【AUA指南】泌尿系损伤（UROTRAUMA）

|本文件于2017年4月修订

Renal Trauma

肾损伤

1.Clinicians should perform diagnostic imaging with intravenous (IV) contrast enhanced computed tomography (CT) in stable blunt trauma patients with gross hematuria or microscopic hematuria and systolic blood pressure < 90mmHG. (Standard; Evidence Strength: Grade B)

1.临床医生应使用静脉（IV）对比增强计算机断层扫描（CT）对患有肉眼血尿或镜下血尿和收缩压<90mmHG的稳定性钝性创伤患者进行诊断性成像。(标准;证据强度：B级)

2.Clinicians should perform diagnostic imaging with IV contrast enhanced CT in stable trauma patients with mechanism of injury or physical exam findings concerning for renal injury (e.g., rapid deceleration, significant blow to flank, rib fracture, significant flank ecchymosis, penetrating injury of abdomen, flank, or lower chest). (Recommendation; Evidence Strength: Grade C)

2.临床医生应对稳定创伤患者使用静脉（IV）对比增强计算机断层扫描（CT）进行诊断性成像，包括损伤机制或肾损伤的体格检查结果（如快速减速、侧翼明显打击、肋骨骨折、明显的侧瘀斑、腹部、侧翼或下胸部穿透性损伤）。(推荐；证据强度：C级)

3.Clinicians should perform IV contrast enhanced abdominal/pelvic CT with immediate and delayed images when there is suspicion of renal injury. (Clinical Principle)

3.当怀疑有肾损伤时，临床医师应做增强腹部/盆腔CT静脉造影，包括即时和延迟图像。(临床原则)

4.Clinicians should use non-invasive management strategies in hemodynamically stable patients with renal injury. (Standard; Evidence Strength: Grade B)

4.临床医生应使用无创的策略管理血液动力学稳定的患者肾损伤。 (标准；证据强度：B 级)

5.The surgical team must perform immediate intervention (surgery or angioembolization in selected situations) in hemodynamically unstable patients with no or transient response to resuscitation. (Standard; Evidence Strength: Grade B)

5.对于血液动力学不稳定的患者，手术团队必须立即进行干预（手术或血管栓塞治疗）。 (标准；证据强度：B 级)

6.Clinicians may initially observe patients with renal parenchymal injury and urinary extravasation. (Clinical Principle)

6.临床医生可以初步观察肾实质损伤和尿外渗的患者。（临床原则）

7.Clinicians should perform follow-up CT imaging for renal trauma patients having either (a) deep lacerations (AAST Grade IV-V) or (b) clinical signs of complications (e.g., fever, worsening flank pain, ongoing blood loss, abdominal distention). (Recommendation; Evidence Strength: Grade C)

7.临床医生应对有以下并发症（如发烧、腰痛加重、持续失血、腹胀）的肾外伤患者进行随访CT检查。结果为：（a）深度撕裂伤（AAST等级IV-V）；或（b）临床症状（如发热、腰痛加剧、持续出血、腹胀）。(推荐；证据强度：C级)

8.Clinicians should perform urinary drainage in the presence of complications such as enlarging urinoma, fever, increasing pain, ileus, fistula or infection. (Recommendation; Evidence Strength: Grade C) Drainage should be achieved via ureteral stent and may be augmented by percutaneous urinoma drain, percutaneous nephrostomy or both. (Expert Opinion)

8.临床医生应在出现尿管扩大、发热、疼痛加重、肠梗阻、瘘管或感染等并发症时进行引流。(推荐；证据强度：C级)引流应该通过输尿管支架来实现，也可以通过经皮肾造瘘或两者同时进行。(专家意见)

Ureteral Trauma

输尿管损伤

9a.Clinicians should perform IV contrast enhanced abdominal/pelvic CT with delayed imaging (program) for stable trauma patients with suspected ureteral injuries. (Recommendation; Evidence Strength: Grade C)

9a.临床医生应该对疑似输尿管损伤的稳定创伤患者行静脉（IV）对比腹部/盆腔CT增强扫描，并进行延迟成像(项目)。(推荐；证据强度：C级)

9b.Clinicians should directly inspect the ureters during laparotomy in patients with suspected ureteral injury who have not had preoperative imaging. (Clinical Principle)

9b.临床医生应在无术前影像学检查怀疑输尿管损伤的患者开腹手术中直接检查输尿管。(临床原则)

10a.Surgeons should repair traumatic ureteral lacerations at the time of laparotomy in stable patients. (Recommendation; Evidence Strength: Grade C)

10a.术者应在手术稳定的患者中修补外伤性输尿管裂伤。(推荐；证据强度：C级)

10b.Surgeons may manage ureteral injuries in unstable patients with temporary urinary drainage followed by delayed definitive management. (Clinical Principle)

10b.外科医师可能处理不稳定患者的输尿管损伤临时尿液引流，然后延迟最终治疗。 (临床原则)

10c.Surgeons should manage traumatic ureteral contusions at the time of laparotomy with ureteral stenting or resection and primary repair depending on ureteral viability and clinical scenario. (Expert Opinion)

