泌尿男生殖系统感染泌尿男生殖系统感染

Genitalia and urinary tract infection of Genitalia and urinary tract infection of malemale

一、分类一、分类 (Classification)(Classification)

一、一、非特异感染非特异感染

the most common bacillus:Gthe most common bacillus:G--

大肠杆菌（大肠杆菌（ 60-80%60-80% ），副大肠杆菌，变形杆），副大肠杆菌，变形杆菌，克雷白菌菌，克雷白菌

GG++ : : 金黄色葡萄球菌，表皮葡萄球菌，链球菌，金黄色葡萄球菌，表皮葡萄球菌，链球菌，粪链球菌粪链球菌

二、二、特异性感染特异性感染

tuberculosistuberculosis ，， gonococcusgonococcus

二、发病机制（二、发病机制（ mechanismmechanism ））

一、感染因素一、感染因素（（ infection factor)infection factor)细菌黏附于尿路黏膜细菌黏附于尿路黏膜（（ Bacterial adhesin Bacterial adhesin ））输尿管蠕动减弱输尿管蠕动减弱（ （ squirm of urethral squirm of urethral ））

二、宿主防御机制二、宿主防御机制（（ resist power of hostresist power of host ））PHPHOsmosisOsmosisHigh concentration of ureaHigh concentration of ureaorganic acidorganic acid immunoreaction(IgA,IgG)immunoreaction(IgA,IgG)

三、诱发因素三、诱发因素

Reduce of immune power with humanReduce of immune power with human

Obstruction of urinary tract Obstruction of urinary tract

Hospital-acquired infection factorHospital-acquired infection factor

四、感染途径（四、感染途径（ routes of infectionroutes of infection ））

上行性感染上行性感染 (ascending route)(ascending route)

血行性感染血行性感染 (hematogenous route)(hematogenous route)

淋巴感染淋巴感染 (lymphatic route)(lymphatic route)

直接蔓延感染直接蔓延感染 (extend invade route)(extend invade route)

五、诊断（ 五、诊断（ diagnosisdiagnosis ））History History (pain,frequency,urgency,dysuria)(pain,frequency,urgency,dysuria)

Urine collectionUrine collection

suprapubic aspirationsuprapubic aspiration

urethral catheterizationurethral catheterization

segmented voided urine specimenssegmented voided urine specimens

Urinalysis Urinalysis ：≥：≥ 101055,infection;<10,infection;<1044,polluti,pollutionon

Urine culture Urine culture

五、诊断（ 五、诊断（ diagnosisdiagnosis ））

LocalizationLocalization

kideny,prestate and urethrakideny,prestate and urethra

Imaging techniquesImaging techniques

Uroflowmetry Uroflowmetry

六、急性膀胱炎六、急性膀胱炎 (acute cystitis)(acute cystitis)

Incidence Incidence

25% to 30% of women between the ages 25% to 30% of women between the ages

of 20 and 40of 20 and 40

Ascending routeAscending route

Nosogenetic bacteria Nosogenetic bacteria

六、急性膀胱炎六、急性膀胱炎 (acute cystitis)(acute cystitis)

Clinical presentationClinical presentation

dysuriadysuria

frequencyfrequency

urgencyurgency

suprapubic or lower abdominal pain hematsuprapubic or lower abdominal pain hematuriauria

六、急性膀胱炎六、急性膀胱炎 (acute cystitis)(acute cystitis)

Diagnosis Diagnosis

1.History1.History

2.Laboratory examitation:urinary routine2.Laboratory examitation:urinary routine

3.Differential diagnosis3.Differential diagnosis

vaginitis vaginitis

urethral infectionurethral infection

六、急性膀胱炎六、急性膀胱炎 (acute cystitis)(acute cystitis)

Management Management

Antimicrobial selectionAntimicrobial selection

Intake with large volume waterIntake with large volume water

七、慢性前列腺炎七、慢性前列腺炎 (chronic prostatitis)(chronic prostatitis)

