Urological and reproductive system injuries

　　Urological and reproductive system injuries are divided into renal injury, ureteral injury, bladder injury, anterior urethral injury, and posterior urethral injury, and their causes of onset are described as follows.

　　Section 1: Renal injury

　　1. Open injury.

　　2. Closed injury.

　　3. Renal intrinsic disease (pathological kidney).

　　4. Medical procedures.

　　II. Ureteral Injury

　　1. Open surgery injury: such as obstetrics and gynecology, general surgery.

　　2. Endoscopic injury: such as percutaneous nephroscope, ureteroscope, cystoscope.

　　3. Radioactive injury: such as cervical cancer, prostate cancer, postoperative radiotherapy.

　　4. Trauma

　　III. Bladder Injury

　　1. Open injury.

　　2. Closed injury.

　　3. Iatrogenic injury.

　　IV. Anterior Urethral Injury

　　Male anterior urethral injury often occurs in the bulb, which is fixed in the perineum. When the perineum is injured by straddling, the bulb of the urethra is compressed below the pubic symphysis, causing injury to the bulb of the urethra.

　　V. Posterior Urethral Injury

　　The membranous urethra passes through the urogenital diaphragm. When the pelvis is fractured, the urogenital diaphragm covered on the inferior branch of the pubic bone suddenly moves, producing a shearing force that breaks the weak membranous urethra, even tearing at the tip of the prostate. After the posterior urethra is ruptured, urine extravasates along the tip of the prostate to the retropubic space and around the bladder.

　　Urological and reproductive system injuries are divided into renal injury, ureteral injury, bladder injury, anterior urethral injury, and posterior urethral injury, and their specific complications are described as follows.

　　1. Renal injury may be complicated by infection.

　　2. Ureteral injury may be complicated by ureteral stricture, fistula, complete obstruction, hydronephrosis, infection, and renal function damage, etc.

　　3. Bladder injury may be complicated by peritonitis, pelvic abscess, ureteral obstruction, urinary incontinence, and urinary leakage, etc.

　　4. Anterior urethral injury may be complicated by urinary extravasation and urethral stricture.

　　5. Posterior urethral injury may be complicated by urethral stricture, urinary incontinence, and impotence.

　　Urological and reproductive system injuries are divided into renal injury, ureteral injury, bladder injury, anterior urethral injury, and posterior urethral injury, and their specific clinical manifestations are described as follows.

　　Section 1: Renal injury

　　1. Shock: Often due to hemorrhagic shock caused by trauma. Clinically, attention should be paid to the possibility of other organ injuries in the chest and abdomen.

　　2. Hematuria: Most cases are accompanied by hematuria, but it should be considered that there may be slight hematuria and anuria when any part of the continuous tract from the kidney, ureter, bladder, to the urethra is subjected to transverse injury, leading to phenomena such as blocked drainage and blood clots.

　　3. Pain.

　　4. Lumbar and abdominal mass.

　　5. Fever.

　　Early stages are related to other site injuries, inflammatory response syndrome (SIRS); late stages (usually after 24-48 hours) may have the possibility of infection.

　　II. Ureteral Injury

　　1. Hematuria.

　　2. Urinary extravasation.

　　3. Urethral fistula.

　　4. Obstruction.

　　III. Bladder Injury

　　1. Shock.

　　2. Abdominal pain.

　　3. Hematuria and difficulty in urination.

　　4. Urinary fistula.

　　Commonly seen in open injuries; closed injuries may develop into infection in the later stage, forming skin breaks, and causing urinary fistula.

　　IV. Anterior Urethral Injury

　　1. Urethral hemorrhage, spotting, or hematuria.

　　2. Pain.

　　3. Difficulty in urination, which may be accompanied by urinary retention.

　　4. Local hematoma.

　　5. Urinary extravasation.

　　6. Urinary fistula.

　　V. Posterior Urethral Injury

　　1. Shock.

　　2. Pain.

　　3. Difficulty in urination.

　　4. Urethral hemorrhage.

　　5. Urinary extravasation and hematoma in the perineum and scrotum.

　　The occurrence of urinary and reproductive system injuries is often caused by trauma and improper surgical procedures, therefore, the prevention of this disease mainly focuses on the prevention of etiology. People should pay attention to safety in their daily life and production to avoid injuries. Medical personnel in hospitals can effectively prevent the occurrence of this disease by improving their medical level, better mastering surgical methods, and being gentle in their techniques during surgery.

　　Injuries to the urinary and reproductive systems are divided into renal injury, ureteral injury, bladder injury, anterior urethral injury, and posterior urethral injury. The specific examination methods are described as follows.

　　Section 1: Renal injury

　　1. Medical history and physical examination.

　　2. Laboratory tests: urine routine, renal function, etc.

　　3. Special examinations: B-ultrasound and enhanced CT are preferred; excretory urography (excretory urography) and selective renal angiography are often used as important auxiliary diagnostic methods when the diagnosis is difficult.

