Injuriestotheurinarytract教学课件精选.ppt

Injuries to the urinary tract
Chen Wei
Associate Prof.
Department of Urology
The First Affiliated Hospital
SUMS
第1页，共2intra-abdominal or pulmonary damage
Selective renal artery embolization
Open surgery: repair, partial nephrectomy,nephrectomy
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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
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extraperitoneal rupture intraperitoneal rupture
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Clinical features
Shock
Hematuria
Dysuria
Pain
Fever
Peritonitis
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Diagnosis
Clinical features
Plain film, IVU and cystogram
Catheterization and instillation test
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Treatment
Extraperitoneal rupture
catheterization or cystostomy
Intraperitoneal
Surgical repair
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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
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Pathology
Type of injury
contusion: will resolve without sequelae
laceration: hematoma, extravasation,
stricture
complete tear: hematoma, obstruction,
retention, extravastion,
urethral occlusion
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Pathologic stage
Acute: < 2 days
inflammation: infection, fistula
urethral stricture: 2~3 weeks
urinary retention, obstructive uropathy
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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 p