2 blader's English reference income
Conclusion Bladder is a hollow organ for storing and excreting urine in abdominal cavity, which expands or empties with the amount of urine stored. In infancy and childhood, the bladder is higher than the pubic arch and located in the lower abdomen. In adult males, the bladder is located between the pubic bone and rectum. Its lower part communicates with the urethra of prostate, followed by seminal vesicle and ampulla of vas deferens. Between the bladder and rectum is a rectal bladder depression. Behind the female bladder is the uterus, and between them is the uterus and bladder depression. Therefore, the position of female bladder is higher than that of male, and the retroperitoneum covering the posterior wall of bladder is higher than that of male because it is connected with uterus. The bladder wall under the urachal tube is in direct contact with the anterior abdominal wall without peritoneal coverage. Therefore, when the bladder is emptied, only the upper edge of the bladder is covered by peritoneum, and a part of the lower front and lower side of the bladder is not covered by peritoneum. When the bladder is inflated, it rises to the lower abdomen, and the peritoneum covering the top of the bladder also rises. It can be seen that the position of bladder and its relationship with surrounding organs can vary with age, sex and urine filling degree. This anatomical and physiological feature of bladder is closely related to the type, location and scope of its injury.
Adult bladder is located in the pelvis when it is emptied, and it is generally not easy to be damaged because of the protection of pelvis and surrounding muscle tissue. When filling, the top of the bladder rises above the pubic symphysis and adheres to the anterior abdominal wall, thus losing the protective effect of the pelvis. At the same time, due to the increase of the volume of the filled bladder, the bladder wall becomes thinner and it is easy to be injured, especially those with bladder retention caused by lower urinary tract obstructive diseases. Children have a high bladder position and a relatively shallow pelvis. If the bladder is slightly full, it can protrude to the lower abdomen without pelvic protection, so it is more likely to be injured.
Bladder contusion injury is mild, which can be asymptomatic or mild abdominal pain and hematuria, and generally does not require special treatment; Bladder rupture can lead to shock, abdominal pain, dysuria, hematuria, urinary fistula and other serious symptoms, and is often combined with pelvic or abdominal organ injury as a compound injury, which should be treated by surgery in time.
4 Name of disease Bladder injury
5 blader's English name income
6 classification urology >; Injury of urogenital system
7 ICD number S37.2
According to the statistics of Waterhouse, among the 25 1 cases of urinary system injuries, bladder injuries accounted for 38 cases (15. 14%). Ochsner counted 1096 cases of war injuries, including 79 cases of urinary system injuries and 0 cases of bladder injuries (10). The occurrence of bladder rupture is closely related to pelvic fracture. 1798 cases of pelvic fracture, 18 1 case (10%) was accompanied by bladder rupture. Patients with severe displacement of pelvic fracture or free bone fragments are most likely to cause bladder injury. Cass reported 1080 cases of pelvic fracture, 93 cases (8.6%) had bladder rupture.
9 Etiology Bladder injury mostly occurs when urine fills the bladder. At this time, the bladder wall is tense, the bladder area increases, and it becomes an abdominal organ higher than pubic symphysis, which is easy to be injured. The bladder is located deep in the pelvis when it is emptied, and it is protected by surrounding soft tissues such as fascia, muscle and pelvis, so it is rarely hurt by external forces except through trauma or pelvic fracture. According to the cause of injury, bladder injury can be divided into three categories:
9. 1 Bladder with closed injury, overfilling or pathological changes (such as tumor, ulcer, inflammation and diverticulum) is easy to rupture due to external force. More common in falls, kicks, transsexuals or accidental traffic accidents. When the pelvis is broken, the debris will also puncture the bladder. Drunkenness is one of the factors leading to bladder rupture. When drunk, the bladder is often full, and the abdominal muscles are slack, which is easy to get hurt. Any disease that can cause urinary retention, such as urethral stricture, bladder stones or tumors, prostatic hypertrophy and neurogenic bladder, can also be the cause of bladder rupture. When you are drunk or have bladder disease, bladder rupture can occur even if there is no obvious external force, which is called spontaneous rupture. Spontaneous bladder rupture is almost always intraperitoneal bladder rupture.
