泌尿道感染及损伤UT injries2h文档资料.ppt

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,HemorrhageExtravasation Severe hemorrhage will result in shock.Hematoma and extravasation of urine will complicate with infectionUrethral stricture and urinary fistula in late stage,Injuries to the kidney,Pathogenesis 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 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,urinomabroad fibrosis in post-peritoneal spacehydronephrosisrenal hypertension,Clinical manifestation,ShockHematuriaPainMassFever,Diagnosis History and physical exam Urine exam X-ray exam,KUB,IVU,CT Ultrasound B,Treatment,ObservationIndication for 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,nephrectomy,Injury to the bladder,Pathogenesis and pathologyOpen injury vesicorectal or vesicovaginal fistulaClosed injury contusion:hemorrhage or hematuria vesical rupture:urine extravasation extraperitoneal intraperitoneal,extraperitoneal rupture intraperitoneal rupture,Clinical features,ShockHematuriaDysuriaPainFeverPeritonitis,Diagnosis,Clinical featuresPlain film,IVU and cystogramCatheterization and instillation test,Treatment,Extraperitoneal rupture catheterization or cystostomyIntraperitoneal Surgical repair,Injury to the urethra,Etiologyopen injury penetrating wound in scrotum,penis or perineumclosed injury fall-astride injuries bulbous urethra pelvic fracture damages membranous urathra instrumental injuries,Pathology,Type of injurycontusion:will resolve without sequelaelaceration:hematoma,extravasation,stricturecomplete tear:hematoma,obstruction,retention,extravastion,urethral occlusion,Pathologic stage,Acute:2 days inflammation:infection,fistulaurethral 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 wallsupramembranous 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,Shockdripping and hematuriapaindysuria and retentionhematomaextravasation,Diagnosis,physical examcatheterizationplain x-ray filmurethrocystogram,Treatment,treat shockextravasation:surgical drainagecontusion:antibiotics,observationsimple laceration:catheterization urethral stent for 2-3 weeks urethral dilatationsurgery:extensive laceration complete tear,Urethral reunion operation,Thank you!,