　　Section 2: Ureter

　　Ultrasound, intravenous pyelography, and retrograde pyelography are common examination methods.

　　III. Bladder Injury

　　1. Medical history and physical examination.

　　Digital rectal examination can feel a fullness in the anterior wall of the rectum, indicating extraperitoneal bladder rupture. Severe peritoneal irritation signs, with mobile dullness, indicate intraperitoneal bladder rupture.

　　2. Catheterization test and water injection test: a significant difference in the amount of liquid in and out often indicates bladder rupture.

　　3. X-ray contrast examination.

　　IV. Anterior Urethral Injury

　　1. Medical history and physical examination.

　　2. Catheterization: strive for a successful insertion in one attempt.

　　3. X-ray urethrogram examination: excretory or retrograde造影.

　　V. Posterior Urethral Injury

　　1. Medical history and physical examination

　　(1) Patients with pelvic compression injury who have urinary retention should consider posterior urethral injury.

　　(2) Digital rectal examination can feel a soft sensation in front of the rectum with tenderness, and the tip of the prostate can float.

　　(3) If the finger cot is stained with blood, it indicates a concurrent rectal injury.

　　2. X-ray examination.

　　Patients with urinary and reproductive system injuries should have a light diet, eat more foods rich in vitamins and fiber; avoid spicy and irritating foods. The specific dietary precautions are described as follows.

　　1. Patients with urethral injury should have a light diet and pay attention to a balanced diet. Patients should eat more foods rich in vitamins and fiber.

　　2. Patients with urethral injury should avoid spicy and刺激性, fragrant and dry, warm and hot, and easy-to-get-hot foods, such as chili, pepper, beef, and mutton. Avoid drinking刺激性 beverages such as coffee, cola, and alcohol.

　　3. Patients with renal injury may experience abdominal distension due to trauma or surgery. It is advisable to eat less food that is prone to cause bloating, such as milk and sweets.

　　Injuries to the urinary and reproductive systems are divided into renal injury, ureteral injury, bladder injury, anterior urethral injury, and posterior urethral injury. The specific examination methods are described as follows.

　　Section 1: Renal injury

　　It is divided into emergency treatment, conservative treatment, surgical treatment (arterial embolization), and management of complications.

　　1. Emergency treatment for trauma: Stabilize vital signs, save lives.

　　2. Conservative Treatment

　　Mainly for the treatment of subcapsular hematoma under the renal capsule, superficial renal cortex laceration, and perirenal hematoma. Patients with stable conditions without infection, such as full-thickness renal laceration, hematoma, and urinary extravasation, can also be considered for selective treatment.

　　During the treatment process, attention should be paid to absolute bed rest, strict monitoring of the condition, anti-inflammatory, hemostasis, and maintaining homeostasis, etc., for active symptomatic and supportive treatment.

　　3. Surgical Treatment

　　(1) Open renal injury: Almost all cases require surgery.

　　(2) Closed renal injury: It is necessary to grasp the indication for surgical exploration.

　　Selective renal vascular embolization can be used for treatment first.

　　II. Ureteral Injury

　　1. Principles of treatment for traumatic ureteral injury: First, anti-shock, then manage other severe combined injuries, and finally manage ureteral injury.

　　2. Treatment of Late Complications

　　(1) Ureteral stricture.

　　(2) Urinary fistula.

　　(3) When complete obstruction caused by ureteral injury cannot be temporarily relieved, a renal fistula can be performed first, and then ureteral repair can be performed 1-2 months later.

　　(4) Severe renal hydronephrosis or infection caused by traumatic ureteral stricture, severe renal dysfunction or loss, if the contralateral kidney is normal, nephrectomy can be performed.

　　III. Bladder Injury

　　1. Emergency treatment for other organ injuries, resuscitation, routine anti-infection.

　　2. Conservative Treatment: Small fissures can mostly heal spontaneously with sufficient drainage of urine (7-10 days).

　　3. Surgery: Repair bladder rupture, and need to perform cystostomy in severe cases to prevent postoperative hemorrhage and bladder spasm.

　　4. Management of complications: including peritonitis, pelvic abscess, ureteral obstruction, urinary incontinence, urinary leakage, etc.

　　IV. Anterior Urethral Injury

　　Emergency treatment for combined injuries, control bleeding.

　　V. Posterior Urethral Injury

　　1. Emergency Treatment.

　　2. Surgical Treatment

　　(1) Patients with stable condition and insignificant urethral end displacement can undergo conservative treatment or only suprapubic cystostomy.

　　(2) Patients with stable pelvic fracture and stable vital signs can also undergo emergency urethral reimplantation.

　　(3) Management of complications: It is difficult to manage the three major complications of late urethral stricture, urinary incontinence, and impotence.