9. 1. 1. 1. Direct violence mostly occurs when the bladder is inflated, and the bladder is above the pubic bone. Direct violence acts on the lower abdomen and causes bladder injuries, such as kicking, boxing and collision. When the bladder is full, the external force acts equally on all parts of the bladder. According to hydrodynamics, it acts on the weakest part of the bladder, mostly the top of the bladder covered by peritoneum, and the rupture here is mostly intraperitoneal bladder rupture. Urine flows into the abdominal cavity, forming urinary peritonitis, and the patient has severe abdominal pain. Patients with urinary retention 1 person. After catheterization, the urine outflow rate is too slow, and the patient's pubic bone is pressed by hand. The patient suddenly felt abdominal pain, and the originally inflated bladder suddenly disappeared. It was confirmed by surgery that the top of the bladder ruptured and urine flowed into the abdominal cavity.
9. 1.2 2. Indirect violence often occurs in pelvic fractures, accounting for about 80%. Sometimes it is a compound injury, which can be combined with other organ injuries. Such as traffic accidents, earthquakes, car accidents, falling from a height, crushing injuries, war injuries, work-related injuries, etc. When a pelvic fracture occurs, the broken end or free bone fragments puncture the bladder. At this time, the bladder injury is mostly extraperitoneal bladder rupture, and the rupture site is mostly at the bottom of the bladder. There are also manifestations such as posterior urethral rupture or abdominal organ vascular injury, comminuted pelvic fracture, urinary extravasation, severe blood loss and shock. Intraperitoneal and extraperitoneal bladder rupture (mixed injury and compound injury) may also occur, and the injury is very serious. For example, 1 The patient fell from the tractor, resulting in fracture of pubic branch and sciatic branch, rupture of the anterior wall of bladder and urine extravasation. After rescue, bladder repair and urinary extravasation drainage, he recovered smoothly and was discharged from hospital. Bladder injury is usually caused by indirect violence.
9. 1.3 3. Spontaneous rupture This kind of bladder rupture is mostly due to the original lesions of the bladder, such as tuberculosis, inflammation, ulcer and diverticulum. The bladder wall is weak, and it is easy to rupture even if it encounters lower abdominal violence or increased abdominal pressure. In recent years, some people drink too much beer, some people drink 5000~6000ml beer in a short time, and a large number of people enter the water. People are intoxicated, their consciousness is blurred, and their bladder is extremely inflated. A little carelessness will lead to bladder rupture, almost all in the peritoneum. Bladder rupture caused by alcoholism, there is no primary disease in the bladder.
9.2 Open injuries Open injuries are mainly seen in wartime, which are caused by firearms and sharp instruments, and are often combined with other organ injuries, such as rectal injuries and pelvic injuries. Generally speaking, the bladder injury caused by shrapnel or stab wound entering from hip, perineum or thigh is mostly extraperitoneal injury, while the penetrating injury through abdomen is mostly intraperitoneal injury.
9.3 Surgical injuries Surgical injuries can be seen in cystoscopy, lithotripsy, intravesical B-ultrasound, transurethral resection of prostate, transurethral resection of bladder neck, transurethral resection of bladder cancer, delivery, pelvic and * * * surgery. Even when inguinal hernia (bladder sliding hernia) is repaired, it may happen. The main reason is improper operation, and the lesion of bladder itself increases the chance of this kind of injury.
Due to the examination of bladder in recent years. Cystoscope, intravesical lithotripsy, transurethral intravesical surgery and treatment, such as electrocautery and electrocision, can all cause bladder perforation. Most of them need cystoscopy because of bladder diseases, and some indications are not mastered properly. If some bladder capacity is too small, it will cause bladder perforation when sending cystoscopy. During transurethral resection of bladder tumor, if the incision is too deep or the observation is unsatisfactory, the bladder is dilated and the bladder wall is thin, which is easy to cause bladder perforation, such as perforation in the top peritoneum and bladder rupture (perforation) in other parts of the peritoneum. Injecting corrosive agents, chemicals or hardeners into the airbag will damage the airbag. Another example is pelvic surgery, gynecological surgery, obstetric surgery, rectal surgery, hernia repair surgery and so on. , can cause bladder damage. When the pregnant woman gives birth, the baby's head has entered the pelvic cavity, and the second stage of labor takes a long time. When the bladder is compressed, soft tissues such as bladder triangle, bladder wall and urethra are often compressed, resulting in ischemia, hypoxia and necrosis, and falling off to form bladder fistula or urinary fistula. Especially when there is urinary retention caused by labor stagnation, the bladder is more likely to be compressed because of its thin swelling wall, leading to ischemic necrosis and fistula. This kind of "fistula" usually does not appear immediately after delivery, but at postpartum 1 week or longer.
