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吉林大学第一医院泌尿系统疾病诊治中心副主任医师副教授硕士研究生导师王伟刚.cn专业外语

泌尿系统部分1.Anadultwomanrelatesthat5daysagoshebegantonoticefrequent,painfulurination,withsmallvolumesofcloudyandmalodorousurine.Forthefirst3daysshehadnofever,butforthepast2daysshehashadpainintherightflank.Shehashadnotreatmentwhatsoeveruptothistime.Whatisit?Pyelonephritis

Pyelo-nephritis2.A63-year-oldmalecomplainsof6-monthhistoryofdifficultyvoidingandfeelingasthoughhecannotemptyhisbladdercompletely.Aftervoiding,heoftenfeelsasthoughheneedstourinateagain.Hedeniesurethraldischargeorburningwithurination.Hehashadmild

hypertensionandtakesathiazidediuretic.Hisonlyothermedicationhasbeenampicillinfortwourinarytractinfectionsduringthepreviousyear.Onexamination,hisbloodpressureis130/84mmHg,pulserate80beats/min,andheiswithoutfever(afebrile).Theheartandlungexaminationarenormal,andtheabdominalexaminationshowsnomasses.Whatisthemostlikelydiagnosis?Benignprostatichyperplasia(BPH)3、A5-year-oldgirlandhermotherarereferredforevaluationofbed-wetting.Themotherstatesthatherdautherhasneverfullygainedcontrolofherbladder.Ittookheranextendedperiodoftimetogrowoutofdiapersandthegirlhasfinallystoppedhaving“accidents”duringtheday.However,shecontinuestowetherbedatnight.Thepatienthasdevelopednormallyinallotheraspectsandwillbefrustratedandhavebeenlosingsleep,asthegirlwakesupatnight4to5timesperweek.Physicalexaminationisunremarkable.Whichofthefollowingwillmostlikelybetheresultoffurtherinvestigation?LargecapacitybladderLearningdisabilityNormal“work-up”UrinarytractinfectionUrologicalcancerThecorrectanswerisC4、A62-year-oldmanpresentswithchills,fever,dysuria,urinaryfrequency,diffuselowbackpain,andanexquisitelytenderprostateonrectalexam.Whatisit?Acutebacterialprostatitis.5、A62-year-oldmanknowntohavenormalrenalfunctionreportsanepisodeofgross,painlesshematuria.Furtherquestioningdeterminesthatthepatienthastotalhematuriaratherthaninitialorterminalhematuria.Whatisit?Thebloodiscominganywherefromthekidneystothebladder,ratherthantheprostateortheurethra.Eitherinfectionortumorcanproducehematuria.Inolderpatientswithoutsignsofinfection,canceristhemainconcern,anditcouldbeeitherrenalcellcarcinomaortransitionalcellcancerofthebladderorureter.Management.DoaCTscanandcystoscopy.DisordersoftheUrinarySystemandSomeMeansforFindingThemOut泌尿系统疾病及检查手段DisordersoftheUrinarySystemInfectionsGlomerulonephritisAcuterenalfailureUrinarystonesCancer泌尿系统疾病感染肾小球性肾炎急性肾衰竭尿石病癌症InfectionsCystitisisaninfectionoftheurinarybladder.Organismsgenerallyenterthroughtheurethraandascendtowardthebladder.感染膀胱炎是膀胱（urinarybladder）的感染，病菌一般从尿道而入，并上行到膀胱，引起感染。感染Cystitis,膀胱炎Gallbladder,胆囊InfectionsTheinfectingorganismsareusuallycolonbacteriacarriedinfeces.Cystitisisthusmorecommoninfemalesthaninmalesbecausethefemaleurethraisshorterthanthemaleurethraandit’sopeningisclosertotheanus.感染病菌通常是大便中携带的结肠菌。因女性尿道比男性的短，而且尿道口更靠近肛门，故女性膀胱炎比男性更常见。感染Feces[‘fi:si:z]n.

排泄物，粪便，渣滓

Anus['einəs]n.