ClassificationClassification

acute bacterial prostatitis acute bacterial prostatitis

chronic bacterial prostatitischronic bacterial prostatitis

nonbacterial prostatitis nonbacterial prostatitis

prostatodyniaprostatodynia

七、慢性前列腺炎七、慢性前列腺炎 (chronic prostatitis)(chronic prostatitis)

Etiology and pathogenesisEtiology and pathogenesis

1.ascending urethral infection or reflux of 1.ascending urethral infection or reflux of

urine into proststic ducturine into proststic duct

2.gram-negative bacteria2.gram-negative bacteria

3. NBP3. NBP

4.prostatodynia4.prostatodynia

七、慢性前列腺炎七、慢性前列腺炎 (chronic prostatitis)(chronic prostatitis)

Clinical presentation Clinical presentation

1.Irritative symptoms1.Irritative symptoms

2.Pain (vesical,prostate,penile,testis)2.Pain (vesical,prostate,penile,testis)

3.Erectile dysfunction3.Erectile dysfunction

4.strain4.strain

七、慢性前列腺炎七、慢性前列腺炎 (chronic prostatitis)(chronic prostatitis)

Diagnosis Diagnosis

1.Clinical presentation1.Clinical presentation

2.Rectal examination 2.Rectal examination

3.Ultrsound 3.Ultrsound

4.Examination of the expressed prostatic 4.Examination of the expressed prostatic

secretions(EPS) and bacteriologic cultusecretions(EPS) and bacteriologic cultu

rere

七、慢性前列腺炎七、慢性前列腺炎 (chronic prostatitis)(chronic prostatitis)

Treatment Treatment

1.Antibiology treatment1.Antibiology treatment

2.α-receipt blockage 2.α-receipt blockage

3.Prostatic expressate3.Prostatic expressate

4.Fine health habit 4.Fine health habit

八、肾结核八、肾结核 (Tuberculosis of the kindey)(Tuberculosis of the kindey)

EpidemiologyEpidemiology

age:20-40 years ,male/female=2/1age:20-40 years ,male/female=2/1

PathologyPathology

Infected routeInfected route

八、肾结核八、肾结核 (Tuberculosis of the kindey)(Tuberculosis of the kindey)

DiagnosisDiagnosis

1.History1.History

2.Clinical presents2.Clinical presents

Increasing painless fequency of micturitionIncreasing painless fequency of micturition

hematuria hematuria

renal pain and massrenal pain and mass

3.Lab test (urine,blood,tuberculin test)3.Lab test (urine,blood,tuberculin test)

4.Radiography4.Radiography

八、肾结核八、肾结核 (Tuberculosis of the kindey)(Tuberculosis of the kindey)

Management Management

1.Antituberculosis drugs1.Antituberculosis drugs

earlyearly ，， uniteunite ，， appropriateappropriate ，， rulerule ，， integrityintegrity

2.Sugery 2.Sugery

nephrectomynephrectomy

partial nephrectomy partial nephrectomy

reconstructive surgeryreconstructive surgery

尿 石 症尿 石 症

Urinary lithiasisUrinary lithiasis

一、概述一、概述

1. 1. 流行病学流行病学 (Epidemiologic Aspects): 1-5 %(Epidemiologic Aspects): 1-5 %

HeredityHeredity Age and sex:20-50 years ,male:female=3/1Age and sex:20-50 years ,male:female=3/1 Geography:tropical and subtropicalGeography:tropical and subtropical Climatic and Seasonal FactorsClimatic and Seasonal Factors Water Intake :intake low Water Intake :intake low Medicine:steroid,vitamin, sulfanilamideMedicine:steroid,vitamin, sulfanilamide OccupationOccupation

一、概述一、概述

2. 2. 结石成分结石成分

草酸盐结石草酸盐结石（（ CaCCaC22OO44.H.H22O, CaCO, CaC22OO44.H.H22O)O)

磷酸盐结石 磷酸盐结石 (Hydroxylapatite)(Hydroxylapatite)

