'$nl$h pene*$* serin neri s'rotu& $'ut" t$pi tid$' /$r$n setel$h oper$si inuin$l" oper$si herni$ 'hususn$ H$l ini /u$ d$p$t ter/$di setel$h oper$si $ri'o'el" seperti d$l$& '$sus ini
Mi,rolithi$sistestis estis &i,rolithi$sis (M) d$p$t di$&*$r'$n se*$$i 'l$si' (B$&*$r ?$) $t$u ter*$t$s (B$&*$r ?*) *erd$s$r'$n $d$n$ li&$ $t$u le*ih &i,roliths p$d$ s$tu $t$u le*ih $&*$r p$d$ testis (1) Hu*un$nn$ den$n per'e&*$n$n tu&or $d$l$h 'ontroersi$l Etioloi M tid$' di'et$hui" &es'ipun $sosi$si den$n dis%unsi sel Sertoli d$n se*u$h $no&$li d$l$& L+.1 en" $n &e&et$'$n 'ro&oso& 18p1<<" tel$h dihipotesis'$n untu' *ert$nun /$-$* untu' M (1?) M d$p$t di'$it'$n den$n *e*er$p$ 'ondisi" seperti testis $n tid$' turun" $leol$r &i,rolithi$sis" %istul$ urethroperine$l 'onenit$l" d$n sindro& +line%elter Mere'$ le*ih u&u& p$d$
38
p$sien den$n oliosper&i$ Pri$ den$n M" *entu' terut$&$ 'l$si'" *er$d$ p$d$ penin'$t$n risi'o &ene&*$n'$n tu&or sel er&in$l" 'hususn$ se&ino&$ () resi'on$ 'e,il t$pi tid$' /el$s diu'ur $hun$n S'rinin AS $t$u *i$s$ pe&eri's$$n diri di$n/ur'$n +esi&pul$nn$" penun$$n s'$l$ $*u4$*u" -$rn$" 'e'u$t$n" d$n *erdenut Doppler AS $'$n &e&*eri'$n di$nosis $n *en$r d$l$& 'ondisi $n p$lin *il$ diun$'$n den$n tep$t Penet$hu$n tent$n %itur AS entit$s *$i' u&u& d$n *$ru di/el$s'$n pentin *$i penelol$$n 'el$in$n s'rotu&
B$&*$r ? $" * Mi,rolithi$sis Seor$n pri$ 274t$hun den$n &i,rolithi$sis" &en,$ri peno*$t$n untu' in%ertilit$s setel$h 1"5 t$hun hu*un$n se'su$l $n nor&$l ($) r$pesiu& &e&$n/$n -$rn$ Doppler AS &enun/u''$n &i,rolithi$sis 'l$si' den$n *$n$' h$lus (92 &&)" ,er$h" nonsh$do-in %o'us hpere,hoi, $n ser$$& d$l$& u'ur$n d$n didistri*usi'$n d$l$& pol$ di%us p$d$ iris$n tun$l Perh$ti'$n /u$ *in$r $rte%$' (p$n$h) di *el$'$n &i,rolith $ Seor$n pri$ 24t$hun den$n ter*$t$s testis &i,rolithi$sis (*) r$pesiu&" &e&*u/ur ,itr$ AS r$4s,$le &enun/u''$n 'ur$n d$ri 5 &i,roliths di testis (p$n$h)" di'l$si%i'$si'$n se*$$i &i,rolithi$sis ter*$t$s Mi,roliths /u$ *is$ *erero&*ol di pinir$n testis Mi,rolithi$sis er*$t$s di$n$p se*$$i /in$' 'ondisi
BAB III
39
PENUTUP
<1 +esi&pul$n S$n$t pentin *$i p$r$ do'ter untu' ter*i$s$ den$n te&u$n ultr$sonor$%i $n spesi%i' $$r d$p$t &enentu'$n di$nosis den$n tep$t sehin$ p$sien d$p$t dit$n$ni den$n *$i' !ltr$sonor$%i &erup$'$n &od$lit$s pilih$n '$ren$ $'ses" &o*ilit$sn$ sert$ tid$' *ersi%$t in$sie d$n persi$p$n p$sien /u$ tid$' terl$lu diperlu'$n Penun$$n !SB Doppler d$n penun$$n 'ontr$s p$d$ !SB /u$ d$p$t &e&$sti'$n den$n *$i' di$nosis d$ri 'el$in$n testis sehin$ n$ntin$ d$p$t &e&utus'$n $p$'$h '$sus terse*ut &e&*utuh'$n pe&*ed$h$n $t$u h$n$ ,u'up ter$pi 'onser$ti% s$/$
DAFTAR PUSTAKA
40
Hu$n" D" Sidhu" P 2012 Fo,$l esti,ul$r Lesions: ,olour Doppler !ltr$sound" @ontr$st Enh$n,ed !ltr$sound $nd issue El$stor$ph $s Ad/u$nts to the Di$nosis Dep$rt&ent o% #$diolo" +insNs @ollee London" +inNs @ollee Hospit$l" London he .ritish 6ourn$l o% #$diolo" Spe,i$l Issue 2012 +h$n" S" #$h&$n" 6" @huht$i" ." et $l" 2008 An$to&i,$l Appro$,h to S,rot$l E&eren,ies : A =e- P$r$di& %or the Di$nosis $nd re$t&ent o% the A,ute S,rotu& he Internet 6ourn$l o% !rolo olu&e 7 =u&*er 2 +lies,h 201 Hdro,ele" Sper&$to,ele" $nd $se,to&: M$n$e&ents o% @o&pli,$tion Dep$rt&ent o% Androlo" @entre o% #eprodu,tie Medi,ine $nd Androlo" !niersit @lini,s o% Muenster" Al*ert S,h-eiter @$&pus" Deuts,hl$nd Lee" S et $l 201 A =$tion-ide Epide&ioloi,$l Stud o% esti,ul$r orsion in +ore$ Dep$rt&ent o% !rolo +un Hee !niersit Seoul 6 +ore$n Med Sd 201 28: 17?417? Lotti" F" M$i"M 201< !ltr$sound o% he M$le Benit$li$ r$,t in #el$tion to M$le #eprodu,tie He$lth SeCu$l Medi,ine $nd Androlo !nit o% Dep$rt&ent o% ECperi&ent$l $nd @lini,$l .io&edi,$l S,ien,es" !niersit o% Floren,e It$l Lun et $l 2012 @ontr$st Enh$n,ed !ltr$sound in the E$lu$tion o% Fo,$l esti,ul$r @o&pli,$tions Se,ond$r to Epidid&itis Dep$rt&ent o% #$diolo +inNs @ollee London =etter" Fr$n' 201< Atl$s An$to&i M$nusi$ Elseeirs S$unders =i,ole et $l 201 I&$in o% r$u&$ti, In/uries to the S,rotu& $nd Penis Dep ;% #$diolo" !niersit o% #o,hester $shinton D@ P$ulse" F" $s,h'e" 6 2012 So*ott$ Atl$s An$to&i M$nusi$ 6ilid 14< edisi 2<" An$to&i !&u& d$n Siste& Mus'ulos'elet$l EB@ 6$'$rt$
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