GENITOGRAPHY

Management in the field of radiology conventional examinations consist of two, namely, non-contrast examinations using contrast media and the media. Non-contrast examination of media covering the upper limb, lower limb, head, abdomen and thorax. As for the examination using contrast media include digestive tract, urinary tract, biliary tract, and genitalia. One of the examination using contrast media is genitography. Genitography is the best procedure to provide information about the internal anatomy of the genital parts, genitography also can provide anatomic information that is not given in other trials (Meschan, 1968:269). According Troger and Seidensticker (2008), genitography examination conducted to see the relationship between the urinary tract and internal genital anatomy. The purpose of this radiological examination is getting imaging the uterus, vagina, bladder and urethra. Various methods can be done in the examination of such genitography flushing technique and catheterization techniques. Flushing technique is by injecting the retrograde contrast media with moderate pressure. While the technique of catheterization, the bladder is filled with the help of a catheter or suprapubic puncture, and was charging like cysto-urethrogram. This examination will show whether the patient has a vagina and urogenital sinus. Some checks also choose to place a catheter in the rectum. Genitography examination should be performed with the patient's true lateral position (Silverman and Kuhn, 1993:1160). Genitography examination is very useful for the children, one of them to see a mass (tumor) contained in the genital tract. Tumor is a group of abnormal cells that formed as a result of excessive cell division process and uncoordinated (www.deherba.com, 2012). Based on its

growth, tumors were divided into 2 major categories namely benign and malignant tumors or popularly known as cancer. Children can be exposed to the tumor, but tumors in children are uncommon. One type of tumor that occurs in children is a tumor (mass) at the vaginal introitus. This tumor occurs in the vagina hole. This disorder can affect the physical, psychological and psychosexual will also have an impact on patients. Every child has a tumor that is almost impossible to know the cause. From the statistical point of view, tumors in children may be associated with chromosomal aberrations genetic defect, deficiency (decrease) immunity, certain viral infections, exposure to radiation, the treatment of immune suppressive or even due to anti-cancer treatment

(www.parkwaycancercentre. com, 2011). Genitography radiology procedures that are designed to show the internal parts of the genitalia. In a sense this examination is able to show all parts of genitalia and especially used to distinguish it from other examinations such as urethrography, cystography and vaginography who do not achieve the objectives in the examination genitography (Kaufmann, 1970:99). Genitography is the best procedure for children suspected of having abnormalities intersexual or with the difference between the internal and the external genitalia. Genitography used to see the detail of the anatomy of the urethra, vagina and also see the possibility of the uterus (Silverman and Kuhn, 1993:1159). In the clinical examination is possible genitography experienced by them are commonly referred to as intersexual or with ambiguous genitalia, hypospadias, CAH and mass.

a. Intersexual (ambiguous genitalia) Double sex or intersexual people that is a disorder where the sufferer has the characteristics of genetic, anatomic and physiologic dubious or between men and women. Intersexual clinical symptoms vary widely, ranging from normal women to look as normal men, most cases in the form of external genitalia dubious. This patient group is actually physically ill (genitals) that affect the psychological state (www.fk.undip.ac.id, 2010) Intersexual cause of disease is very complex, most are caused by genetic abnormalities such as chromosomal abnormalities and external genital anatomy. However, the influence of the environment, especially the use of hormonal drugs during pregnancy is one of the allegations of the intersexual kelaianan (www.fk.undip.ac.id, 2010) Intersexual abnormalities not only be seen from the pattern of sex chromosomes, external genital anatomy, hormonal urinary excretion, and the nature of the gonads by biopsy, but the role of the internal genital anatomy examinations were necessary to establish the urogenital sinus or vagina. Therefore genitography examination is necessary in the case of intersexual disorders which is a simple procedure but it gives a very important anatomical information that is not provided by any other procedure to determine a person's gender with intersexual disorders. a. Hypospadias Hypospadias is a condition in which the urethral opening is in an abnormal position in the penis. The opening of the urethra can be located at the bottom of the penis, near the scrotum, or in the area between the scrotum and the anus (www.kamuskesehatan.com)

b. CAH (Congenital Adrenal Hyperplasia) Congenital Adrenal Hyperplasia (CAH) is an inherited disorder caused by chromosomal abnormalities and gene (autosomal recessive inheritance), causing the failure of the production of hormones by the adrenal gland cortex thickened or overgrowth (hyperplasia) in the womb (congenital). Abnormalities that occur are not the workings of the enzyme 21-hydroxilase thus affecting the production of cortisol and aldosterone. This led to its impact on blood pressure regulation, blood sugar levels, immune system, and salt levels in the body