肛门

InfectionsPoortoilethabitsandurinarystasisarecontributingfactors.Inthehospital,urinarytractinfectionsmaycomplicatecatheterizationforthewithdrawalofurinefromthebladder.感染大小便习惯不良和尿潴留是促发因素。医院用导管从膀胱提取尿液时可并发尿道感染。感染Urinarystasis尿潴留Catheterization导管插入术InfectionsAninfectionthatinvolvesthekidneyandrenalpelvisistermedpyelonephritis.Signsofthisconditionincludedysuria,painfulordifficulturination,andthepresenceofbacteriaandpusintheurine,bacteriuriaandpyuriarespectively,asincystitis.感染波及肾脏和肾盂的感染称为肾盂肾炎。同膀胱炎一样，肾盂肾炎的体征包括尿痛——亦称排尿困难，尿液中有细菌和脓，分别称为菌尿和脓尿。感染Dysuria排尿困难Pyelonephritis肾盂肾炎Bacteriuria细菌尿Pyuria脓尿InfectionsUrethritisisinflammationoftheurethra,generallyassociatedwithsexuallytransmitteddiseasessuchasgonorrheaandchlamydiainfections.感染尿道炎是尿道的炎症，通常与性传播的疾病如淋病、支原体感染有关。

感染Gonorrhea[.gɔnə‘ri:ə]n.

淋病

（-rrhea,流出，溢出）Chlamydia[klə'midiə]n.

[微]衣原体，衣原体疾病

GlomerulonephritisAlthouththenamesimplymeansinflammationofthekidneyandglomeruli,glomerulonephritisisaspecificdisorderthatfollowsanimmunologicreaction.Itisusuallyaresponsetoinfectioninanothersystem,commonlyastreptococcalinfectionoftherespiratorytract.肾小球性肾炎尽管肾小球性肾炎这一名称仅指肾脏和肾小球的炎症，但肾小球性肾炎却是免疫反应引起的一种特异性疾病，通常是对另外某个系统的炎症（常对呼吸道链球菌感染）的反应。肾小球性肾炎Streptococcal[.streptə'kɔkəl]adj.

链状球菌的，链球菌所导致的

Strep[strep]n.

链锁状球菌

adj.

链锁状球菌的

-coccal球菌的GlomerulonephritisItmayalsopanyautoimmunediseasessuchaslupuserythematosus.Thesymptomsarehypertension,edema,andoliguria,thepassageofsmallamountsofurine.Thisurineishighlyconcentrated.肾小球性肾炎发病可伴随红斑狼疮之类的自体免疫疾病。其症状为高血压、水肿和少尿，这种尿的浓度高。肾小球性肾炎lupuserythematosusn.

红斑狼疮

Edema[i:‘di:mə]n.

[医]浮肿，水肿，

[植]瘤腺体

Oliguria[ɔli'gjuəriə]n.

[医]尿过少，少尿(症)GlomerulonephritisBecauseofdamagetokidneytissue,bloodandproteinsescapeintothenephrons,causinghematuria,bloodintheurine,andproteinuria,proteinintheurine.Bloodcellsmayalsoformintosmallmoldsofthekidneytubulecalledcasts,whichcanbefoundintheurine.肾小球性肾炎因肾组织受损，血液和蛋白质渗入肾单位，引起血尿和蛋白尿，红细胞也可形成肾小管的小型模型，称为管型，可在尿液中发现。肾小球性肾炎Hematuria[.hi:mə‘tju:riə]n.

血尿症，血尿

Proteinuria[prəuti:n'juəriə;.prəuti:'nuə'uri:ə]

n.

[医]蛋白尿(症)

GlomerulonephritisGlomerulonephritisisoneofthemostcommoncausesofchronicrenalfailure(CRF),orend-stagerenaldisease(ESRD),inwhichureaandothernitrogencontainingcompoundsaccumulateintheblood,whoseconditionistermeduremia.肾小球性肾炎肾小球性肾炎是最常见的慢性肾衰竭或晚期肾病的原因之一，此时脲和其他含氮化合物积累于血液中，这种症状称为尿毒症。肾小球性肾炎Uremia[ju'ri:miə]n.

尿毒症

GlomerulonephritisThesecompoundsaffectthecentralnervoussystem,causingirritability,lossofappetite,stuporandothersymptoms.Thereisalsoelectrolyteimbalanceandacidosis.肾小球性肾炎这些化合物影响中枢神经系统，故引起易受刺激、厌食、木僵和其他症状，还有电解质失衡和酸中毒。肾小球性肾炎Stupor['stju:pə]n.

