泌尿道感染及损伤(英文版)UT-injuries-2hppt课件

单击以编辑母版标题样式,单击以编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Injuries to the urinary tract,Chen Wei,Associate Prof.,Department of Urology,The First Affiliated Hospital,SUMS,Injuries to the urinary tractC,1,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,Introduction UTI often occurs,2,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,Pathological changes Hemorrhag,3,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,.,Injuries to the kidneyPathoge,4,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,Classification(closed)Contusi,5,Perirenal hematoma,hematuria and operation to stop bleeding,Perirenal hematoma,hematuria,6,Late stage changes,urinoma,broad fibrosis in post-peritoneal space,hydronephrosis,renal hypertension,Late stage changesurinoma,7,Clinical manifestation,Shock,Hematuria,Pain,Mass,Fever,Clinical manifestationShock,8,Diagnosis,History and physical exam,Urine exam,X-ray exam,KUB,IVU,CT,Ultrasound B,Diagnosis History and physi,9,泌尿道感染及损伤(英文版)UT-injuries-2hppt课件,10,泌尿道感染及损伤(英文版)UT-injuries-2hppt课件,11,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,TreatmentObservation,12,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,Injury to the bladderPathogene,13,extraperitoneal rupture intraperitoneal rupture,extraperitoneal rupture int,14,Clinical features,Shock,Hematuria,Dysuria,Pain,Fever,Peritonitis,Clinical featuresShock,15,Diagnosis,Clinical features,Plain film,IVU and cystogram,Catheterization and instillation test,DiagnosisClinical features,16,Treatment,Extraperitoneal rupture,catheterization or cystostomy,Intraperitoneal,Surgical repair,TreatmentExtraperitoneal ruptu,17,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,Injury to the urethraEtiology,18,Pathology,Type of injury,contusion:,will resolve without sequelae,laceration:,hematoma,extravasation,stricture,complete tear:,hematoma,obstruction,retention,extravastion,urethral occlusion,PathologyType of injury,19,Pathologic stage,Acute:2 days,inflammation:infection,fistula,urethral stricture:23 weeks,urinary retention,obstructive uropathy,Pathologic stageAcute:2 da,20,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,Urinary extravasationBulbous u,21,Posterior urethral damage and,urine extravasation,Posterior urethral damage,22,Anterior urethra damage and urine extravasation,Anterior urethra damage and,23,Clinical features,Shock,dripping and hematuria,pain,dysuria and retention,hematoma,extravasation,Clinical featuresShock,24,Diagnosis,physical exam,catheterization,plain x-ray film,urethrocystogram,Diagnosisphysical exam,25,Treatment,treat shock,extravasation:surgical drainage,contusion:antibiotics,observation,simple laceration:catheterization,urethral stent for 2-3 weeks,urethral dilatation,surgery:extensive laceration,complete tear,Treatmenttreat shock,26,Urethral reunion operation,Urethral reunion operation,27,Thank you!,Thank you!,28,泌尿道感染及损伤(英文版)UT-injuries-2hppt课件,29,