1、Injuries to the urinary tractChen WeiAssociate Prof.Department of UrologyThe First Affiliated HospitalSUMSIntroduction?UTI often occursinmaleurethra?Urinary system areanatomicallylocated inadeepconcealed places?when thechest,abdomen,flankorback,pelvishavebeenconfronted with violent attack,theremaybe
2、concomitanturinary system trauma?whichwillneedfurther investigationtoestablish thediagnosisPathological 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 stageInju
3、ries to the kidneyPathogenesis and pathology?Renal damage can be classified into open andclosed injuries?Open injuries are often caused by a sharpinstrumentas a knifeor bullet,makingapenetrating wound in the chest or abdomen?Closed trauma are usually caused by a directviolent hit on abdomen,loin,or
4、an indirect forceby falling from a high place and landing on thefeet or buttocks.Classification(closed)?Contusion:ecchymosis,subcapsular hematoma?partial fissuresubcapsular hematoma,perirenal hematoma?complete fissureextravasation of blood,urine,gross hematuria andshock?laceration of renal vascular
5、pediclePerirenal hematoma,hematuria and operation to stop bleedingLate stage changes?urinoma?broad fibrosis in post-peritoneal space?hydronephrosis?renal hypertensionClinical manifestation?Shock?Hematuria?Pain?Mass?FeverDiagnosis?History and physical exam?Urine exam?X-ray exam,?KUB,IVU,CT?Ultrasound
6、 BTreatment?Observation?Indication for surgeryintractable shockprogressing gross hematuria and anemiaenlarging abdonimal or loin massaccompanying intra-abdominal or pulmonary damage?Selective renal artery embolization?Open surgery:repair,partial nephrectomy,nephrectomyInjury to the bladderPathogenes
7、is and pathology?Open injuryvesicorectal or vesicovaginal fistula?Closed injurycontusion:hemorrhage or hematuriavesical rupture:urine extravasationextraperitonealintraperitonealextraperitoneal rupture intraperitoneal ruptureClinical features?ShockHematuriaDysuriaPainFeverPeritonitisDiagnosis?Clinica
8、l features?Plain film,IVU and cystogram?Catheterization and instillation testTreatment?Extraperitoneal rupturecatheterization or cystostomy?IntraperitonealSurgical repairInjury to the urethraEtiology?open injurypenetrating wound in scrotum,penis or perineum?closed injuryfall-astride injuries bulbous
9、 urethrapelvic fracture damages membranous urathra?instrumental injuriesPathologyType of injury?contusion:will resolve without sequelae?laceration:hematoma,extravasation,stricture?complete tear:hematoma,obstruction,retention,extravastion,urethral occlusionPathologic stage?Acute:2 days?inflammation:i
10、nfection,fistula?urethral stricture:23 weeksurinary retention,obstructive uropathyUrinary extravasation?Bulbous urethralimited by colles fascia,urine extravasate to perineum,scrotum,penis,then up to the abdominal wall?supramembranous urethraurine extravasate into periprostatic and perivesical tissue
11、s and retroperitoneal space,urogenital diaphram is lacerated:scrotum and perineumPosterior urethral damage and urine extravasationAnterior urethra damage and urine extravasationClinical features?Shock?dripping and hematuria?pain?dysuria and retention?hematoma?extravasationDiagnosis?physical exam?catheterization?plain x-ray film?urethrocystogramTreatment?treat shock?extravasation:surgical drainage?contusion:antibiotics,observation?simple laceration:catheterizationurethral stent for 2-3 weeksurethral dilatation?surgery:extensive laceration complete tearUrethral reunion operationThank you!