昏迷，麻木，不省人事AcuteRenalFailureAninjury,shock,exposuretotoxins,infections,andotherrenaldisordersmaycausedamagetothenephronsresultinginacuterenalfailure(ARF).Thereisrapidlossofkidneyfunctionwitholiguriaandaccumulationofnitrogenwastesintheblood.急性肾衰竭损伤、休克、接触毒素、感染和肾的其他疾病可导致肾单位的损害，引起慢性肾衰竭，此时肾功能迅速丧失，排尿少，血液中氮废物积累。AcuteRenalFailureFailureofthekidneystoeliminatepotassiumleadstohyperkalemiaalongwithotherelectrolyteimbalancesandacidosis.Whenthereisdestruction,necrosisofkidneytubules,theconditionmaybereferredtoasacutetubularnecrosis.急性肾衰竭肾脏无能力排除钾，而导致高钾症、其他电解质失衡和酸中毒。当肾小管遭到破坏即坏死时，这种疾病称为急性肾小管坏死。急性肾衰竭Potassium[pə‘tæsiəm]n.

钾

hyperkalemia[haipəkə'li:miə;.haipəkei'li:mi:ə]n.

[医]血钾过多，高钾

AcuteRenalFailureRenalfailuremayleadtoaneedforkidneydialysisortransplantation.Dialysisreferstothemovementofsubstancesacrossasemipermeablemembrane.Inhemodialysis,bloodiscleansedbypassageoveramembranesurroundedbyfluid(dialysate)thatdrawsoutunwantedsubstances.急性肾衰竭肾功能衰竭时需进行透析和肾移植。透析是指体液通过半透膜的运动。透析时，血液透过一层体液即透析液围绕的膜，有害的物质被吸走，血液得以纯净。急性肾衰竭Dialysis[dai‘ælisis]n.

透析，渗析

Unwanted['ʌn'wɔntid]

adj.

不需要的，多余的，无用的，讨厌的，不受欢迎的

AcuteRenalFailureInperitonealdialysis,fluidisintroducedintotheperitonealcavity.Thisfluidisperidicallywithdrawnalongwithwasteproductsandreplaced.Thismaybedoneatintervalsthroughoutthedayincontinuousambulatoryperitonealdialysis(CAPD)oratnightincontinuouscyclicperitonealdialysis(CCPD).急性肾衰竭腹膜透析时，体液导入腹膜腔，这种体液连同废物定期被抽取、替换。白天定期进行连续性非住院性腹膜透析，夜间则进行持续循环腹膜透析。急性肾衰竭Peritoneal[,peritə‘ni:əl]adj.

[解]腹膜的Ambulatory['æmbjulətəri]adj.

可走动的，[医]非卧床的，流动的，[法律]可变更的，可撤销的

UrinaryStonesUrinarylithiasis,whichisknownasaconditionofhavingstones,mayberelatedtoinfection,irritation,diet,orhormonethatleadtoincreasedcalciumintheblood.Mosturinarystones,orcalculi,areformedofcalciumsalts,buttheymaybecomposedofothermaterialsaswell。尿石病尿石，即有结石的疾病，可能与感染、刺激、饮食、或激素分泌失衡有关，从而导致血液中的钙质增多。多数尿石由钙盐构成，但有的可能由其他的物质构成。UrinaryStonesThestonesgenerallyforminthekidneyandmaymovetothebladder.Thisresultsingreatpain,termedrenalcolic,andobstructionthatcanpromoteinfectionandcausehydronephrosis,collectionofurineintherenalpelvis.Becausetheyareradiopaque,stonescanusuallybeseenonsimplex-raysoftheabdomen.

尿石病结石通常在肾脏中形成，可运动至膀胱，引起剧痛，称为肾绞痛，可造成阻塞，进而加剧感染并引起肾盂积水，即尿液滞留于肾盂。因尿石不透光，通常可见于腹部单纯透视片。

尿石病renalcolic肾绞痛

UrinaryStonesStonesmaydissolveandpassoutofthebodyontheirown.Ifnot,theymayberemovedsurgically,inalithotomy,orbyusinganendoscope.Inanewermethod,externalshockwavesareusedtocrushstonesintheurinarytractinaprocedurecalledextracorporeal(outsidethebody)shockwavelithotripsy(crushingofstones).尿石病尿石可溶解，自行排出体外;若不能，可用手术即石切除术或用内镜清除。一种更新的方法是用体外震波将尿路结石破碎，称为体外震波碎石术。尿石病Lithotomy[li‘θɔtəmi]n.

