Injuriestotheurinarytract教学课件精选

1、Injuries to the urinary tractChen WeiAssociate Prof.Department of UrologyThe First Affiliated HospitalSUMS第1页，共28页。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

2、 violent attack, there may be concomitant urinary system trauma which will need further investigation to establish the diagnosis第2页，共28页。Pathological changes HemorrhageExtravasation Severe hemorrhage will result in shock. Hematoma and extravasation of urine will complicate with infectionUrethral str

3、icture and urinary fistula in late stage第3页，共28页。 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

4、 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.第4页，共28页。Classification (closed)Contusion: ecchymosis, subcapsular hematoma partial fissure subcapsular hematoma, perirenal hematoma complete fissure extrav

5、asation of blood , urine, gross hematuria and shock laceration of renal vascular pedicle第5页，共28页。Perirenal hematoma, hematuria and operation to stop bleeding第6页，共28页。Late stage changesurinomabroad fibrosis in post-peritoneal spacehydronephrosisrenal hypertension第7页，共28页。Clinical manifestationShockHe

6、maturiaPainMassFever第8页，共28页。 Diagnosis History and physical exam Urine exam X-ray exam, KUB, IVU, CT Ultrasound B第9页，共28页。第10页，共28页。第11页，共28页。TreatmentObservationIndication for surgery intractable shock progressing gross hematuria and anemia enlarging abdonimal or loin mass accompanying intra-abdom

7、inal or pulmonary damageSelective renal artery embolizationOpen surgery: repair, partial nephrectomy,nephrectomy第12页，共28页。Injury to the bladderPathogenesis and pathologyOpen injury vesicorectal or vesicovaginal fistulaClosed injury contusion: hemorrhage or hematuria vesical rupture: urine extravasat

8、ion extraperitoneal intraperitoneal第13页，共28页。extraperitoneal rupture intraperitoneal rupture第14页，共28页。Clinical featuresShockHematuriaDysuriaPainFeverPeritonitis第15页，共28页。DiagnosisClinical featuresPlain film, IVU and cystogramCatheterization and instillation test第16页，共28页。TreatmentExtraperitoneal rup

9、ture catheterization or cystostomyIntraperitoneal Surgical repair第17页，共28页。Injury to the urethraEtiologyopen injury penetrating wound in scrotum,penis or perineumclosed injury fall-astride injuries bulbous urethra pelvic fracture damages membranous urathra instrumental injuries第18页，共28页。PathologyTyp

10、e of injurycontusion: will resolve without sequelaelaceration: hematoma, extravasation, stricturecomplete tear: hematoma, obstruction, retention, extravastion, urethral occlusion第19页，共28页。Pathologic stageAcute: 2 days inflammation: infection, fistulaurethral stricture: 23 weeks urinary retention, ob

11、structive uropathy第20页，共28页。Urinary 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

12、 lacerated: scrotum and perineum 第21页，共28页。 Posterior urethral damage and urine extravasation 第22页，共28页。Anterior urethra damage and urine extravasation第23页，共28页。Clinical featuresShockdripping and hematuriapaindysuria and retentionhematomaextravasation第24页，共28页。Diagnosisphysical examcatheterizationplain x-ray filmurethrocystogram第25页，共28页。Treatmenttreat shockextravasation: surgical drainagecontusion: antibiotics, observat