外科-泌尿系统损害PPT.ppt

Injuries to the urethra Urethral injuries are uncommon, occur most often in male, usually associated with pelvic fractures or straddle-type falls, they are rare in female straddle-type falls: 骑跨伤 Urethra Posterior urethra 1. Prostatic urethra 2. Membranous urethra ? Anterior urethra 3. bulbous urethra ? 4. Pendulous urethra ? ? ? ? Injuries to the Anterior Urethra Anatomy The anterior urethra is the portion distal to the urogenital diaphragm Etiology Straddle injury may cause laceration or contusion of the urethra iatrogenic instrumentation may cause partial disruption iatrogenic:医原性的 Straddle-type fall Pathology Extravasation Symptoms history of a straddle fall Bleeding from the urethra Local pain into the perineum and sometimes massive perineal hematoma Dysuria, Sudden swelling in the area when voiding with extravasation Sepsis and severe infection may present if diagnosis has been delayed Signs Tenderness mass in perineum Swollen and discolored of local skin Signs DRE reveals a normal prostate DRE: digital rectal examination X-ray Urethrogram X-ray Urethrogram ruptured bulbar urethra following straddle injury, extravasation on urethrogram Treatment Major blood lost usually does not occur from straddle injury If heavy bleeding does occur, local pressure for control bleeding, followed by resuscitation is required Urethral contusion Urethra remains intact Without pain and bleeding, no additional treatment is necessary If bleeding persists, urethral catheter drainage for 1 week Prevent infection: antibiotics Injuries to Urinary System Urinary System Kidney Ureter Bladder Urethra Ur Injuries to urinary system About 10% of all injuries in the emergency room involve the genitourinary system Many of them are difficult to define Early diagnosis is essential to prevent serious complications Injuries to urinary system Basic Pathological change Shock Urinary extravasation Urinary obstruction (destruction) Injuries to th