(www.clanchildhealth.org, 2012) c. Mass The tumor is a general term used to describe the growth of the mass (solid / solid) or abnormal tissue in the body. This mass arises as a result of an imbalance of growth and cell regeneration. It also usually useless and not needed by the body. Different tumor with a cyst (fluid) or abscesses (boils). There are 2 tumors are benign tumors and malignant tumors (cancer). In Indonesia alone, the term refers to a tumor over benign tumors (www.cancerhelps.com, 2013). Symptoms usually shaped lump tumor seen on the body and no pain. When you disturb the surrounding tissue, the doctor may suggest surgical removal (surgery). Current surgical techniques are evolving rapidly, even involving laser surgery technology, or cryosurgery (freezing) tumors (www.cancerhelps.com, 2013). The medical world has not been able to determine the exact cause of a person suffering from a tumor but is generally believed that the process of tumor formation associated with 3 main factors, namely genetics (heredity), carcinogenic (oncogenes), and co-carcinogens (co-

oncogenes). Tumors are initially benign if not treated properly, it will become inflamed and turn into malignant cancer alias (www.deherba.com, 2012) In this genitography examination of patients with vaginal introitus mass or tumor is also called the vaginal introitus. Vaginal introitus (vaginal opening) is derived from the Latin word "intro" meaning inside and "ire" which means go. In anatomy introitus is the entrance to the canal or a hollow organ such as the vagina (www.medterms.com). Can be defined so that the tumor is a tumor that occurs in the entrance channel into the vaginal cavity. 1. Examination techniques Genitography According to Silverman and Kuhn (1993), genitography performed using a catheter that is inserted from the urethra to the bladder. Injection of contrast media into the urethra to the tip of the catheter is placed in the posterior urethra also often describes vagina and cervix. Then, a second catheter may be placed slightly miss the first dorsal of the catheter so that it can enter the vagina associated with proximal urethra. At some checks done on rectal catheter placement as well. This examination should be performed with true lateral position of the patient. According to Kaufmann (1970), the use of fluoroscopy genitography very important, because the examination by using blind photograph may not help in the direction of openings (holes) and contrast media filling. Able to optimize the use of fluoroscopy x-ray films documenting when charging contrast media and patient positioning accuracy. There are two methods that can be used to ensure the genital cavity filling using contrast media, namely, engineering flushing (flushing) or using catheterization techniques According to Emmett and Witten (1977), the goal will be achieved genitography enough to fill all the parts of the internal genitalia. It makes no difference what method is used as long as

the goal is reached. In doing genitography, experts must first radilogi memeriksaan external genital organs carefully to look for openings (holes). The openings may occur anywhere in the region of the tip of the phallus phallus to the anus, but usually it was towing phallus or perineum. There are two methods that can be used in the filling of contrast material into the genital tract flushing techniques and catheter techniques. a. Flushing technique Leak-proof seal that is placed between the injection and the perineum is necessary for the success of this technique. With a seal to prevent leakage menggunakkan contrast media allow all flows cavity using a catheter compared to only fill one cavity. Flushing technique can best be achieved with the use of blunt tip needles and syringes only entry on the perineal skin perforated. Injection of contrast media on this condition will usually result in filling all cavities.

Importation of contrast media with flushing techniques (Kaufman, 1970)

b. Catheter technique This technique is done when flushing technique failure. The danger in this procedure is when the placement of a catheter in one cavity and not in the other cavity. If only one channel is found through a search using fluoroscopy, the catheter tip is pulled into the skin of the perineum that are around the channel and then injected contrast media. If the catheter entry dai kelebih one channel, then each channel will be injected contrast media simultaneously using the technique of flushing.

Importation of contrast media with catheter techniques (Kaufman, 1970)

SOURCE: Emmett, John.L and David.M.Witten. , 1977. Clinical urography An Atlas and Textbook of Roentgenologic Diagnosis. W.B.Saunders: Philadelphia Kaufman. 1970. Progress in Pediatric Radiology, Volume V. Yearbook: Chicago Medical Publisher

Meschan, Isadore. , 1968. Radiographic Positioning and Related Anatomy. W.B. sauders Company: Philadelphia Silverman, Frederic N and Jerald P. Kuhn. , 1993. Caffey's Pediatric X-ray diagnostic, volume 2, ninth edition. Mosby: St. Louis Internet, (http://www.fk.undip.ac.id/artikel-lepas/kelamin-ganda-penyakit-atau-penyimpangan-

gender-.html), accessed on December 31, 2012 Internet, (http://www.clanchildhealth.org/ondex.php/overview.html), accessed on January 3, 2013 Internet, (http://www.deherba.com/obat-tumor.html # ixzz2U2B2cSTa), accessed on May 22, 2013 accessed on 23 Mei2013