泌尿道感染及損傷 (2)ppt課件

1、Injuries to the urinary tractChen WeiAssociate Prof.Department of UrologyThe First Affiliated HospitalSUMSIntroduction 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

2、attack, there may be concomitant urinary system trauma which will need further investigation to establish the diagnosisPathological changes Hemorrhage Extravasation Severe hemorrhage will result in shock. Hematoma and extravasation of urine will complicate with infection Urethral stricture and urina

3、ry fistula in late stage Injuries to the kidneyPathogenesis and pathologyRenal damage can be classified into open and closed injuriesOpen injuries are often caused by a sharp instrument as a knife or bullet, making a penetrating wound in the chest or abdomenClosed trauma are usually caused by a dire

4、ct violent hit on abdomen, loin, or an indirect force by falling from a high place and landing on the feet or buttocks.Classification (closed) Contusion: ecchymosis, subcapsular hematoma partial fissure subcapsular hematoma, perirenal hematoma complete fissure extravasation of blood , urine, gross h

5、ematuria and shock laceration of renal vascular pediclePerirenal hematoma, hematuria and operation to stop bleedingLate stage changes urinoma broad fibrosis in post-peritoneal space hydronephrosis renal hypertensionClinical manifestation Shock Hematuria Pain Mass Fever Diagnosis History and physical

6、 exam Urine exam X-ray exam, KUB, IVU, CT Ultrasound BTreatment Observation Indication for surgery intractable shock progressing gross hematuria and anemia enlarging abdonimal or loin mass accompanying intra-abdominal or pulmonary damage Selective renal artery embolization Open surgery: repair, part

7、ial nephrectomy,nephrectomyInjury to the bladderPathogenesis and pathologyOpen injury vesicorectal or vesicovaginal fistulaClosed injury contusion: hemorrhage or hematuria vesical rupture: urine extravasation extraperitoneal intraperitonealextraperitoneal rupture intraperitoneal ruptureClinical feat

8、ures Shock Hematuria Dysuria Pain Fever PeritonitisDiagnosis Clinical features Plain film, IVU and cystogram Catheterization and instillation testTreatment Extraperitoneal rupture catheterization or cystostomy Intraperitoneal Surgical repairInjury to the urethraEtiologyopen injury penetrating wound

9、in scrotum,penis or perineumclosed injury fall-astride injuries bulbous urethra pelvic fracture damages membranous urathra instrumental injuriesPathologyType of injurycontusion: will resolve without sequelaelaceration: hematoma, extravasation, stricturecomplete tear: hematoma, obstruction, retention

10、, extravastion, urethral occlusionPathologic stage Acute: 2 days inflammation: infection, fistula 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 abdomina

11、l wall supramembranous urethra urine extravasate into periprostatic and perivesical tissues and retroperitoneal 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: antib