最新：泌尿道感染及損傷(英文版)UT injuries2h文檔資料

1、introduction uti often occurs in male urethra urinary system are anatomically located in a deep concealed places when the chest, abdomen, flank or back, pelvis have been confronted with violent attack, there may be concomitant urinary system trauma which will need further investigation to establish

2、the diagnosispathological changes hemorrhage extravasation severe hemorrhage will result in shock. hematoma and extravasation of urine will complicate with infection urethral stricture and urinary fistula in late stage injuries to the kidneypathogenesis and pathology renal damage can be classified i

3、nto open and closed injuries open injuries are often caused by a sharp instrument as a knife or bullet, making a penetrating wound in the chest or abdomen closed trauma are usually caused by a direct violent hit on abdomen, loin, or an indirect force by falling from a high place and landing on the f

4、eet or buttocks.classification (closed) contusion: ecchymosis, subcapsular hematoma partial fissure subcapsular hematoma, perirenal hematoma complete fissure extravasation of blood , urine, gross hematuria and shock laceration of renal vascular pedicleperirenal hematoma, hematuria and operation to s

5、top bleedinglate stage changes urinoma broad fibrosis in post-peritoneal space hydronephrosis renal hypertensionclinical manifestation shock hematuria pain mass fever diagnosis history and physical exam urine exam x-ray exam, kub, ivu, ct ultrasound btreatment observation indication for surgery intr

6、actable shock progressing gross hematuria and anemia enlarging abdonimal or loin mass accompanying intra-abdominal or pulmonary damage selective renal artery embolization open surgery: repair, partial nephrectomy,nephrectomyinjury to the bladderpathogenesis and pathologyopen injury vesicorectal or v

7、esicovaginal fistulaclosed injury contusion: hemorrhage or hematuria vesical rupture: urine extravasation extraperitoneal intraperitonealextraperitoneal rupture intraperitoneal ruptureclinical features shock hematuria dysuria pain fever peritonitisdiagnosis clinical features plain film, ivu and cyst

8、ogram catheterization and instillation testtreatment extraperitoneal rupture catheterization or cystostomy intraperitoneal surgical repairinjury to the urethraetiology open injury penetrating wound in scrotum,penis or perineum closed injury fall-astride injuries bulbous urethra pelvic fracture damag

9、es membranous urathra instrumental injuriespathologytype of injury contusion: will resolve without sequelae laceration: hematoma, extravasation, stricture complete tear: hematoma, obstruction, retention, extravastion, urethral occlusionpathologic stage acute: 2 days inflammation: infection, fistula

10、urethral stricture: 23 weeks urinary retention, obstructive uropathyurinary extravasation bulbous urethra limited by colles fascia, urine extravasate to perineum, scrotum, penis, then up to the abdominal wall supramembranous urethra urine extravasate into periprostatic and perivesical tissues and re

11、troperitoneal space,urogenital diaphram is lacerated: scrotum and perineum posterior urethral damage and urine extravasation anterior urethra damage and urine extravasationclinical features shock dripping and hematuria pain dysuria and retention hematoma extravasationdiagnosis physical exam catheterization plain x-ray film urethrocystogramtreatment treat shock extravasation: surgical drainage contusion: antibiotic