泌尿生殖系外伤GENITOURINARY TRAUMA.pptVIP

GENITOURINARY TRAUMA kidney Mechanisms of Injury 1.Blunt renal trauma accidents, falls, crush 2.Penetrating trauma gunshot, stab kidney Classification of Injury 1.Simple laceration 2.Subcapsular hematoma 3.Renal contusion 4.Renal rupture 5.Laceration of renal artery and vein 6.Perirenal hematoma 7.Laceration through collecting system kidney Diagnosis 1.History 2.Presentation Shock, hematuria, pain 3.Physical examination Mass kidney Diagnosis 4.Urinalysis gross hematuria,microscopic hematuria The degree of hematuria may not predict the severity of renal injury. 5.X-ray examination KUB Intravenous pyelogram (IVU) Arteriography kidney Diagnosis 6. Computed tomography(CT) 7. Ultrasonography 8. Radionuclide scans kidney Treatment 1.Observation Blood pressure,pulse,breathe,urine, hemachrome keep the bed 3-4 weeks kidney Treatment 2. Renal exploration Indication: Uncontrolled bleeding Renovascular injury Nonviable parenchyma Major urinary extravasation Ureter Causes 1. Injury 2. Surgery 3. Endoscopy 4. Radiolgy therapy Ureter Presentation: History Urine leak Infection Aurina Hematuria Obstruction Ureter Diagnosis History Intravenous pyelogram (IVU) Retrograde pyelogram Ureter Treatment One-stage repair during the initial evaluation of a trauma External drainage for 3 months if injury above 24h. Bladder Classification and Mechanism of Injury 1.Causes Blunt trauma, penetrating trauma Endoscopy 2.Site Extraperitoneal Rupture Intrapritoneal Rupture Combined Rupture Bladder Diagnosis History Catheterization examination Cystography Bladder Treatment Intrapritoneal Rupture Surgical exploration and repair Extraperitoneal Rupture Surgical exploration and repair or Catheterization 3. Anti-infection Urethra Causes Endo-urethra injury endosocopy Exterior-urethra injury pelvis-fracture Urethra Site Posterior urethra prostatic and membranous injuries above or including the uro