Zvizhinji zvezvi zvinosanganisa varume chete
Urology ndiyo inyanzvi yezvokurapa iyo inobata nerutivi rwekuvhenekera kune varume nevakadzi uye nehurume hwekubereka huri varume. Zvinetso zvakawanda zvehuroyi hazvisingaperi, zvakadai sebenign prostatic hypertrophy uye urinary incontinence , uye inogona kuongororwa neurorosi muchechi. Zvisinei, zvimwe zvinetso zvehuroyi zvinowanzoitika uye dzinoda kurapwa kwechimbichimbi kunovimbisa hutano huchauya.
Kunyange zvazvo urology inonzi inoshandiswa pakuvhiya, zvinetso zvakawanda zvehuroyi-kusanganisira zvirwere zvinokurumidza-zvinoshandisa masangano akasiyana ehumba. Nokudaro, urologist inofanira kuva neruzivo rwekurapa kwemukati, gynecology, chirwere chepfungwa, chirwere chepfungwa, nezvimwe kunyanya kubata zvirwere zvehutano. Uyezve, urologists, sevanyori vose, vanowanzotaurirana nemamwe marudzi echiremba kuti vakwanise kutarisira.
Maererano neAmerica Urological Association, kune huro huno urology subspecialties:
- vanachiremba urology
- renal (kidyo) kupemha
- calculi (kidney stones)
- murume asina simba
- mukadzi urology (funga urinary incontinence)
- neurourology (fungidzira zvinokonzera voiding uye erectile dysfunction)
- urologic oncology (kanzira)
Hezvino nhanhatu dzenguva dzekusaziva dzinofanirwa kuziva iwe. Kuva akakwanisa kuziva zviratidzo zvavo uye zviratidzo zvichaita kuti mushonga unokurumidza uye unoshanda. Zvizhinji zvezviitiko izvi zvinobaya varume; zvisinei, vamwe vanobata varume nevakadzi.
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PriapismJokes dzakagadzirwa pamusoro pekugumburwa dzinotenda kutenda kwakanyanya kwechiitiko ichi. Priapism inorondedzerwa semusangano unopedza maawa anopfuura mana, izvo zvisina chokuita nekukurudzira zvepabonde. Uyezve, kunamata hakugoni kuregererwa nejeri.
Chimiro chakajairika chakanyanya kuderera kana ischemic priapism. Nechipasimusi, miviri ye cavernosal, iyo inobatanidza shaft yepenis, inogadzika apo ganda kana kuti chidimbu chiri chikafu. Uyezve, chirume chinonyatsonaka, izvo zvikonzero zvakakwana zvevarume vakawanda kutsvaga kurapwa kwekurumidza.
Priapism inowanzokonzerwa nekudzivirira kwemafuro ekubuda; iyo inongova chikwata chemapirini chepenisi.
Inenge 25 kubva muzana yemhosva dzekugadziriswa dzinofanirwa nehanle cell cell, kenza yemastrose kana leukemia. Kushandisa zvinodhaka zvisina kufanira, zvakadai secocaine, MDMA (ecstasy), methamphetamine (crystal meth), uye marijuana, inogonawo kutungamirira kukunda. Kuwedzeresa, kunamata kunogona kuva nengozi yakaipa yekurapa mishonga seyakadai se calcium-channel blockers, antipsychotics uye warfarin (ropa rakaonda).
Kusimudzika kuderera muhutano hwemvura kunogona kuunza zvinotevera:
- Edema (kuzvimba)
- Hypoxia
- Acidosis
- Fibrosis
- Kutadza
- Necrosis (rufu rwemhuka)
Kana ikasatenderwa, priapism inogona kuparadza basa rekuita zvepabonde mune ramangwana. Saka, kurapa nokukurumidzira kunokosha. Kana nguva yakareba iyo inopera isingateereri, inowedzera dambudziko rekugara kwepenile kusagadzikana. Chinangwa chekurapa kubuda, kana kuderedza penile kuzvimba.
Penile ropa gases rinogona kuswededzwa kugadzirisa kuongororwa kwepasapism. Pakutanga, kunyoresa kunogona kurapwa nemuromo wemishonga pseudoephedrine (a sympathomimetic) kana baclofen (musingazorodza). Kazhinji, mishonga iyi yemuromo haishandisi zvose zvakanyatsonaka saka nhare yakakura (18-gauge) neta inopindirwa mune imwe nhengo kana kuti shaft yepenisi uye ropa rinoshuva kana kubviswa. Phenylephrine inoshandiswa mujeni.