Improper obstetric operations, such as fetal head aspiration, forceps, fetal fragmentation, cesarean section, artificial placental abruption, etc., can all cause bladder (urethra) fistula due to improper operation. In the old method, the midwife used scissors, hands and hooks indiscriminately, and the injuries were more common. When cesarean section, the bladder pressure is not enough, and it is easy to accidentally injure the bladder wall or give birth in the placenta of the fetus when making longitudinal incision of the lower uterus, resulting in uterine bleeding. If not found in time, it will become a bladder fistula. Because the bottom of the bladder is closely connected with the lower segment of uterus and the upper part of uterus, when the lower segment of uterus ruptures, it can involve the bladder and cause bladder-cervical fistula. Raghavaiah( 1975) reported that 22% of cases of uterine rupture were complicated with bladder injury, of which 14% were superficial bladder injury and 8% were full-thickness bladder injury.
Urinary fistula caused by bladder injury in gynecological surgery accounts for about 5.4%(294/5465) of all urinary fistula. However, due to the increase of gynecological surgery, the proportion of bladder injury is relatively high. If it can be found and repaired in time, the incidence of urinary fistula will be relatively reduced. In recent years, sewing needle and thread with needle can be closely sutured during operation or with the assistance of urologist, and the incidence of urinary fistula will be greatly reduced. When performing * * * hysterectomy, * * plasty, tubal ligation and other * * * operations, special attention should be paid to the close adhesion of the bladder to the uterus and cervix, and special care should be taken when separating to avoid damaging the bladder. In recent years, it has been reported that metal contraceptive rings have also pierced the uterus and bladder.
Bladder calculus, pelvic inflammatory disease, colon cancer, small intestine cancer, cervical cancer, cancer and radiotherapy, as well as injection of corrosive agent, sclerosing agent and anhydrous alcohol into or outside the bladder cavity can cause bladder tissue necrosis, ulcer, bladder fistula, bladder colon (small intestine) fistula, etc.
The pathogenesis of 10 can act on the bladder for various reasons, but according to the degree of bladder injury and its relationship with peritoneum, it can be divided into the following situations.
10. 1 Bladder contusion accounts for about 50% ~ 80% of bladder injury. After trauma, the bladder was only bruised in mucosa and muscularis to varying degrees, and the bladder wall was not broken. Hematuria can occur, but there is no urine extravasation, which generally will not cause serious consequences.
10.2 bladder rupture, bladder wall continuity destroyed, urine extravasation, and its corresponding symptoms appeared. According to the position relationship between rupture orifice and peritoneum, bladder rupture can be divided into three categories:
(1) Extraperitoneal bladder rupture: the bladder wall is ruptured, but the peritoneum is intact. It is often a complication of pelvic fracture, and the rupture is mostly located at the bottom of the bladder. Urine extravasates to the tissues around the bladder and retropubic space, and extends to the subcutaneous of the anterior abdominal wall, along the pelvic fascia to the pelvic floor, or along the loose tissues around the ureter to the renal area. The injury site is more common in the anterior wall of bladder. Extraperitoneal bladder rupture is often accompanied by pelvic fracture. Pelvic fracture 1798 cases, including bladder rupture 18 1 case (10%). In another group of 259 cases of bladder rupture caused by pelvic fracture, 2 12 cases (82%) were extraperitoneal rupture. There were 47 cases (65438 0.2%) in abdominal cavity.
