外科学 泌尿系统损伤.ppt

医学课件 医学课件 Straddle fractures” involving all four pubic rami open fractures, and fractures resulting in both vertical and rotational pelvic instability are associated with the highest risk of urologic injury 医学课件 Urethral disruption is heralded by the triad of blood at the meatus, inability to urinate, and palpably full bladder urethral catheter cannot be placed; misplaced into pelvic hematoma. impalpable prostate Urethrography 医学课件 Suprapubic Cystostomy Primary Realignment Delayed Reconstruction: At 3 months, scar tissue at the urethral disruption site is stable enough to allow posterior urethroplasty to be undertaken safely, provided that associated injuries are stabilized and the patient is ambulatory 医学课件 医学课件 医学课件 医学课件 The majority occur after straddle injury and involve the bulbar urethra In 20% of the cases of rupture of corpora cavernosa, the urethra is involved 医学课件 医学课件 Penis (Fracture, Gunshots and Penetrating Injuries, Animal and Human Bites, Amputation ) Testis Genital Skin Loss 医学课件 The diagnosis of penile fracture is often straightforward and can be made reliably by history and physical examination alone Early exploration and repair of testis injury is associated with increased testis salvage, reduced convalescence and disability, faster return to normal activities, and preservation of fertility and hormonal function Testis salvage rates exceed 90% with exploration and repair within 3 days of injury, versus orchiectomy rates threefold to eightfold higher with conservative management and delayed surgery 医学课件 医学课件 * * * 医学课件 医学课件 Iatrogenic Injury External Trauma 医学课件 Anatomy Iatrogenic Renal Injury External Renal Injuries Spontaneous Retroperitoneal Hemorrhage 医学课件 Blunt renal injuries most often come from motor vehicle accidents, falls from heights, and assaults. Penetrating renal injuries most often come from gunshot and stab wounds. Percutaneous Renal Procedures 医学课件 医学课件 Hematuria is the best indicator of traumatic urinary system in