泌尿系統(tǒng)疾病課件：泌尿系梗阻

1、 Urinary Tract ObstructionUrinary Tract ObstructionMedical TherapySurgical TherapyPerioperativeFollow-upPrognosisFutureBackgroundProblemEpidemiologyEtiologyPathophysiologyPresentationLaboratoryImagingHistology CystoscopyUreteroscopyPEUrinary Tract Obstruction Background common problem occur at any p

2、oint in the urinary tract develops secondary to- results in- urine stasis and thencalculus renal pelvis CaRCCUPJOstrictureligationtumor or papillanephroptosiscalculusextrinsic causesbladder tumorcalculuscalculusBPH or P Castricturestricturestricturereflux History Urinary Tract Obstruction urethral c

3、atheter-time of Hippocrates suprapubic cystostomy-the 16th century nephrostomy-open and percutaneous surgeryCompany LogoIn an autopsy series of 59,064 patients aged 0-80 years, the frequency was 3.1%In women, during age of 30-70 years Epidemiology Hydronephrosis In men, after age 60 years In childre

4、n, the frequency is 2-2.5%.occur anywhere from the kidneys to the urethral meatusextrinsic, from compressive or restrictive forceintrinsic, from a multitude of factors Etiology DifferencesmaleBPHUrethral stricturefemaleProlapsePregnancyMalignancychildUPJOUVJOUreteroceleMegaureter Etiology Pathophysi

5、ology Acute Urinary Tract Obstruction Increased intraluminal pressure Increased contractions of smooth muscle and ureteral wall pressure. As the duration of the obstruction lengthensSmooth muscle cells contract with less force Ureteral wall dilation increasesReflux of urinewhile obstructed Pathophys

6、iology Chronic Urinary Tract ObstructionLeads to permanent damage to urinary tract. Infravesical obstruction leads to changes in the bladder, ultimately, detrusor muscle decompensation. Leads to progressive back pressure on the ureters and kidneys and can cause hydroureter and hydronephrosis. Pathop

7、hysiology Chronic Urinary Tract ObstructionThe ureter dilated and tortured, then can not to adequately propel urine forward. Urinary stasis increases the risk of stone formation and infection. Leads to permanent damage to urinary tract.ureter dilated and tortured Company LogoVaries with the location

8、, duration, and degree of obstructionUpper urinary tract obstruction- painLower urinary tract obstruction-voiding dysfunction Presentation Company LogoUrinalysis BiochemicalComplete blood cell count Laboratory Ultrasonography initial study Imaging renal parenchymal masseshydronephrosisdistended blad

9、dercalculiprostateComputed tomography scananatomic detailcalculiright-sided hydronephrosis and an obstructing right ureteropelvic junction stonerenal pathologyIntravenous pyelographydelayed calyceal fillingdelayed contrast excretionprolonged nephrography resultsdilatation of the urinary tract proxim

10、al to the point of obstructionCT UrographyA combination CT scan and IVPAn excellent but expensive modalityRetrograde urethrographyA particularly useful in working up lower urinary tract traumaRetrograde pyelography Any ureteral or renal pelvis filling defects or abnormalitiesDoes not interfere with

11、renal functionIn patients with an IVP dye allergy Radionucleotide studiesdiureticrenogramSPECTMedicalHistoryOperationDisease OtherConsultation with a urologistImmediate attention: Complete urinary tract obstruction; In a solitary kidney; With fever or infection; Renal failure Medical Therapy Consult

12、ation with a urologist Initially, analgesics or prophylactic antibiotics Then, complete urologic evaluation And definitive management Medical Therapy Goal: completely relieve the obstruction Based on completely etiology solutionSurgical intervention is obtained once the point and the cause of obstru

13、ction is identified or palliativeoperationto preserve renal function Surgical Therapy Upper urinary tractsurgeryagainstetiology gets satisfactory effectbut sometimes its just impossible Completely surgeryUreteral stentNephrostomy tubeNephrectomy Surgical Therapy lower urinary tractsurgeryagainstetio

14、logy gets satisfactory effectbut sometimes its just impossible completely surgery (TURP)urethral cathetersuprapubic tube or catheter Surgical Therapy Intraoperative DetailsDifferent interventions can temporarily relieve the obstructionIf planned procedure cannot be performed safely or is not adequate other modes of urinary tract decompression can be tried Surgical Therapy Surgical Therapy fluid replacementelectrolyte replacementpost-obstructive diuresis Follow up after definitive treat