1、 Chen Wei Associate Prof.Department of Urology The First Affiliated Hospital SUMS Introduction DefinitionPathogen stay and grow in any part of GUT causing inflammationDefense system in GUT Normal flora stay in meatal skin and mucosa of urethra,secrete bacteriocin,metabolic products,to suppress the g
2、rowth of pathogen,compete nutrients Urothelium secrete mucin preventing bacteria adhesion Anti-reflux mechanismPredisposing factors Obstructive:as stones,tumor,stricture,BPH Body resistance,hypertension,diabetes,pregnancy,congenital immunodeficiency Iatrogenic:catherterization,cystoscopy Renal paren
3、chyma diseases:renal injury,renal failure,interstitial nephritis Anatomical:female urethraPathogen Gram-negative:85%Bacillus coli Gram-positive:Staphylococcus aureus Chlamydia Mycoplasma Mode of infection retrograde blood lymph direct Diagnosis Clinical features Laboratory investigation Bacterial cu
4、lture and colony counting:105/mlPrinciples of treatment Select sensitive antibiotics Use at least two kinds of sensitive antibiotics to avoid production of drug resistant strain Use full dose as early as possible Administer lower nephrotoxin antibiotics Pyonephrosis Infection in parenchyma,pelvis or
5、 calyces cause broad parenchyma damage,pus accumulated in pelvis and calyces gradually,in the end the kidney becomes a pus containing cyst.It may be caused by bacterial pyelonephritis or specific infection as renal TBPyonephrotic kidney:outer surfacePyonephrosis.The dilated pelvis was filled with pu
6、s and abscesses are present in the renal parenchyma and communicate with the pelvisDiagnosis and treatment Clinical manifestation are fever,anorexia,anemia,loin mass,tendness in renal region and bladder irritating symptoms when pus goes down along the ureter into the bladder Pus disgorging from uret
7、eral orifice can be seen under cystoscopy when there is no obstruction in upper urinary tract IVU and isotope renogram suggest renal failure Nephrostomy or nephrectomy is neededChronic prostatitisEtiology Bacteria may retrograde into peripheral zone of the prostate when the posterior urethra become
8、infected Non bacterial prostatitis is often related to chlamydia and mycoplasma infection There exists a prostate-blood barrier,it is difficult to control the UTIPreprostatic sphincterPeripheral zoneExternal sphincterTransitional zonetrigonedetrusorurethraAFMSCentral zoneverumontamun Symptoms Irrita
9、ting symptoms Dysuria Pain in perineum,loin,testis etc.Sexual disorder:premature ejaculation,ED Fever,chill:unusual Neuropsychiatric symptoms Diagnosis DRE:a soft and enlarged gland with mild tendness may be felt when prostate is congested Prostatic fluid exam:wbc 10 under high power microscope Pros
10、tatic fluid culture Hypoechoic lesion may be seen on TRUSTreatment Administer sensitive antibiotics Prostatic massage every week Physical treatment Regular sexuality,abandon alcohol Etiology Its often complicated with prostatitis,long time catherterization and postoperation of TURP,because pathogen
11、can pass through orifice of ejaculatory duct and result in infection When urine flows retrograde into ejaculatory duct,a chemical epididymitis will occur When there is a repeated epididymitis in children,an ectopic ureteral orifice in seminal vesicle should be suspectedSymptoms and diagnosis Scrotum
12、 ache refers to spermatic cord A rapid epididymis or testis swelling High fever Typical history and symptomsTreatment Administer broad spectrum antibiotics Use 33%magnesium sulfate liquid to do wet drssing on scrotum Surgical drainage if abscess developedTB of the kidneyIntroduction Pathology pathol
13、ogical stage clinical stage caseationComplete destruction of the kidney by tuberculosisRenal TB.In the bottom right corner of the picture is a granuloma.Clinical features Frequency dysuria Hematuria or pyuria Mass Systemic symptomsDiagnosis History and clinical features Urine exam Cystoscope X-ray P
14、CRAn advanced middle calyceal lesion,which is shown on retrograde pyelogramTB cause fibrosis of the calyceal stem,so that the area of the kidney that drains into the diseased calyceal system ceases to function and on urography gives the typical cut-off appearanceTreatment Medical regimen INH+RFP+EBT Surgical intervention focal cleaning partial nephrectomy nephrectomy ureterocystostomy sigmoid augmentation cystoplasty Surgical choiceCT scan shows the left kidney is almost destroyed by TBNephrectomy 谢谢谢谢谢谢谢谢中山一院泌尿外科中山一院泌尿外科中山一院泌尿外科中山一院泌尿外科