10c.外科医生应根据输尿管的存活性和临床情况，在开腹手术、切除或一期修复的同时处理外伤性输尿管挫伤。(专家意见)

11a.Surgeons should attempt ureteral stent placement in patients with incomplete ureteral injuries diagnosed postoperatively or in a delayed setting. (Recommendation; Evidence Strength: Grade C)

11a.对于手术后诊断不完全或延迟放置输尿管损伤的患者，外科医生应尝试放置输尿管支架。(推荐；证据强度：C级)

11b.Surgeons should perform percutaneous nephrostomy with delayed repair as needed in patients when stent placement is unsuccessful or not possible. (Recommendation; Evidence Strength: Grade C)

11b.当支架置入不成功或不可能时, 外科医生应进行经皮肾造口术, 并根据需要延迟修复。(推荐；证据强度：C 级)

11c.Clinicians may initially manage patients with ureterovaginal fistula using stent placement. In the event of stent failure, clinicians may pursue additional surgical intervention. (Expert Opinion)

11c.临床医生最初可能使用支架置入来治疗输尿管阴道瘘患者。如果支架置入失败，临床医生可能会采取额外的手术干预。(专家意见)

12a.Surgeons should repair ureteral injuries located proximal to the iliac vessels with primary repair over a ureteral stent, when possible. (Recommendation; Evidence Strength: Grade C)

12a.如果可能的话，外科医师应该修复位于髂血管附近的输尿管损伤，并通过输尿管支架进行一期修复。(推荐；证据强度：C级)

12b.Surgeons should repair ureteral injuries located distal to the iliac vessels with ureteral reimplantation or primary repair over a ureteral stent, when possible. (Recommendation; Evidence Strength: Grade C)

12b.如果可能的话，外科医师应该用输尿管再植或者在输尿管支架上进行一次修复，来修复位于髂血管远端的输尿管损伤。(推荐；证据强度：C级)

13a.Surgeons should manage endoscopic ureteral injuries with a ureteral stent and/or percutaneous nephrostomy tube, when possible. (Recommendation; Evidence Strength: Grade C)

13a.如果可能的话，外科医生应该用输尿管支架和/或经皮肾造口置管来处理输尿管损伤。(推荐；证据强度：C级)

13b.Surgeons may manage endoscopic ureteral injuries with open repair when endoscopic or percutaneous procedures are not possible or fail to adequately divert the urine. (Expert Opinion)

13b.当内镜或经皮肾造瘘不可能或不能适当地将尿液改道时，外科医生可以通过开放修补术来处理内镜输尿管损伤。(专家意见)

Bladder Trauma  

膀胱损伤

14a.Clinicians must perform retrograde cystography (plain film or CT) in stable patients with gross hematuria and pelvic fracture. (Standard; Evidence Strength: Grade B)

14a.临床医生必须对稳定性大血尿和骨盆骨折的患者进行逆行性膀胱造影（平片或CT）检查。 (标准；证据强度：B 级)

14b.Clinicians should perform retrograde cystography in stable patients with gross hematuria and a mechanism concerning for bladder injury, or in those with pelvic ring fractures and clinical indicators of bladder rupture. (Recommendation; Evidence Strength: Grade C)

14b.对于稳定性血尿和膀胱损伤的患者，以及骨盆环骨折和膀胱破裂临床指标患者，临床医生应进行膀胱逆行造影检查。(推荐；证据强度：C级)

15.Surgeons must perform surgical repair of intraperitoneal bladder rupture in the setting of blunt or penetrating external trauma. (Standard; Evidence Strength: Grade B)

15.外科医生必须在钝器或穿透性外伤的情况下对腹膜内膀胱破裂进行外科修复。 (标准；证据强度：B 级)

16.Clinicians should perform catheter drainage as treatment for patients with uncomplicated extraperitoneal bladder injuries. (Recommendation; Evidence Strength: Grade C)

16.对于无并发症的腹膜外膀胱损伤，临床医生应采用导尿管引流治疗。(推荐；证据强度：C级)

17.Surgeons should perform surgical repair in patients with complicated extraperitoneal bladder injury. (Recommendation; Evidence Strength: Grade C)

17.对于有复杂腹膜外膀胱损伤的患者，外科医师应进行手术修复。(推荐；证据强度：C级)

18.Clinicians should perform urethral catheter drainage without suprapubic (SP) cystostomy in patients following surgical repair of bladder injuries. (Standard; Evidence Strength: Grade B)

18.在膀胱损伤修复后，临床医师应在不行耻骨上膀胱造瘘的情况下行导尿管引流。 (标准； 证据强度：B 级)

Urethral Trauma  

尿道损伤 

19.Clinicians should perform retrograde urethrography in patients with blood at the urethral meatus after pelvic trauma. (Recommendation; Evidence Strength: Grade C)

19.临床医师应对骨盆外伤后尿道口出血患者行逆行尿道造影。(推荐；证据强度：C级)