(2) Intraperitoneal bladder rupture: most of the bladder is full, and it breaks at the top of the weak bladder. The bladder wall rupture is accompanied by peritoneal rupture, and the bladder wall rupture communicates with the abdominal cavity, and urine flows into the abdominal cavity, causing peritonitis. The injury site is more common in the posterior wall and top of bladder. In a group of 100 cases of bladder rupture, 50% were extraperitoneal rupture, 30% were intraperitoneal rupture, and 20% were extraperitoneal and intraperitoneal rupture. Exudated urine enters the abdominal cavity, causing urinary peritonitis (Figure 2).
(3) Mixed bladder rupture: It has the above two types at the same time, and the injury is generally serious, often complicated with other organ injuries.
1 1 Clinical manifestations of bladder injury The degree of bladder injury is different, and its clinical manifestations are different.
1 1. 1 The clinical manifestation of bladder contusion is mild. Because the continuity of the bladder wall has not been destroyed, there may be no obvious symptoms, or only dull pain and discomfort in the lower abdomen and slight hematuria. Sometimes, frequent urination occurs due to the bladder mucosa, which can generally heal itself in a short time.
1 1.2 clinical manifestations of bladder rupture (1) shock: patients with bladder rupture complicated with other organ injuries or severe bleeding from pelvic fractures are prone to hemorrhagic shock; In the case of bladder rupture in peritoneum, the exuding urine * * * peritoneum causes peritonitis, leading to severe abdominal pain, and infectious urine * * * plays a stronger role, which can also lead to shock. Someone counted 57 cases of bladder rupture and found that 34 cases (60%) had shock symptoms.
(2) Abdominal pain: When the intraperitoneal bladder ruptures, urine seeps into the abdominal cavity, and the pain spreads from the lower abdomen to the whole abdomen with the urine, resulting in signs of peritonitis such as abdominal muscle tension, tenderness and rebound pain. When the extraperitoneal bladder ruptures, the spilled urine and blood gather around the pelvic bladder. The patient's lower abdomen is dilated, and the pain is located in the pelvis and lower abdomen, with tenderness and muscle tension. Sometimes pain can radiate to the rectum, perineum and lower limbs. When accompanied by pelvic fracture, the pain is more serious.
(3) Dysuria and hematuria: The bleeding of patients with bladder rupture often overflows from the rupture mouth with urine, and the bladder may urinate frequently due to urine extravasation, but generally urine cannot be discharged from the urethral orifice or only a small amount of hematuria can be discharged, and a large amount of hematuria rarely occurs.
(4) Urinary fistula: In patients with open bladder injury, urine can be seen flowing from the wound. If gas or feces are discharged from the wound at the same time, or urine is discharged from the rectum or * * * *, it means that there is a bladder fistula or a bladder fistula at the same time.
12 Complications of bladder injury Bladder injury is often accompanied by pelvic or abdominal organ injury, which belongs to compound injury. It is not easy to get a definite diagnosis at once, and the possibility of bladder injury is often ignored because attention is focused on abdominal organs or blood vessels, pelvis and other injuries. Especially in patients with intraperitoneal bladder rupture, if the diagnosis is uncertain, the incidence of peritonitis will increase significantly and the mortality will also increase. According to statistics, it is above 10%.
13 laboratory examination and blood routine showed leukocytosis; Urine routine showed that red blood cells filled the visual field and urine occult blood test was positive. Due to the absorption of urine, blood biochemical examination showed that urea nitrogen and creatinine values increased.
14 auxiliary examination 14. 1 intravesical water injection test found bladder emptying or only a small amount of hematuria. A certain amount of sterile physiological saline (100 ~ 150 ml) was injected into the bladder through a catheter, and it was extracted after a period of time; If the amount of liquid pumped out is obviously less than or more than that injected, it suggests that there is a possibility of bladder rupture.
14.2 cystography: inject 300 ~ 400 ml of contrast agent into the bladder, and take pictures in the anteroposterior position, oblique position or when the contrast agent is discharged. According to the leakage of contrast agent, the diagnosis, type and degree of bladder rupture can be made clear.
14.3 cystoscopy can diagnose bladder contusion.
