急性尿滞留中英文课件

急性尿滞留中英文课件

学习目标

1.熟悉急性尿滞留鉴别诊断。2.熟悉急性尿滞留的紧急处置。3.熟悉各种引起急性尿滞留的治疗准则。急性尿滞留-定义与临床意义-Acuteurinaryretention(AUR)istheinabilitytovoluntarilypassurine.-Inmen,AURismostoftensecondarytobenignprostatichyperplasia(BPH);AURisrareinwomen.J?EPIDEMIOLOGYAcuteurinaryretention(AUR)iscommoninmen.Theincidenceincreaseswithage,occurringmostfrequentlyinmenoverage60.Itisestimatedthat,overafive-yearperiod,approximately10percentofmenovertheageof70andalmostone-thirdofmenintheir80swilldevelopAUR.AURisrareinwomen.ItisestimatedthattherearethreecasesofAURper100,000womenperyear.Thefemaletomaleincidencerateratiois1:13.急性尿滞留-临床表现InabilitytopassurineLowerabdominal

and/or

suprapubicdiscomfort.Restlessanddistress.Acute-on-chronicurinaryretentionmaypresentwithoverflowincontinence.Thepatientsmaycomplainofincontinenceratherthantheinabilitytopassurine.急性尿滞留-病理生理学Obstruction

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ObstructionisthemostcommoncauseofAUR.Male-Benignprostatichyperplasia(BPH)-Constipation-Cancer(prostateorbladder)-Urethralstricture-Urolithiasis-Phimosis-Paraphimosis急性尿滞留-病理生理学Obstruction

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ObstructionisthemostcommoncauseofAUR.Female-Rectocele-Cystocele-Benignormalignanttumors-Urethraldiverticulum急性尿滞留-病理生理学Outflowobstruction

-Theflowofurineisimpededwithoutflowobstructionbymechanical

and/or

dynamicfactors.Mechanicalobstructionreferstoaphysicalnarrowingoftheurethralchannel.-Dynamicobstructionreferstoincreasedmuscletonewithinandaroundtheurethra.急性尿滞留-病理生理学Neurologicimpairment

-AURmaydevelopsecondarytotheinterruptionofthesensoryormotornervesupplytothedetrusormuscle.-Incompleterelaxationoftheurinarysphinctermechanism(dyssynergia),whichcanresultinelevationsinbothvoidingpressuresandpost-voidresidualvolumes.-Inefficientbladder(detrusor)musclecontraction.急性尿滞留-病理生理学Inefficientdetrusormuscle

-AURmayoccurinpatientswithaninefficientdetrusormusclewhenaprecipitatingeventresultsinanacutedistendedbladder(eg,withafluidchallenge,duringgeneralorepiduralanalgesiawithoutanindwellingcatheter)急性尿滞留-病理生理学Medication

-Sympathomimetics(alpha-adrenergicagents)-Sympathomimetics(beta-adrenergicagents)-Antidepressants-Antiarrhythmics-Anticholinergics

-Antiparkinsonianagents急性尿滞留-病理生理学Medication-Antipsychotics-Antihistamines-Antihypertensives-Musclerelaxants-Hormonalagents急性尿滞留-病理生理学Neurologicimpairment

–AURcanoccurwithspinalcordinjuriesfromtrauma,infarctordemyelination,epiduralabscessandepiduralmetastasis,Guillain-Barrésyndrome,diabeticneuropathy,andstroke.急性尿滞留-病理生理学Infection

–InfectionsmayleadtoAURinthesettingofinflammationthatcausesobstruction.Trauma

–Patientswithtraumatothepelvis,urethra,orpenismaydevelopAUR.

HistoryPrevioushistoryofretentionorlowerurinarytractsymptoms,prostatedisease(hyperplasiaorcancer),pelvicorprostatesurgery,radiation,orpelvictrauma.Hematuria,dysuria,fever,lowbackpain,neurologicsymptoms,orrash.HistoryAcompletelistofmedicationsshouldbeobtained.Historyofcancerorintravenousdrugabuse,andthepresenceofbackpainorneurologicsymptomssuggestthepossibilityofspinalcordinjuryorcompression.PhysicalexaminationLowerabdominalpalpation–Theurinarybladdershouldbepalpable.Rectalexamination–Evaluationformasses,fecalimpaction,perinealsensation,andrectalsphinctertone.PhysicalexaminationPelvicexamination–Womenwithurinaryretentionshouldhaveapelvicexamination.Neurologicevaluation–Assessmentofstrength,sensation,reflexes,andmuscletone.LaboratorystudiesUrinalysis.Urineculture.Serumchemistriesandcreatinine.CBCforsuspectedinfection.急性尿滞留-影像检查Ultrasound急性尿滞留-影像检查CTACUTEMANAGEMENTBladderdecompressionbycatheterization.A16gaugeFrenchcathetershouldbeinsertedasfirst-linetherapyinmostpatientswithAUR.ThemostcommoncauseofobstructionwouldbeanenlargedprostateAlargercatheter(20or22gauge)withafirmtipmaybeneeded.ACUTEMANAGEMENTApartiallyobstructingurethralorprostaticscarmaybepresentifthepatienthashadapriortransurethralprocedure,orpelvictraumaorradiationDownsizingthecathetertoa10or12gaugeFrenchindwellingcatheter.

Iffailed,

urologyconsultationmaybeanoptionforbedsideflexiblecystoscopy.ACUTEMANAGEMENTSuprapubiccatheterization.

Placementofasuprapubic(SP)catheterissometimesnecessaryinpatientswhohavecontraindicationstoorfailurethralcatheterization.ComplicationsofdecompressionHematuria

–Hematuriaoccursin2to16percentofpatientsbutisrarelyclinicallysignificant.Transienthypotension

–Afterinitialbladderdecompression,patientsmayexperienceatransienthypotension.Postobstructivediuresis

–Reliefofurinarytractobstructioncanleadtoapostobstructivediuresis.SUBSEQUENTMANAGEMENTEvaluation

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Forpatientswhohaveaknownreversibleetiology(eg,urinarytractinfectionormedication),nofurtherevaluationisneededunlesstheacuteurinaryretention(AUR)doesnotresolvewithtreatment.SUBSEQUENTMANAGEMENTBPH-alpha-1-adrenergicantagonist;Surgery(TURP).Neurologicimpairment-Suprapubiccatheter,Cleanintermittentcatheterization.Anatomicproblem–Surgery.参考资料1.Campbell-WalshUrology,11thEdition2.Smith&Tanagho’sGeneralUrology,18thEdition考题一下列何者药物不会有引起急性尿滞留（acuteurinaryr