Pseudoephedrine, iyo inoita kuti unzwirwe tsitsi, inoshandiswa kurapa priapism nokuti zvinogadziriswa zvinopindirana nepasasympathetic input. Pseudoephedrine counters idzi zvinokonzera kuparadza. Nenzira, ejaculation inopindirana nehukama hwekunzwira tsitsi. (Vadzidzi vezvokurapa vanoyeuka kusiyana uku kuburikidza vachishandisa "mnemonic" uye "kupfura").
Mumatambudziko akakura ekugadzirisa, chirwere chinoputika chinogona kuiswa.
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Testicular TorsionKusiyana nezvimwe zvingave zvaunotenda iwe, masheti haagoni kushandura nzvimbo. Zvisinei, tambo yepermatic, iyo inopa ropa ku epididymis uye testis, inogona kushanduka.
Testicular torsion inowanzokonzera vana nevechiri kuyaruka asi inogona kuitika chero ipi zvayo. Testicular torsion ishoma kune varume vane makore makumi matatu nevekare.
Zvimwe zvinokonzera njodzi ye testicular torsion zvinosanganisira maronda asina kufungidzirwa uye matumbo e testicular.
Vakomana kana varume vane ruzivo rwekupupurira vanoona kushungurudzika kwakanyanya pakarepo pakutevedzerwa nekuputika kwechinyorwa. Nausea uye kurutsira pamwe chete nemarwadzo. Uyezve, vakomana nevarume vanouya nehupupuriro hwepupuriro vanowanzova nenhoroondo yekutambudzika kwakadaro kutevedzerwa nekudzokororazve nyaya yacho pachayo.
Zvose izvi nhoroondo yekliniki uye kuongorora kwemuviri ndizvo zvinokosha pakutsvaga testicular torsion. Ultrasound inotsigira kuongororwa, asi kana kuongororwa ne ultrasound hakuwanikwi, kutsvaga kutsvakurudza kunotsvaga kunokosha. Mukuwedzera pakusimbisa kuongororwa, ultrasound inogonawo kubvisa zvakaipa, izvo zvingave zvichikonzera testicular torsion.
Sezvo nekunyepedzera, nguva ndeyezvakakosha. Kana kuvhiyiwa kuchiitwa mukati maawa matanhatu ekutanga, mukana wekuponesa testis ndeye 80 muzana. Kana maawa anopfuura 12 apfuura, kubudirira kwehutano hwekuvhiya inodonha kusvika pasi pe20 muzana.
Kuvhiya kunosanganisira kuvhiringidza kana kusanzwisisika kwechinyorwa. Nguva yakakwana inopiwa kuti uone kana kupararira kune testis kuchidzoka, uye ichi revascularization inopupurirwa neDoppler ultrasound. Munyaya ye necrosis ye testis, orchiectomy, kana kubviswa kwechinyorwa, inoitwa.
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Acute Urinary RetentionKunyatsodzivirira urinary (AUR) inowanzoitika kune varume vane benign prostatic hypertrophy (BPH) kana kuwedzera kweprostate. Yeuka kuti prostate inopoteredza urethra, uye kuwedzera kwayo kunovhara kukwira kwemuti.
Kunyange zvazvo yakawanda inowanikwa mune varume neBPH, AUR inogona kuitika semagumisiro ezvimwe zvinhu zvakasiyana-siyana zvinoita kuti chivharo chekuvhara chisina kuvhara kusanganisira zvinotevera:
- Diabetes neuropathy
- Chirwere chePalinson
- Multiple sclerosis
- Mishonga yakafanana neopiates uye anticholinergics
- Ropa rinovhara chikamu kune hematuria
AUR inowanzoitika mune chirwere chepachirwere kana chipatara apo varwere vari kutora mishonga inoderedza bladder kubvisa uye ine simba rakakwana rokubuda panhovo uye kufamba-famba. Uyezve, kuvhiringidzika, iyo yakajairikawo muzvirongwa zvechipatara, kunogona kuita kuti urinary retention iwedzere.
