泌尿系统肿瘤泌尿内科内科八年制英语教学课件.ppt

* * This is our hospital building and you are welcome. Urogenital Trauma Urogenital Trauma Renal Ureteral Injury Bladder Injury Urethral Injury Injuries of the external genitalia Three to 10% of trauma patients have GU involvement; 10-15% of trauma patients with abdominal injuries have GU involvement. Renal Injury Renal Injury Renal injuries constitute 45% of all GU injuries; Most renal injuries (80%) are minor and do not require surgical intervention; Renal trauma can happen in both blunt or penetrating trauma; Renal injuries are most commonly from motor vehicle accidents (MVAs); Renal Injury Scale Renal Injury Physical examination: Flank ecchymosis or mass indicates a retroperitoneal process but is not specific to renal injuries and rarely occurs acutely. The most important indicator of renal trauma is gross or microscopic hematuria. The absence of hematuria, although rare, does not exclude renal injury because it is absent in 5% of patients. Radiographic Staging IVP - double dose CT Scan - best method of staging - radiographic study of choice Ultrasound Angiography - used for suspected renovascular injury Renal Injury CT Staging for Renal Injury Right renal stab wound (Grade IV) Left renal laceration Management of Renal Injury Surgical Management for Renal Injury Ureteral Injury Ureteral Injury Ureteral injuries after external violence are rare, occurring in less than 4% of cases of penetrating trauma and less than 1% cases of blunt trauma. Ureteral injuries after external violence, unlike renal injuries, are difficult to detect with the usual array of diagnostic tools. Ureteral Injury Excretory urography demonstrating extravasation in the upper right ureter consequent to stab wound (Arrow) Surgical Management for Ureteral Injury Bladder Injury Bladder injuries classified into contusions, extraperitoneal and intraperitoneal ruptures ; Intraperitoneal (20%) Extraperitoneal (80%) Rupture A full bladder is more likely to become injured than an empty