Shlamovitz Gil Z, McCullough Lynne
Department of Emergency Medicine, UCLA Medical Center, David Geffen School of Medicine, Los Angeles, California 90095, USA.
J Trauma. 2007 Feb;62(2):330-5; discussion 334-5. doi: 10.1097/01.ta.0000221768.68614.36.
The goals of our study were to review all cases of urethral and bladder trauma that presented to the University of California, Los Angeles (UCLA) Medical Center between January 1998 and August 2005 and determine (1) the clinical characteristics of patients with urethral and/or bladder injuries as well as the sensitivities of those clinical characteristics; (2) whether or not a blind attempt to insert a urethral catheter was performed; and (3) whether there is any evidence that a blind attempt to insert a urethral catheter worsened the initial urinary tract injury.
This is a retrospective chart review.
The study cohort comprised 46 patients with a mean age of 30 years, including 36 men (78.2%) and 10 women (21.8%). Bladder tears were found in 33 patients, 10 patients had urethral lacerations, and 3 patients had combined bladder and urethral lacerations. The most sensitive finding for urinary bladder or urethral injury was the presence of gross hematuria in the urethral catheter (100%, 95% confidence interval [CI] 0.63-0.89). Blinded insertion of a urethral catheter was attempted in 30 (90.9%, 95% CI 0.75-0.98) patients who suffered from urinary bladder injury, 6 (50%, 95% CI 0.26-0.87) patients who suffered from urethral injury and 1 (33%, 95% CI 0.0-0.9) patient who suffered from a combined urinary bladder and urethral injuries. We did not find evidence that a blind attempt to insert a urethral catheter worsened the initial urinary injury.
Gross hematuria in the urethral catheter was the most sensitive sign for the presence of a urethral or urinary bladder injury in our study cohort, and often the only sign of such an injury. We found no evidence that a blind attempt to insert a urethral catheter in patients suffering from urethral and or urinary bladder injuries worsened the initial injury. Larger studies will be needed to determine the safety of blind urethral catheterization in patients that are suspected to suffer from a lower urological trauma. It is our opinion that the current guidelines should be revised to better reflect the current knowledge, technologies, and clinical practice.
我们研究的目的是回顾1998年1月至2005年8月期间在加利福尼亚大学洛杉矶分校（UCLA）医学中心就诊的所有尿道和膀胱创伤病例，并确定：（1）尿道和/或膀胱损伤患者的临床特征及其敏感性；（2）是否尝试盲目插入尿道导管；（3）是否有证据表明盲目插入尿道导管会使初始尿路损伤恶化。
这是一项回顾性病历审查。
研究队列包括46例患者，平均年龄30岁，其中男性36例（78.2%），女性10例（21.8%）。发现33例患者有膀胱撕裂伤，10例患者有尿道裂伤，3例患者有膀胱和尿道联合裂伤。尿道导管中有肉眼血尿是膀胱或尿道损伤最敏感的表现（100%，95%置信区间[CI]0.63 - 0.89）。30例（90.9%，95%CI 0.75 - 0.98）膀胱损伤患者、6例（50%，95%CI 0.26 - 0.87）尿道损伤患者和1例（33%，95%CI 0.0 - 0.9）膀胱和尿道联合损伤患者尝试了盲目插入尿道导管。我们没有发现证据表明盲目插入尿道导管会使初始尿路损伤恶化。
在我们的研究队列中，尿道导管中有肉眼血尿是尿道或膀胱损伤最敏感的体征，且常常是此类损伤的唯一体征。我们没有发现证据表明在尿道和/或膀胱损伤患者中盲目插入尿道导管会使初始损伤恶化。需要进行更大规模的研究来确定在疑似下尿路创伤患者中盲目尿道插管的安全性。我们认为当前指南应进行修订，以更好地反映当前的知识、技术和临床实践。