Kazhinji, AUR chirwere chinorwadza. Zvisinei, mune vamwe vanhu vane kudzvinyirira kusingaperi kwechirwere, izvi zvinogona kunge zvisingarwadzi. Kana isina kusiyiwa, AUR inogona kupfuurira pakufashukira kushaya chimiro, uyezve, mushure memazuva mashomanana, kushaya simba rekushaya simba. Nokudaro, AUR inofanira kurapwa nokukurumidza kuti ibvise marwadzo uye kudzivirira matambudziko.
Kukundikana kwakanyanya kwekushaya renal kunotanga kurapwa nekuiswa kwe catheter yerereth kukonzera urini. Muvarume vane BPH, catheter yakakomberedzwa inoshandiswa nokuti prostatic urethra yakagadzirirwa paakona. Kana kuve kwekuvhenekera kuripo, unyanzvi urologist unoda kubvisa AUR uchishandisa cystoscopy, urethral dilators uye nezvimwe zvakadaro.
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Fournier's GangreneFournier's gangrene is rare. Icho chinonzi necrotizing fasciitis ("nyama-kudya" chirwere) chinokanganisa mazamu ehurume uye perineum, kana kuti chidimbu chedzimba pakati pezvinyorwa uye anus.
Sezvo necrotizing fasciitis chero ipi zvayo, utachiona hudya kuburikidza nemhando dzakapfava. Nechinetso chechina chaSinenier, utachiona huno hunoita dartos, Scarpa's uye Colles 'fascias.
Fournier's gangrene inokurumidza kukurumidza, uye kana kurapwa kunonoka, zvinhu zvakaipa zvinoitika.
Pano pane zvimwe zvinokonzera ngozi zvinobatsira pakukudzirwa kwechikwata cha Fournier:
- Zvinotambudza perineum hygiene
- Chirwere cheshuga
- HIV / AIDS
- Urethral strictures
- Perirectal abscess
- Cancer
Kuvharirwa neine Fournier's gangrene yakanaka chaizvo uye inosanganisira zviratidzo nezviratidzo zvinotevera:
- Kutambura kunorwadza
- Perineal pain
- Fever
- Cellulitis
- Induring
- Eschars
- Necrosis
- Crepitus (kupamba pasi peganda)
Nyaya ine chikwata cha Fournier, kurwadziwa kunorondedzerwa nemurwere kazhinji hakubvi maererano nekuongorora mumuviri.
Fournier's gangrene inobatwa nekubvisa kana kukanganiswa kwevakafa kana necrotic tissue pamwe nekushandiswa kwema antibiotic akawanda. Kazhinji, zvinopfuura kuvhiya mumwechete zvinodiwa, uye kamwe chete zvisikwa zvose zvakafa zvabviswa, kuvhiyaniswa kunoitwa kunoitwa. Mune mamwe mazwi, kubudirira kurapwa kwevana vaSinnier chirwere chakareba.
Nemhaka yokuti ma testes ane ropa ravo rakasiyana, vanogona kuponeswa kune vanhu vane chirwere cha Fournier. Aya ma testes anogona kuiswa mu "chikwama chehudyu" munguva yekudzikinura kuitira kuti uwedzere hutungamiri.
Kuchengetwa kwemavara kwakakodzera uye kuchinja kwekugadzika kazhinji kunokosha panguva yekudzikinura. Uyezve, varume vane chirwere cheshuga vanofanira kuva nemazinga avo eglucose anodzorwa uye vagowana kudya kwakakwana kunoita kuti kuporesa vakuvadzwa.
Kutsvakurudza kunoratidza kuti kufa kwehuwandu hwemakumbo aNenier huri pakati pe20 ne40 muzana.
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ParaphimosisParaphimosis inowanikwa mune varume vasina kudzingiswa uye saka vane cheputi. Kazhinji, ichi chiitiko chinowanikwa mune varume vari kureva nhema vachikwira mumubhedha kwenguva yakareba sepachipatara. Mune chinzvimbo ichi, chipfeko chinowanzochera uye edema kana kuvhara kunounganidza mupenis, uye kurwadziwa kwepenile kunoitika. Muvanhu vakashandurwa kuziva, kurwadziwa uku kunogona kuitika zvisingaonekwi kwechinguva kusvikira nguva isati yanyanyisa uye peni inowedzera necrotic kuderedza kuwedzerwa kweropa kunzvimbo (ischemia).
