Urogenital injury
Introduction
Introduction to genitourinary injury Urogenital damage is caused by high-altitude fall impact, traffic accident stab wound, and blow wound, etc., causing damage to the kidney ureter, bladder urethra, scrotal testis, etc., including: renal contusion, renal rupture, ureteral rupture, bladder contusion, urethral rupture, scrotum Laceration, testicular contusion, etc. In addition to rupture of the kidney or kidney pedicle, patients with major hemorrhage, early hemorrhagic shock is easy to diagnose, some organs are more concealed, such as ureter, posterior urethra, etc. In the early stage of injury, symptoms and signs are often not obvious, orthopedics need to observe Hematuria is a common symptom of urinary tract injury: aggravation of hematuria means the continuation of the injury, and indwelling catheterization is the best measure to observe changes in hematuria. The principle of treatment of traumatic ureteral injury should be treated with anti-shock treatment to treat other serious combined injuries and then treat ureteral injury. basic knowledge The proportion of illness: 0.052% Susceptible people: no special people Mode of infection: non-infectious Complications: hemorrhagic shock, urinary retention
Cause
Causes of genitourinary injury
Causes of kidney injury:
Open injury, closed injury, kidney disease (pathological kidney), medical operation.
Pathological type of kidney injury:
Renal contusion, partial renal laceration, full-thickness laceration, and kidney pedicle injury.
Late lesions: urinary cysts; hematoma tissue fibrosis hydronephrosis; arteriovenous fistula or pseudo renal aneurysm; renal vascular hypertension.
Causes of ureteral injury:
1. Open surgical injury: such as obstetrics and gynecology, general surgery;
2. Intracavitary instrument damage: such as percutaneous nephrolithotomy, ureteroscopy, bladder urethra mirror;
3. Radiation damage: such as cervical cancer, prostate cancer, postoperative radiotherapy;
4. Trauma
Pathology of ureteral injury:
Contusion, perforation, ligation, clamping, cutting or incision, tearing, twisting, ischemia, necrosis, etc. after exfoliation.
The ureter, bladder, and urethral mucosa are covered by transitional epithelial cells, rich in blood supply, and strong in tissue ability.
Complex cause of bladder injury
1. Open injury
2, closed injury
3. Iatrogenic injury
Pathology of bladder injury
1. Contusion
2, bladder rupture
(1) Extraperitoneal urine extravasation to the surrounding tissues of the bladder and the posterior pubic space, along the pelvic fascia to the pelvic floor, or along the loose tissue around the ureter to the kidney. Mostly caused by damage to the anterior wall of the bladder.
(2) rupture of the intraperitoneal bladder wall with peritoneal rupture, and urine into the abdominal cavity causes peritonitis. More common in the posterior wall and top of the bladder.
Causes of anterior urethral injury
Male anterior urethral injury occurs mostly in the ball, and this urethra is fixed in the perineum. When the perineum is riding a cross-injury, the urethral tract of the ball is accumulated below the ulna, causing damage to the urethral ball.
Pathology of anterior urethral injury
1. Only edema and hemorrhage can heal itself during urethral contusion.
2, urethral laceration caused by periurethral hematoma and urinary extravasation after healing caused by scarring urethral stricture.
3, the urethra completely rupture so that the broken end retracted, separated, hematoma is large, urinary retention occurs, urinary excretion easily caused by urinary exudation.
Etiology and pathology of posterior urethral injury
The urethra of the membrane passes through the urogenital ridge. When the pelvis is fractured, the urogenital ridge that covers the subpubic branch is suddenly displaced, causing shear-like violence, which causes the weak membrane to break the urethra and even tear at the tip of the prostate. When the posterior urethra is broken, urine leaks along the tip of the prostate to the posterior pubic space and around the bladder.
Prevention
Urogenital injury prevention
Pay attention to safety and avoid injuries during the production process.
Complication
Urogenital injury complications Complications, hemorrhagic shock, urinary retention
Urogenital damage can have complications such as hemorrhagic shock and urinary retention.
