1泌尿系统损伤分析.ppt

Injuries to the genitourinary tract Yi lin Department of urology Tianjin medical university Anatomy Emergency diagnosis and management About 10% of all injuries in the emergency room are genitourinary injuries. The most common injuries is the urethra, the second is kidney, the third is bladder. Early diagnosis is essential to prevent serious complications. Emergency diagnosis and management The history should include a detailed description of the accident. In cases involve gunshot wounds, the type and caliber of the weapon etc. Fractures of the lower ribs are often associated with renal injuries. Pelvic fractures often accompany bladder and urethral injuries. Emergency diagnosis and management If possible, before the patient is moved. Plain films of the abdomen are very important . Lower rib fractures, vertebral body and transverse process fractures, and pelvic fractures may be associated with severe urinary tract injuries. Patients who do not have life-threatening injuries and whose blood pressure is stable can undergo more deliberate radiographic studies. This provides more definitive staging of the injury. Special examinations When genitourinary tract injury is suspected on the basis of the history and physical examination, additional studies are required to establish its extent. Special examinations A. catheterization and assessment of injury Catheterization Excretory urography Retrograde cystography Urethrography Arteriography Computed comography (CT) Special examinations B. cystoscopy and retrograde urography C. abdominal sonography Injuries of the kidney The kidney is well protected by heavy lumbar muscles, vertebral bodies, ribs, and the viscera anteriorly. Most injuries occur from automobile accidents or sporting mishaps. chiefly in men (age 20~40) and boys. Kidneys with existing pathologic conditions such as hydronephrosis or malignant tumors are more readily ruptured from mild trauma. Etiology Blunt trauma directly to the abdomen, flank, or b