Genitourinary Tract Injuries

Signs & symptoms

泌尿生殖系统损伤的症状因损伤部位的不同而不同. However, some common symptoms may include:

• 血尿，尿中有血的一种情况
• Inability to urinate
• Lower rib fractures
• Fractures to the pelvic bone
• 疼痛和/或擦伤涉及人的侧面，腹股沟或阴囊

Diagnosis

许多泌尿生殖系统的损伤都很微妙，很难诊断. Therefore, an early diagnosis and great diagnostic expertise are essential to prevent serious complications.

Your doctor will begin by taking a detailed medical history to determine whether you experienced any events, such as an accident or fall, 这可能伤害了你的泌尿生殖系统. A physical examination will then be performed to check for any symptoms associated with injuries to the genitourinary tract.

If injuries are suspected, the following tests may be recommended to make a definite diagnosis:

• Catheterization. 导尿管是放置在膀胱里的管子，用来排出尿液. Catheterization will not be performed if there is blood at the opening of the urethra, a sign of injury to the urethra.
• Abdominal computed tomography (CT). A computed tomography (CT) scan uses X-rays to produce detailed pictures of the body's internal structures, such as the abdomen. 腹部CT扫描用于帮助识别肾脏损伤.
• Retrograde cystography. During this test造影剂通过尿道注入膀胱. X-rays are then taken of the bladder, which helps to identify injuries to the bladder.
• Urethrography. This test involves taking X-rays of the urethra to identify any injuries or obstructions in this area.
• Arteriography. Arteriography involves taking an X-ray of blood vessels. Before X-rays are taken, a dye is injected into surrounding arteries so that the blood vessels are visible on the X-ray. In cases of suspected genitourinary injuries, arteriographies are useful in examining the blood vessels of the kidneys to check for injuries in that area.
• Intravenous urography. This test involves taking an X-ray of the urinary tract. Before X-rays are taken, 注射一种染料使尿液在x射线上可见, 检查是否有尿路堵塞或肾脏问题.

Treatments

泌尿生殖系统损伤的治疗可能是复杂的，取决于许多因素, including the severity, location and type of injury, 病人的健康状况以及病人是否有其他伤害.

伤口分为钝伤和穿透伤. Blunt trauma includes car accidents, straddle-injuries, serious falls and industrial accidents. Penetrating trauma includes gunshot wounds.

Short-term management

一旦你的十大赌博平台排行榜诊断并评估了你的伤势, short-term management may be performed before a definitive treatment plan is developed. Short-term management may include:

• Urethral catheter. 一根管子通过尿道插入膀胱排出尿液.
• Suprapubic catheter. 一根管子穿过腹壁进入膀胱排出尿液.
• Nephrostomy tube. A tube is placed through the patient's flank (side) to drain urine directly from the kidney.
• Ureteral stent. 一个临时的管子通过输尿管连接肾脏和膀胱.

Kidney injuries

肾损伤的治疗取决于损伤的类型和严重程度, and whether the patient has any other injuries.

• Blunt injuries. In 85 percent of cases, injuries to the kidneys are minor, 是钝器造成的，不需要手术. 治疗的目的是阻止肾脏出血. Hospital admission, bed rest and hydration are required until bleeding from the kidney stops and urine is clear.
• Penetrating injuries. 手术更有可能是穿透性损伤, such as those from a gunshot wound, 哪一种会导致严重的肾出血. Patients also may have serious injuries to other parts of the abdomen, such as the bowel and liver. In these instances, surgical exploration and repair of the kidneys may be performed at the same time as surgery for other injured parts. 手术的目的是修复和保护受损的肾脏. However, if the kidney is severely injured and beyond repair, surgical removal may be required.

Ureteral injuries

Injuries to the ureters – the tubes that connect each kidney to the bladder – are rare and usually occur during a difficult pelvic surgical procedure or from a gunshot wound. 治疗取决于损伤的类型和严重程度.

• Complete disruption. 输尿管损伤导致完全破坏, 也就是说输尿管被撕成两半, require emergency surgical repair. 手术修复的最佳结果是在受伤时及时治疗.
• Partial injuries. Partial ureteral injuries, 比如那些发生在骨盆手术中的, often can be managed by a ureteral stent. Ureteral stents are thin tubes, called catheters, 它们被插入输尿管携带尿液的部分, produced by the kidney, either down into the bladder, or to an external collection system. 输尿管支架植入术可长期放置, ranging from months to years, to bypass ureteral obstruction. Short-term stenting, ranging from weeks to months, may be placed during an open surgical procedure of the urinary tract to provide a mold around which healing can occur, 或者将尿流从渗漏部位转移.

Bladder injuries

膀胱损伤通常是由意外事故引起的, such as a car accident, 严重跌倒或重物落在小腹上. Treatment depends on the type of injury.

• Contusion injury. 在这些类型的损伤中，膀胱壁只是擦伤而不会破裂. 挫伤可以用导尿管处理, 这是一根通过尿道插入膀胱的管子, so that blood clots pass. 一旦尿液清澈，病人病情稳定，就可以拔除导尿管.
• Extraperitoneal rupture. 这些类型的损伤可以用导尿管来处理, 这是一根通过尿道插入膀胱的管子, to keep the bladder empty and allow the urine and blood to drain out into a collection bag. 在大多数情况下，病人会在10天内痊愈. However, large blood clots in the bladder or injuries involving the bladder neck require surgical repair.
• Intraperitoneal rupture. These ruptures require surgical repair to prevent urine from leaking into the abdomen. The repair is performed by making an incision in the abdomen and then sewing the tear closed. 手术后，导尿管在膀胱内放置几天，使膀胱得到休息.
• Penetrating injuries. 穿透性损伤通常需要手术修复膀胱上的任何孔洞. 在大多数情况下，周围器官受损，也需要修复. 如上所述，在膀胱中留下导管以排出尿液和血液.

Urethral injuries

Management and treatment of urethral injuries can be complex and depends on the severity and location of injury, 病人的健康状况以及是否有其他伤害. In some cases, emergency surgical repair is recommended, but should be limited to select cases. As a general rule, initial suprapubic cystostomy, 其中包括通过下腹部在膀胱中放置导尿管, is the safest and simplest option.

有关更多信息，请参阅关于的完整部分 urethral injuries.

Penile injuries

Penile injuries can occur in various ways. For instance, penile fractures may occur during sexual intercourse and are usually surgically repaired. In other instances, placing obstructing rings around the base of the penis may lead to gangrene and urethral injuries. 障碍物可以在不造成进一步损害的情况下移除. In addition, 机械事故可能对阴茎皮肤造成损伤, which can be repaired by skin grafting.

尿道损伤常伴发阴茎损伤. Therefore, when making a diagnosis of penile injuries, an urethrography – a test involving X-rays of the urethra – will be performed to identify any injuries or obstructions in this area.

Testicular injuries

睾丸损伤通常是由于对腹股沟或阴囊的创伤性打击而发生的, which can cause severe pain, nausea, vomiting and in some instances, lower abdominal tenderness. In these cases, a testicular ultrasound – a non-invasive test that uses high-frequency sound waves to create images of the testicles and other parts inside the scrotum – is usually performed to evaluate possible damage to the testicle. 如果诊断为睾丸骨折，则需要手术探查和修复.