Kurapa kweparaphimosis kunosanganisira kuderedza manyore ezvinyorwa, zvichiita kuti zvidzoke mumamiriro ayo akakodzera. Iyi nzira inorwadza zvikuru asi inobatsira pakurapa kwakakodzera. Nemhaka yokuti kuderedzwa uku kwakanyanya kunorwadza, mishonga inorwadza, penile blocks, uye kunyange sedation inogona kudiwa.
Kufanana nedzimwe mamiriro ezvinhu anotsanangurwa munyaya ino, paraphimosis ndeyechokwadi yehutano inokurumidza inoda kurapwa nokukurumidza kusati kwakuparadzwa zvachose.
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Emphysematous PyelonephritisPyelonephritis urwere hwekuvhenekera hwetsvo. Apo utachiona uhwu hunokonzerwa nebhakitiriya rinobudisa gasi, inonzi emphysematous pyelonephritis . Emphysematous pyelonephritis inowanzoitika kuvanhu vane chirwere cheshuga uye kazhinji inokonzerwa naEli. Iyi utachiona inogona kupararira zvehutano uye inokonzera sepsis, iyo inopisa upenyu. Zvose mune zvose, emphysematous pyelonephritis inotyisa.
Vanhu vane emphysematous pyelonephritis vanogona kutarisira kurapwa nemishonga inorwisa mabhakitiriya uye kutarisira kunovatsigira. Kuwedzerwa kurapwa kwepelelonephritis kunobva pakuti kureba kwetachiona kwakapararira sei mukati mehvo. Kana hutachiona huripo pane parenchyma, mushonga unogadzirisa unogona kushanda. Izvi zvinoshandiswa kurapwa zvinosanganisira kuiswa kweephrostomy tube kuti ibvise pus-filled material. Kana hutachiona hwehvo huri kupararira uye sepsis huripowo, kubviswa kushandiswa kwemafuta (nephrectomy) inogona kudiwa.
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MhedzisoNenzira yakanaka, dzakawanda zvezviitiko izvi zvinotyisa zvinowanzoitika zvisingaiti. Kunyange zvakadaro, mamiriro aya ose uye zvirwere zvinongoerekana zvaitika uye dzinoda kurapwa nokukurumidza. Kana iwe kana munhu waunoda achifungidzira chimwe chezvinetso izvi, tapota taura nemabasa ekukurumidza uye chiremba wako pakarepo. Nezvose izvi, nguva ndeyomusiyo uye kukurumidza kurapwa kwakakosha kunobatsira kudzivirira kukwana kweramangwana kana rufu.
Pamusoro pekupedzisira, sezvakambotaurwa, huzhinji hwemamiriro aya hunobata varume. Kunyange zvakadaro, kugadziriswa kwekuvhota kwakanyanya kunogona kukanganisawo vakadzi, uye pyelonephritis inowanzokonzera vakadzi vechidiki vechidiki.
Kunyange kana iwe uchifungidzira kuti unogona kunge uine chimwe chezviitiko izvi uye zvinoitika kuti iwe hausi, inogara iri pfungwa yakanaka yekutevera nechiremba pamusoro pezviratidzo zvakakonzera zvinetso zvako pakutanga. Iwe unogonawo kukumbira kutumira kune urologist kune zvinetso zvese zvaungave nazvo pamusoro pehutano hwako rwekuvhenekera uye zvepabonde. Ndapota yeuka kuti chiremba wako aripo kuti akubatsire kuwana hutano hwaunoda uye unoda.
Sources:
Chamie K, Rochelle J, Shuch B, Belldegrun AS. Urology. Mu: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Schwartz's Principles of Surgery, 10e . New York, NY: McGraw-Hill; 2014.
Heidenreich J. Chitsauko 39. Genitourinary Emergencies. Mu: Stone C, Humphries RL. eds. CURRENT Diagnosis & Treatment Emergency Medicine, 7e . New York, NY: McGraw-Hill; 2011.
"Necrotizing Fasciitis: Dare Darease Inonyanya Kurapa" kubva kuCDC: http://www.cdc.gov/features/necrotizingfasciitis/
Sorenson MD, uye al. "Fournier's Gangrene: Population Based Epidemiology uye Zvibereko." Journal of Urology 2009.