切开取石术

Extracorporeal[.ekstrəkɔ:'pɔ:riəl]

adj.

身体外的

CancerCarcinomaofthebladderhasbeenlinkedtooccupationalexposuretochemicals,parasiticinfections,andcigarettesmoking.Akeysymptomissudden,painlesshematuria.Oftenthecancercanbeseenbyviewingtheliningofthebladderwithacystoscope.Thisinstrumentcanalsobeusedtobiopsytissueforstudy.癌症膀胱癌与职业性接触化学物质、与寄生虫感染及吸烟有联系。最重要的症状是突然无痛性血尿。常可用膀胱镜观察膀胱粘膜发现膀胱癌。该方法也可用于取病理活检。CancerIftreatmentisnoteffectiveinpermanentlyremovingthetumor,acystectomy,removalofthebladder,maybenecessary.Inthiscase,theuretersmustbeventedelsewhere,suchasdirectlytothesurfaceofthebody,throughtheileuminanilealconduitortosomeotherportionoftheintestine.癌症若治疗不能根治肿瘤，则需进行膀胱切除术，此时输尿管应在其他地方开口排尿，例如回肠造瘘，通过回肠直接通到体外排尿或接通到肠道的其他某部分排尿。CancerCancermayalsoinvolvethekidneyandrenalpelvis.Additionalmeansfordiagnosingcancerandotherdisordersoftheurinarytractincludeultrasound.CTscans,andx-raystudies:intravenouspyelogramandretrogradepyelography.

癌症癌也可累及肾和肾盂。诊断泌尿道的癌症和其他疾病的其他手段包括超声波、CT扫描和下列放射线检查：静脉肾盂造影和逆行性肾盂造影术。癌症Pyelogram[‘paiələgræm]肾盂造影

Retrogradepyelography逆行性肾盂造影术SomeMeansforFindingoutDisordersoftheUrinarySystemCTscans

Intravenouspyelogram（IVP）Retrogradepyelogramultrasonography部分泌尿系统检查方法

CT扫描静脉肾盂造影照片（IVP）逆行性肾盂造影照片超声波检查CT

scansTransversex-rayviewsofthekidneyaretakenwithorwithoutcontrastmaterialandareusefulinthediagnosisoftumors,cysts,abscessesandhydronephrosis.Studiesmaybeobtainedinrenalfailure,whencontrastmaterialshouldnotbegiven.CT扫描不论是否使用造影剂，肾的横向透视影像均可拍摄，有利于诊断肿瘤、囊肿、脓肿和肾盂积水。在肾衰竭患者也可应用，但不用造影剂。Intravenouspyelogram（IVP）Contrastmaterialisinjectedwithinaveinandtravelstothekidneywhereitisfilteredintotheurine.X-raysarethentakenshowingthedyefillingthekidneys,ureters,bladder,andurethra.Thesex-raysprovideanindexofrenalfunctionaswellasshowcysts,tumors,infections,hydronephrosis,andcalculi.Alsocalledanexcretoryurogram.IVPtomogramsshowaseriesofpicturesofthekidney.

静脉肾盂造影照片（IVP）对比剂注入静脉，流至肾脏，在此渗透至尿液，而后透视，显现染料充填肾脏、输尿管、膀胱和尿道情况。这些透视不仅显现囊肿、肿瘤、感染、肾盂积水和结石，而且提供肾功能指数，静脉肾盂造影（IVP）X线断层照片也称为排泄性尿路造影照片，显现肾的系列影像。