20.Clinicians should establish prompt urinary drainage in patients with pelvic fracture associated urethral injury. (Recommendation; Evidence Strength: Grade C)

20.对于骨盆骨折伴尿道损伤的患者，临床应及时建立引流。(推荐；证据强度：C级)

21.Surgeons may place suprapubic tubes (SPTs) in patients undergoing open reduction internal fixation (ORIF) for pelvic fracture. (Expert Opinion)

21.在骨盆骨折行切开复位内固定（ORIF）的患者中，外科医生可以放置耻骨上管（SPTs）。(专家意见)

22.Clinicians may perform primary realignment (PR) in hemodynamically stable patients with pelvic fracture associated urethral injury. (Option; Evidence Strength: Grade C) Clinicians should not perform prolonged attempts at endoscopic realignment in patients with pelvic fracture associated urethral injury. (Clinical Principle)

22.对于骨盆骨折合并尿道损伤的血流动力学稳定患者，临床医生可能会进行初步的重新校准（PR）。（期权；证据强度：C级）对于骨盆骨折伴尿道损伤的患者，临床医生不应进行长时间的内镜修复。（临床原则）

23.Clinicians should monitor patients for complications (e.g., stricture formation, erectile dysfunction, incontinence) for at least one year following urethral injury. (Recommendation; Evidence Strength: Grade C)

23.尿道损伤后, 临床医生应监测患者的并发症 (如狭窄形成、勃起功能障碍、尿失禁) 至少一年。(推荐；证据强度：C 级)

24.Surgeons should perform prompt surgical repair in patients with uncomplicated penetrating trauma of the anterior urethra. (Expert Opinion)

24.对于无并发症的前尿道穿透性损伤，外科医生应及时进行手术修复。(专家意见)

25.Clinicians should establish prompt urinary drainage in patients with straddle injury to the anterior urethra. (Recommendation; Evidence Strength: Grade C)

25.临床医师应在前尿道损伤患者中及时建立尿液引流。(推荐；证据强度：C级)

Genital Trauma 

生殖创伤

26.Clinicians must suspect penile fracture when a patient presents with penile ecchymosis, swelling, cracking or snapping sound during intercourse or manipulation and immediate detumescence. (Standard; Evidence Strength: Grade B)

26.当阴茎出现瘀斑、肿胀、破裂或咬合声音，以及立即消肿时，临床医生必须怀疑阴茎骨折。(标准；证据强度：B 级)

27.Surgeons should perform prompt surgical exploration and repair in patients with acute signs and symptoms of penile fracture. (Standard; Evidence Strength: Grade B)

27.对于阴茎骨折急性体征和症状的患者，外科医生应及时进行手术探查和修复。 (标准；证据强度：B 级)

28.Clinicians may perform ultrasound in patients with equivocal signs and symptoms of penile fracture. (Expert Opinion) 

28.临床医生可以对有不明确体征和阴茎骨折症状的患者进行超声检查。(专家意见)

29.Clinicians must perform evaluation for concomitant urethral injury in patients with penile fracture or penetrating trauma who present with blood at the urethral meatus, gross hematuria or inability to void. (Standard; Evidence Strength: Grade B)

29.临床医生必须对阴茎骨折或穿透性外伤患者并发尿道损伤进行评估，这些患者在尿道口处有血尿，肉眼血尿或无法排尿。 (标准；证据强度：B 级)

30.Surgeons should perform scrotal exploration and debridement with tunical closure (when possible) or orchiectomy (when non-salvagable) in patients with suspected testicular rupture. (Standard; Evidence Strength: Grade B)

30. 外科医生应在疑似睾丸破裂的患者中进行阴囊探查和清创, 并进行手术治疗 (如有可能) 或睾丸切除术 (当无挽救可能时)。（标准；证据强度：B级）

31.Surgeons should perform exploration and limited debridement of non-viable tissue in patients with extensive genital skin loss or injury from infection, shearing injuries, or burns (thermal, chemical, electrical). (Standard; Evidence Strength: Grade B)

31.对于因感染、剪伤或烧伤（热、化学、电）而导致生殖器皮肤大面积损失或损伤的患者，外科医生应进行探查和有限的组织清创。(标准；证据强度：B 级)

32.Surgeons should perform prompt penile replantation in patients with traumatic penile amputation, with the amputated appendage wrapped in saline-soaked gauze, in a plastic bag and placed on ice during transport. (Clinical Principle)

32.在阴茎离断伤时，手术者应及时行阴茎再植，同时将切除的附件用盐水纱布包裹，放在塑料袋内，并在运输过程中加冰敷。（临床原则）

33.Clinicians should initiate ancillary psychological, interpersonal, and/or reproductive counseling and therapy for patients with genital trauma when loss of sexual, urinary, and/or reproductive function is anticipated. (Expert Opinion)

33.临床医生应该开始辅助的心理，人际，和/或生殖咨询和治疗生殖创伤的患者，预计失去性，泌尿系统和/或生殖功能损伤时。(专家意见)

编辑：榭小仙

审核：陈仁宗 付光