泌尿道感染及损伤（英文版）ut 课件

Injuries to the urinary tract Chen Wei Associate Prof. Department of Urology The First Affiliated Hospital SUMS 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 the diagnosis Pathological 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 kidney Pathogenesis and pathology Renal damage can be classified into 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 feet 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 pedicle Perirenal hematoma, hematuria and operation to stop bleeding Late stage changes urinoma broad fibrosis in post-peritoneal space hydronephrosis renal hypertension Clinical manifestation Shock Hematuria Pain Mass Fever Diagnosis History and physical exam Urine exam X-ray exam, KUB, IVU, CT Ultrasound B Treatment 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, partial nephrectomy,nephrectomy Injury to the bladder Pathogenesis and pathology Open injury vesicorectal or vesicovaginal fistula Closed injury contusion: hemorrhage or hematuria vesical rupture: urine extravasation extraperitoneal intraperitoneal extraperitoneal rupture intraperitoneal rupture Clinical features Shock Hematuria Dysuria Pain Fever Peritonitis Diagnosis Clinical features Plain film, IVU and cystogram Catheterization and instillation test Treatment Extraperitoneal rupture catheterization or cystostomy Intraperitoneal Surgical repair Injury to the urethra Etiology open injury penetrating wound in scrotum,penis or perineum closed injury fall-astride injuries bulbous urethra pelvic fracture damages membranous urathra instrumental injuries Pathology Type of injury contusion: will resolve without sequelae laceration: hematoma, extravasation, stricture complete tear: hematoma, obstruction, retention, extravastion, urethral occlusion Pathologic stage Acute: 2 days inflammation: infection, fistula urethral stricture: 23 weeks urinary retention, obstructive uropathy Urinary 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 retroperitoneal space,urogenital diaphram is lacerated: scrotum and perineum Posterior urethral damage and urine extravasation Anterior urethra damage and urine extravasation Clinical features Shock dripping and hematuria pain dysuria and retention hematoma extravasation Diagnosis physical exam catheterization plain x-ray film urethrocystogram Treatment treat shock extravasation: surgical drainage contusion: antib