RetrogradepyelogramContrastmaterialisintroduceddirectlyintothebladderanduretersthroughacystoscopeandx-raysaretakentodeterminethepresenceofstonesorobstructions.Thistechniquemaybeindicatedwhenpoorrenalfunctionmakesitimpossibletovisualizethekidneys,ureters,andbladderbyuseofintravenousdyeasinanIVP.ItmayalsobeusedasasubstituteforanIVPwhenapatientisallergictointravenousdye.逆行性肾盂造影照片：用膀胱镜直接将对比剂导入膀胱和输尿管，摄影确定有无结石或梗阻。因肾功能不良而不能象静脉肾盂造影照片（IVP）中使用造影剂显现肾脏、输尿管、膀胱时，便可使用逆行性肾盂造影照片技术。患者对静脉造影剂过敏时，这一方法可用来替代静脉肾盂造影照片（IVP）.UltrasonographyKidneysize,tumors,hydronephrosis,polycystickidney,andureteralandbladderobstructionaresomeofthemanyconditionsthatcanbediagnosedusingsoundwaves,butnoinformationaboutrenalfunctionisobtained.超声波检查有些疾病，例如肾脏大小异常、肿瘤、肾盂积水、多囊肾和输尿管及膀胱阻塞可用超声波诊断，但不可用来诊断肾功能情况。1.Anadultwomanrelatesthat5daysagoshebegantonoticefrequent,painfulurination,withsmallvolumesofcloudyandmalodorousurine.Forthefirst3daysshehadnofever,butforthepast2daysshehashadpainintherightflank.Shehashadnotreatmentwhatsoeveruptothistime.Whatisit?Pyelonephritis

Pyelo-nephritisUrinarytractinfectionsshouldnothappeninmenorinchildren,andthustheyshouldtriggeraworkuplookingforacause.Womenofreproductiveage,ontheotherhand,getcystitisallthetime,andtheyaretreatedwithappropriateantibioticswithoutgreatfuss.However,whentheygetflankpainandsepticsignsit’sanotherstory.Thiswomanneedshospitalization,IV(intravenousinjection)antibiotics,andatleastasonogramtomakesurethatthereisnoitantobstruction.2.A63-year-oldmalecomplainsof6-monthhistoryofdifficultyvoidingandfeelingasthoughhecannotemptyhisbladdercompletely.Aftervoiding,heoftenfeelsasthoughheneedstourinateagain.Hedeniesurethraldischargeorburningwithurination.Hehashadmild

hypertensionandtakesathiazidediuretic.Hisonlyothermedicationhasbeenampicillinfortwourinarytractinfectionsduringthepreviousyear.Onexamination,hisbloodpressureis130/84mmHg,pulserate80beats/min,andheiswithoutfever(afebrile).Theheartandlungexaminationarenormal,andtheabdominalexaminationshowsnomasses.Whatisthemostlikelydiagnosis?Benignprostatichyperplasia(BPH)Summary:A63-year-oldmalewhohashypertensioncomplainsofa6-monthdifficultyinvoidingandthesensationthathecannotemptyhisbladdercompletely.Hehashadtwoepisodesofurinarytractinfectionsbutdeniesdysuria(burningwithurination)orurethraldischarge.Mostlikelydiagnosis:Benignprostatichyperplasia3、A45-year-oldfemaleunderwentsurgicalremovaloftheuterus(totalhysterectomy)forsymptomaticendometriosis2dayspreviously.Shecomplainsofrightbackandflanktenderness.Onexamination,hertemperatureis102F,heartrateis100beats/min,andbloodpressureis130/90mmHg.Theheartandlungexaminationsarenormal.Herabdomenisslightlytenderdiffusely,butbowelsoundsarenormal.Thesurgicalincisionappearswithinnormallimits.Thereisexquisiterightcostovertebralangletendernessonpalpation.Ultrasoundofthekidneysshowsmarkeddilationoftherightrenalcollectingsystemanddilationoftherightureter.Whatisthemostlikelydiagnosis？Whatistheanatomicalexplanationforthiscondition?UreteralinjuryatsurgerySummary:A45-year-oldfemalewhounderwenttotalabdominalhysterectomyforsymptomaticendometriosis2dayspreviouslyhasfeverof102Fandexquisiterightflanktendernessatthecostovertebralangle.Thesurgicalincisionappearsnormal.Mostlikelydiagnosis:InjurytotherightureterAnatomicalexplanationforthiscondition:Probableligationoftherightureterasitpassesinferiorlytotheuterinearterywithinthetransversecervical(cardinal)ligamentoftheuterus.4、A5-year-oldgirlandhermotherarereferredforevaluationofbed-wetting.Themotherstatesthatherdautherhasneverfullygainedcontrolofherbladder.Ittookheranextendedp