14.4 B ultrasound can detect the morphology of bladder. If there is no bladder rupture, the bladder can be detected completely. If there is a bladder rupture, the bladder can't fill, and the shape of the bladder will change. If combined with water injection test, we can detect whether the bladder can be filled and where the liquid flows in, which will also be helpful to the types of bladder injury. Detection of "ascites" in abdominal cavity is also helpful for peritoneal bladder rupture.
14.5 If the patient has signs of peritonitis or the bladder rupture in the abdominal cavity is suspected by the above cystography, abdominal puncture is feasible. If the patient has obvious abdominal distension, puncture should be cautious to avoid hurting the intestine. When the liquid is obtained by puncture, routine examination can be performed, and urea nitrogen content can also be measured (it can be compared with urea nitrogen in blood and urine to judge whether urine flows into abdominal cavity).
14.6 Computed X-ray tomography (CT) has the characteristics of clear images and high density resolution, which can clearly show the contours, structures and injuries (lesions) of various organs of the brain, chest, abdomen and pelvis. It can accurately and stereoscopically judge the shape, size, position and adjacent relationship of tissues and organs. Especially when compound injury occurs, it can make a comprehensive and timely diagnosis of multiple organ injuries. CT examination is a safe and non-invasive examination. The examination site can be selected according to the patient's injury. For example, the liver and spleen can be scanned if liver and spleen damage is suspected. If there is urinary tract injury, kidney and bladder examination is feasible. Generally, the bladder should be checked when it is full. If there is no urine, the catheter can be inserted for water injection inspection or contrast agent injection inspection. You can observe the shape of the bladder, the structure around the bladder, and whether there is urine extravasation. CT examination can distinguish the density of tissue structure and determine the scope of urine overflow. Generally, there is only lower abdominal injury, and CT examination is not done except pelvic or abdominal plain film. If you still have doubts about the above cystography, you can consider CT examination.
14.7 magnetic resonance imaging (MRI) MRI not only provides more information than other imaging methods in medical imaging, but also has no X-ray radiation. The parameters involved in imaging are proton density and proton relaxation time constant (T 1, T2) of hydrogen nuclei in human tissues, that is, the motion characteristics of protons. Nuclear magnetic resonance still belongs to computer imaging, and all imaging is tomography. The advantages of MRI are as follows: ① images of cross section, sagittal plane, coronal plane and various inclined planes can be made directly; ②CT images have no artifacts; ③ No ionizing radiation, no adverse effects on the body; ④ Cardiac cavity, vascular cavity, urinary tract and nervous system can be developed without injection of contrast agent. For urinary tract, MRI hydrography can be performed without injection of contrast agent, and the image can be displayed as clearly as intravenous urography. If there is urinary extravasation, blood vessel injury and other parts of the injury, especially when there are organ, blood vessel and nervous system injuries, it is necessary to make a diagnosis in time. Nuclear magnetic resonance is a good examination method.
15 diagnosis 15. 1 patients with bladder injury often have a clear history of trauma, such as a history of violence or stabbing in the pelvis or lower abdomen, abdominal pain after injury, urination but unable to urinate or only a small amount of hematuria. In severe cases, the patient may go into shock. Although spontaneous bladder rupture has no clear history of trauma, it has a history of primary bladder disease or lower urinary tract obstruction, which usually occurs when abdominal pressure rises sharply due to forced urination and defecation. Iatrogenic bladder injury also has a corresponding history.
15.2 physical examination patients with bladder contusion often have no obvious signs. Patients with bladder rupture will find corresponding signs during physical examination. The palpation of tenderness and muscle tension in the lower abdomen showed moving dullness, and the finger palpation of the rectum touched the filling of the anterior wall of the rectum, indicating the rupture of the extraperitoneal bladder. Total abdominal tenderness and rebound pain suggest intraperitoneal bladder rupture. Urine was found to flow from the wound, indicating open bladder injury.
16 differential diagnosis 16. 1 urethral injury is often caused by pelvic fracture or riding injury. The patient may have symptoms such as shock, dysuria and urethral bleeding, but there are no symptoms such as abdominal pain, bloating, intestinal paralysis and abdominal muscle tension. Physical examination showed that the bladder was full and the urine was clear without hematuria. When pelvic fracture leads to rupture of membranous urethra, rectal digital examination can touch the tip of prostate and move backward, making it feel floating. The above can be differentiated from simple bladder injury.
