Dreitlein D A, Suner S, Basler J
Department of Emergency Medicine, Rhode Island Hospital, Brown University School of Medicine, Providence, Rhode Island, USA.
Emerg Med Clin North Am. 2001 Aug;19(3):569-90. doi: 10.1016/s0733-8627(05)70204-2.
Injuries to the GU system commonly occur in patients with high-energy lower abdominal or pelvic trauma. The emergency physician should be well versed in the diagnosis and management of GU trauma, although these injuries are not usually life threatening because of the potential for loss of urinary or sexual function. In the setting of hemodynamic instability, diagnosis and treatment of GU injuries is often accomplished in the operative setting. In the stable patient, diagnostic testing is directed by the type of suspected injury and must proceed in a reverse manner, i.e., external injury then urethral injury then bladder, and finally urethral and renal damage. Treatment focuses on a team approach between the emergency physician, general, orthopedic, and urologic surgeon. The decision for operative repair is often dictated more by other associated injuries than urologic injuries, and the urologic surgeon often provides temporizing measures with definitive repair at a later time. Prompt diagnosis and treatment of injuries to the external genitals results in excellent long-term outcome, minimizing the devastating consequences of impotence, urinary incontinence, and sexual disfiguration.
泌尿生殖系统损伤常见于高能下腹部或骨盆创伤患者。急诊医生应精通泌尿生殖系统创伤的诊断和处理，尽管这些损伤通常不会危及生命，但存在泌尿或性功能丧失的可能性。在血流动力学不稳定的情况下，泌尿生殖系统损伤的诊断和治疗通常在手术过程中完成。对于病情稳定的患者，诊断性检查根据疑似损伤的类型进行，且必须按相反顺序进行，即先检查外部损伤，然后是尿道损伤，接着是膀胱，最后是输尿管和肾脏损伤。治疗重点在于急诊医生、普通外科医生、骨科医生和泌尿外科医生之间的团队协作。手术修复的决策通常更多地取决于其他相关损伤而非泌尿系统损伤，泌尿外科医生通常会采取临时措施，待后期进行确定性修复。及时诊断和治疗外生殖器损伤可带来良好的长期预后，将阳痿、尿失禁和性器官畸形等灾难性后果降至最低。