尿酸和尿酸盐 尿酸和尿酸盐 (Uric acid,C(Uric acid,C55HH44NN44OO33))

胱氨酸 胱氨酸 (Cystin,C(Cystin,C66HH1212NN22OO44SS22))

黄嘌呤 黄嘌呤 (Xanthin,C(Xanthin,C55HH44NN44OO22))

一、概述一、概述

3.3. 病理病理 (Pathophysiology of stone formation)(Pathophysiology of stone formation) 肾小管病变肾小管病变 基质的产生基质的产生 肾钙斑形成肾钙斑形成 局部机械性损害局部机械性损害 尿路梗阻尿路梗阻 感染感染 结石合并息肉或恶性肿瘤结石合并息肉或恶性肿瘤

二、肾结石二、肾结石 (Kidney Stones)(Kidney Stones)

1. 1. 临床表现临床表现 (Clinical Presentation)(Clinical Presentation) painpain hematuriahematuria

2. 2. 诊断诊断 (Diagnosis)(Diagnosis) HistoryHistory Lab examination(urinary routine)Lab examination(urinary routine) Uroradiology (B-us,KUB,IVU,RP,CT)Uroradiology (B-us,KUB,IVU,RP,CT)

二、肾结石二、肾结石 (Kidney Stones)(Kidney Stones)

3. 3. 治疗治疗 (Treatment):pathogeny and stone(Treatment):pathogeny and stone

非手术治疗非手术治疗 (Medical Treatment)(Medical Treatment)

体外冲击波碎石术体外冲击波碎石术

(Extracorporeal shock wave lithotripsy ES(Extracorporeal shock wave lithotripsy ES

WL)WL)

开放式手术开放式手术 (Operation)(Operation)

三、输尿管结石三、输尿管结石 (Ureter Calculi)(Ureter Calculi)

1. 1. 临床表现临床表现 (Clinical presentation)(Clinical presentation)

PainPain

hematuriahematuria

2. 2. 诊断诊断 (Diagnosis)(Diagnosis)

HistoryHistory

Lab examination(hematuria)Lab examination(hematuria)

Uroradiology (B-us,KUB,IVU,RP,CT)Uroradiology (B-us,KUB,IVU,RP,CT)

三、输尿管结石三、输尿管结石

3. 3. 治疗治疗 (Treatment)(Treatment)

保守治疗保守治疗 (Medical Treatment)(Medical Treatment)

体外冲击波碎石术体外冲击波碎石术 (Extracorporeal shock wave lithotripsy E(Extracorporeal shock wave lithotripsy E

SWL)SWL)

输尿管镜取石术输尿管镜取石术 (Removal of large ureteral calculi with ure(Removal of large ureteral calculi with ure

teroscopic)teroscopic)

输尿管切开取石术输尿管切开取石术 (Ureterolithotomy)(Ureterolithotomy)

四、膀胱结石四、膀胱结石 (Vesical Calculi)(Vesical Calculi)

1. 1. 临床表现临床表现 (Clinical presentation)(Clinical presentation) intermittent micturateintermittent micturate painful voiding with terminal hematuriapainful voiding with terminal hematuria suprapubic painsuprapubic pain

2. 2. 诊断诊断 (Diagnosis)(Diagnosis)

HistoryHistory

Lab examinationLab examination Uroradiology(B-us,KUB,IVU)Uroradiology(B-us,KUB,IVU) Cystoscopy Cystoscopy

四、膀胱结石四、膀胱结石 (Vesical Calculi)(Vesical Calculi)

3. 3. 治疗治疗 (Treatment)(Treatment)

经尿道取石术经尿道取石术 (Trans-urethra crush stone)(Trans-urethra crush stone)

体外冲击波碎石术体外冲击波碎石术 (Extracorporeal shock (Extracorporeal shock

wave lithotripsy ESWL)wave lithotripsy ESWL)

开放式手术开放式手术 (operation):diameter>4cm(operation):diameter>4cm

谢 谢