16.2 acute peritonitis includes abdominal pain, abdominal muscle tension, tenderness and rebound pain. Similar to the peritoneal symptoms caused by urine leaking into abdominal cavity. However, acute peritonitis has no history of trauma, and is often secondary to diseases such as perforation of gastric and duodenal ulcer, acute appendicitis and acute gallbladder perforation. Generally, there are clinical manifestations of primary disease first, and then it develops into acute peritonitis. No dysuria or hematuria can be identified by catheterization, intravesical water injection test or cystography.
16.3 Abdominal organ injuries are mainly liver and spleen rupture, accompanied by abdominal pain, hemorrhagic shock and other critical symptoms. There are obvious peritoneal symptoms and signs. No dysuria and hematuria symptoms. Blood was taken by abdominal puncture, and no red blood cells were found in urine. Catheterization, intravesical water injection test or cystography will be helpful for differential diagnosis.
16.4 Ovarian rupture is more common in women aged 14 ~ 30, mainly characterized by severe lower abdominal pain, abdominal distension with urination, and heavy feeling after urgency. Symptoms and signs of peritoneum may appear. Severe cases can cause hemorrhagic shock. The disease mostly occurs during and after ovulation, and there is no history of menopause, dysuria, hematuria and urinary extravasation. It can be identified by catheterization, intravesical water injection test or cystography.
16.5 ovarian cyst or torsion of tumor pedicle showed sudden severe abdominal pain, localized muscle tension and other peritoneal symptoms and signs; Similar to the peritoneal symptoms caused by bladder rupture and urine leaking into abdominal cavity. However, ovarian cysts or torsion of tumor pedicle are mostly caused by * * * changes during pregnancy or changes in uterine position. No history of trauma or surgery, dysuria, hematuria or urinary extravasation. Gynecological examination can find a lump with obvious tenderness and great tension. It can be identified by catheterization, intravesical water injection test or cystography.
17 Treatment of Bladder Injury 17. 1 Non-surgical treatment of bladder contusion generally does not require special treatment. Please drink plenty of water and have a proper rest. In severe cases, urethral intubation can be used to drain urine, and antibiotics can be given if necessary.
For patients with extraperitoneal bladder rupture, simple transurethral intubation was used 50 years ago, but it was gradually forgotten because of many complications. Since 1970s, there have been more and more clinical reports. It is generally believed that the rupture of extraperitoneal bladder can be handled in this way, regardless of the size of the rupture and the amount of exudation. However, in 29 cases treated by Kotkin et al, 26% had complications, including delayed bladder healing, urinary extravasation infection and pelvic hematoma infection complicated with sepsis. The main reason of failure is that there is no preventive use of antibiotics to treat urinary tract infection and catheter drainage is not smooth.
In view of this, some doctors suggested that the indications should be strictly selected when simply draining urine for extraperitoneal bladder rupture, and the following matters should be paid attention to: ① The diagnosis must be made within 12h; ② No other complicated injuries requiring surgical exploration; ③ No previous history of urinary tract infection; (4) The fissure is not big, and there is no obvious bleeding; ⑤ The diameter of the inserted catheter should be large enough, not less than 24F for adults, and the drainage should be smooth. If this goal cannot be achieved within 24 ~ 48h, we should change to surgical exploration. ⑥ Observe the condition closely and operate at any time if there are indications; ⑦ Preventive use of broad-spectrum antibiotics, especially drugs for gram-negative bacilli.
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17.2 the surgical treatment of open bladder injury should be explored quickly in order to understand not only bladder injury, but also other complications. Surgical repair is safer for patients with intraperitoneal bladder rupture. It has been proved that it is natural for patients with abdominal injury to treat bladder at the same time through surgical exploration. The principles of surgical treatment include fully cleaning the leaked urine around the bladder and other parts, repairing the bladder wall defect, and keeping the urine flow away from the injured part.
