泌尿道感染及损伤(英文版)UTinjuries2h课件

1、泌尿道感染及损伤(英文版)UTinjuries2h泌尿道感染及损伤(英文版)UTinjuries2hIntroduction 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 w

2、hich will need further investigation to establish the diagnosisIntroduction UTI often occursPathological changes HemorrhageExtravasation Severe hemorrhage will result in shock. Hematoma and extravasation of urine will complicate with infectionUrethral stricture and urinary fistula in late stagePatho

3、logical changes Hemorrhag 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 dir

4、ect violent hit on abdomen, loin, or an indirect force by falling from a high place and landing on the feet or buttocks. Injuries to the kidneyPathogeClassification (closed)Contusion: ecchymosis, subcapsular hematoma partial fissure subcapsular hematoma, perirenal hematoma complete fissure extravasa

5、tion of blood , urine, gross hematuria and shock laceration of renal vascular pedicleClassification (closed)ContusiPerirenal hematoma, hematuria and operation to stop bleedingPerirenal hematoma, hematuria Late stage changesurinomabroad fibrosis in post-peritoneal spacehydronephrosisrenal hypertensio

6、nLate stage changesurinomaClinical manifestationShockHematuriaPainMassFeverClinical manifestationShock Diagnosis History and physical exam Urine exam X-ray exam, KUB, IVU, CT Ultrasound B Diagnosis History and physi泌尿道感染及损伤(英文版)UTinjuries2h泌尿道感染及损伤(英文版)UTinjuries2hTreatmentObservationIndication for

7、surgery intractable shock progressing gross hematuria and anemia enlarging abdonimal or loin mass accompanying intra-abdominal or pulmonary damageSelective renal artery embolizationOpen surgery: repair, partial nephrectomy,nephrectomyTreatmentObservationInjury to the bladderPathogenesis and patholog

8、yOpen injury vesicorectal or vesicovaginal fistulaClosed injury contusion: hemorrhage or hematuria vesical rupture: urine extravasation extraperitoneal intraperitonealInjury to the bladderPathogeneextraperitoneal rupture intraperitoneal ruptureextraperitoneal rupture intClinical featuresShockHematur

9、iaDysuriaPainFeverPeritonitisClinical featuresShockDiagnosisClinical featuresPlain film, IVU and cystogramCatheterization and instillation testDiagnosisClinical featuresTreatmentExtraperitoneal rupture catheterization or cystostomyIntraperitoneal Surgical repairTreatmentExtraperitoneal ruptuInjury t

10、o the urethraEtiologyopen injury penetrating wound in scrotum,penis or perineumclosed injury fall-astride injuries bulbous urethra pelvic fracture damages membranous urathra instrumental injuriesInjury to the urethraEtiologyPathologyType of injurycontusion: will resolve without sequelaelaceration: h

11、ematoma, extravasation, stricturecomplete tear: hematoma, obstruction, retention, extravastion, urethral occlusionPathologyType of injuryPathologic stageAcute: 2 days inflammation: infection, fistulaurethral stricture: 23 weeks urinary retention, obstructive uropathyPathologic stageAcute: 2 daUrinar

12、y extravasationBulbous urethra limited by colles fascia, urine extravasate to perineum, scrotum, penis, then up to the abdominal wallsupramembranous urethra urine extravasate into periprostatic and perivesical tissues and retroperitoneal space,urogenital diaphram is lacerated: scrotum and perineum U

13、rinary extravasationBulbous u Posterior urethral damage and urine extravasation Posterior urethral damageAnterior urethra damage and urine extravasationAnterior urethra damage and Clinical featuresShockdripping and hematuriapaindysuria and retentionhematomaextravasationClinical featuresShockDiagnosisphysical examcatheterizationplain x-ray filmurethrocystogramDiagnosisphysical examTreatmenttreat shockextravasation: surgical drainagecontusion: antibiotics, observationsimple lacerat