外科-泌尿系统损害.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 Urethral laceration ? Instrumentation of the urethra following urethrography should be Avoided ? Drainage the extravasation areas ? Immediate repair of urethral laceration through perineum ? Antibiotics for preventing infection Injuries to Urinary System Ur