Unless a special incision is needed due to other complicated injuries, a midline incision on the pubic bone can generally be adopted, and it can be extended upwards if necessary. Cut the anterior sheath of rectus abdominis and separate rectus abdominis, that is, see the hematoma around the bladder. First, the peritoneum is cut open to explore whether there is abdominal organ damage. If there is abdominal organ injury, the bladder should be explored after proper treatment. For patients with intraperitoneal bladder rupture, suture the bladder rupture with 30 or 40 intestinal lines for two or three layers, suck out peritoneal urine and suture the peritoneum. If it is an extraperitoneal bladder rupture, cut the front wall of the bladder, explore the position, size and number of the bladder rupture, and repair it in it. Don't widely separate it, and look for the rupture in the layman. In the process of exploration, we should pay close attention to bilateral ureteral openings, especially firearm injuries. If in doubt, 5ml of 0.4% indigo carmine can be injected intravenously, and blue urine can be discharged from its opening in 5 ~ 8 minutes, indicating that the ureter is not damaged; You can also insert a ureteral catheter into the problematic ureter. When clear urine flows out of the catheter, it also means that the ureter is not damaged. Special care should be taken when sewing the fissure near the bladder neck to avoid injuring the sphincter. No matter what kind of bladder rupture, suprapubic cystostomy should be performed after operation, and drainage should be placed around the bladder.
Management of bladder rupture with membranous urethral injury: it is not uncommon for bladder and urethra to rupture at the same time due to trauma, and its incidence rate is 10% ~ 29%. ① After several hours, patients with posterior urethral injury and pelvic fracture still can't feel the swollen bladder on the pubic bone, and the patient has no obvious hypotension, so the possibility of bladder rupture should be considered. ② Patients with pelvic fracture accompanied with urethral injury and multiple injuries should also pay attention to the existence of bladder rupture. ③ Urography should be actively arranged for patients with blood or hematuria at the urethral orifice after lower abdominal crush injury. ④ If the patients with pelvic fracture and urethral injury have no obvious signs of dehydration and no previous history of renal disease, the possibility of bladder rupture in abdominal cavity should be suspected. ⑤ When patients with pelvic fracture and urethral injury need surgical exploration due to intra-abdominal injury, bladder, especially bladder, should be explored. ⑥ Once diagnosed, simple transurethral intubation or suprapubic intubation will easily lead to serious complications. It is best to repair the bladder rupture first, and as for the posterior urethral rupture, choose the corresponding treatment.
The prognosis of 18 shows that the healing ability of bladder is very strong, and if it is handled in time and properly, few complications will occur. Urgency, frequent urination or bladder instability may occur in the early stage after injury, and will gradually return to normal with the extension of time. The bladder infection caused by catheter was treated with appropriate antibiotics, and the effect was satisfactory. As long as there is no obstruction of urethra, urinary fistula is rarely formed after suprapubic fistula resection. The mortality rate of bladder injury is still high. It is reported that it is 15.6% ~ 22%, which is mainly caused by concurrent injury, while the bladder injury is related to delayed diagnosis and improper treatment.
19 related drugs oxygen, urea and indigo carmine
20 Related examination of urea nitrogen and blood urea nitrogen.
The acupoint bladder for treating bladder injury, that is, it enters between the fascia and rectum after Dinonville, which will damage the rectum and cause fecal fistula. Inside the bladder: The inside of the bladder is divided into triangular area and triangular area. ...
Bladder genitalia and external * * *. For patients with urinary incontinence, acupuncture should be performed after urination to prevent bladder injury. Urine should be emptied before injection. Pregnant women should use it with caution. Moxibustion: moxibustion is acceptable. moxa cone ...
Gas fish genitals and external * * *. For patients with urinary incontinence, acupuncture should be performed after urination to prevent bladder injury. Urine should be emptied before injection. Pregnant women should use it with caution. Moxibustion: moxibustion is acceptable. moxa cone ...
Qi external genitalia and external * *. For patients with urinary incontinence, acupuncture should be performed after urination to prevent bladder injury. Urine should be emptied before injection. Pregnant women should use it with caution. Moxibustion: moxibustion is acceptable. moxa cone ...
Urine cell