Complications of kidney injury: often caused by hemorrhagic effusion and secondary infection.
Ureteral injury complications:
(1) ureteral stricture. (2) urinary fistula. (3) When complete obstruction caused by ureteral injury can not be relieved, nephrostomy can be performed first, and ureteral repair can be performed after l~2 months. (4) severe hydronephrosis or infection caused by injurious ureteral stricture, severe renal damage or loss, if the contralateral kidney is normal, renal resection can be performed.
Complications of anterior urethral injury: (1) extravasation of urine. (2) urethral stricture.
Complications of posterior urethral injury: late urethral stricture, urinary incontinence, and impotence are all difficult to treat.
Symptom
Urinary genital damage symptoms Common symptoms Neurogenic urinary frequency dysuria and urinary retention urinary dysfunction Abdominal mass urinary exocytosis shock urinary urinary fistula
Clinical manifestations of renal injury
Shock: Due to traumatic hemorrhagic shock, clinical attention should be paid to the possibility of other tissues and organs and injuries of the chest and abdomen.
Hematuria: Most of them are accompanied by hematuria, but it should be considered that there may be slight hematuria and anuria when there is a possibility of drainage and clot blockage in any part of the continuous pipeline path of kidney, ureter, bladder and urethra.
Pain: a bump in the waist and abdomen.
Fever: early is associated with combined site injury and inflammatory response syndrome (sirs); late (generally 24 to 48 hours later) infection may occur.
Clinical manifestations of ureteral injury
1, hematuria. 2, extravasation of urine. 3, urinary fistula. 4, obstructive symptoms.
Clinical manifestations of bladder injury
1, shock. 2, abdominal pain. 3, hematuria and urination are difficult to suffer. 4, urinary fistula. 5, more common in open injury; closed injury combined infection in the later stage, can form skin rupture, urinary fistula.
Clinical manifestations of anterior urethral injury
1, urethral bleeding, blood or hematuria. 2, pain. 3, dysuria, can be accompanied by urinary retention. 4, local hematoma. 5, extravasation of urine. 6, urinary fistula.
Clinical manifestations of posterior urethral injury
1, shock. 2, pain. 3, difficulty urinating. 4, urethra bleeding. 5, extravasation of urine and perineal scrotum hematoma.
Examine
Examination of genitourinary damage
1. Catheterization and injury assessment
1) Urinary catheterization.
2) Excretory urography.
3) Retrograde cystography.
4) ureteral angiography.
5) Arteriography.
6) CT.
2. Cystoscopy and retrograde urography.
Diagnosis
Diagnosis and diagnosis of genitourinary injury
Diagnosis of kidney damage:
Medical history and physical examination.
Morning tests: including hematuria, routine renal function, etc.
Special inspection: b-super and enhanced ct are preferred.
Excretory urography and selective renal angiography are important adjuncts for diagnosis.
Diagnosis and differential diagnosis of ureteral injury:
b super, intravenous pyelography and retrograde angiography are common examination methods.
In the differential diagnosis, the main screening is to check for damage to other parts of the urinary system.
Diagnosis of bladder injury:
1, medical history and physical examination
The rectal finger touches the anterior wall of the rectum with a feeling of fullness, suggesting a rupture of the extraperitoneal bladder.
Severe peritoneal irritation, combined with mobile dullness, suggests a ruptured intraperitoneal bladder.
2, catheterization test and water injection test
A large difference in the amount of fluid in and out often indicates a bladder rupture.
3, x-ray contrast examination
Diagnosis of anterior urethral injury:
1, medical history and physical examination.
2, catheterization, and strive for a smooth insertion.
3, x-ray urethral angiography: excretion or retrograde angiography.
Diagnosis of posterior urethral injury:
1, medical history and physical examination
(1) pelvic crush injury, the patient has urinary retention, should consider the posterior urethra injury.
(2) The rectal examination can touch the softness of the front of the rectum, with the tenderness of the prostate tip floating.
(3) If the fingertips are stained with blood, it is combined with rectal injury.
2, x-ray inspection
