injuries 尿路损伤课件

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1、UrethralinjuriesIntroductionUrologicalinjuriesoccurinapproximately10%ofpatientswhopresentfollowingbluntorpenetratingtraumaOfthese,anumberinvolvetheurethra:65%arecompleteand35%partialUrethralinjuriesbythemselvesareneverlife-threatening,except.Itisofnosurprisethatthehighestincidence

2、ofurethralinjuriesisinadultsaged15-25years.Urethralinjuriescanrangefromamildcontusionwithpreservationofepithelialcontinuity,toapartialtearoftheurethralepitheliumorafullurethraltransectionanddisruption.Theycanalsobeclassifiedbysiteintoanteriorurethralinjuriesandposteriorurethralinj

3、uries,whichisprobablythebestwaytoconsiderthem,sincebothsitesareexposedtodifferentmechanismsofinjury.AnatomyThemaleurethraisdividedintotheanteriorandposteriorsectionsbytheso-calledurogenitaldiaphragm.TheposteriorurethraconsistsoftheprostaticandthemembranousurethraThelatterisenclose

4、dintheurogenitaldiaphragm.Itextendsfromthebladdernecktothedistalsphinctermechanismforalengthof3cm.Theanteriorurethraconsistsofthebulbarandpenileurethraandisa15cmcanalextendingfromtheendofthemembranousurethratotheexternalmeatus.Thebladder-necksphincterisfunctionalfromtheinternalmea

5、tusdountotheleveloftheverumontanum,inmalesitisreliablycomptent,provideditisnotsurgicallydamagedorrenderedincompetentbyunstabledetrusorcontractions.Thedistalsphinctermechanismisabout2.5cmlong,butitisonly3-4mmthick;itformsthewholethicknessofthemembranousurethraandextendsupwards,thro

6、ughtheapicalprostaticcapsule,totheverumontanum.Thecompetenceofthisdistalurethralmechanismis,infact,entirelydependentonthesphinctermuscleswithinthe3-4mm.AnteriorurethralinjuriesStraddleinjuryPosteriorurethralinjuriesUnfortunately,thetermposteriorurethralstricture’isstillwidelyusedt

7、oincludesimplesphincterstrictures,subprostatecpelvicfractureurethraldistractiondefects,andstricturesfollowingradicalprostatectomy.Thisisconfusingbecausetheyandtheprinciplesoftheirsurgicalresolutionareentirelydifferent.UrethralinjuriesassociatedwithpelvicfracturesPelvicfracturesare

8、commonlycausedbyroadtrafficaccide