№ 1
* 1 - one correct answer
Sign of complete rupture of the urethra
1) lack of urine
2) hematuria
3) beer-colored urine
4) piss-colored urine
! 1
№ 2
* 1 - one correct answer
Sign of a bruised kidney
1) false urge to urinate
2) pain when urinating
3) a positive symptom of Shchetkin-Blumberg
4) micro or gross hematuria
! 4
№ 3
* 1 - one correct answer
Additional study confirming bladder damage
1) general urine analysis
2) cystography
3) test according to Zemnitsky
4) excretory urography
! 2
№ 4
* 1 - one correct answer
First aid for bladder injury
1) catheterization
2) ice pack
3) diuretics
4) nitrofuran drugs
! 2
№ 5
* 1 - one correct answer
First aid for acute urinary retention due to prostate adenoma
1) ice pack
2) diuretics
3) pain relievers
4) catheterization
! 4
№ 6
* 1 - one correct answer
Symptom Confirming Intraperitoneal Bladder Rupture
1) soft belly
2) Shchetkin-Blumberg symptom
3) Sitkovsky symptom
4) bleeding from the urethra
! 2
№ 7
* 1 - one correct answer
Use a solution to flush the bladder
1) furacilin
2) hydrogen peroxide
3) physiological
4) pervomura
! 1
№ 8
* 1 - one correct answer
First aid for kidney injury
1) narcotic drugs
2) cold, urgent hospitalization
3) warm
4) diuretics
! 2
№ 9
* 1 - one correct answer
Urohematoma is a reliable symptom
1) kidney injury
2) damage to the renal parenchyma and pelvis
3) damage to the spleen
4) adrenal injury
! 2
№ 10
* 1 - one correct answer
Does not apply to methods of research of the urinary system
1) cystoscopy
2) choledochoscopy
3) isotope renography
4) ultrasound
! 2
№ 11
* 1 - one correct answer
When renal colic the most characteristic is the irradiation of pain in
1) the umbilical region
2) groin and thigh
3) shoulder
4) epigastrium
! 2
№ 12
* 1 - one correct answer
The cause of pain in renal colic
1) urge to urinate
2) difficulty urinating
3) ureteral spasm and trauma to the ureteral mucosa
4) ascending infection
! 3
№ 13
* 1 - one correct answer
To relieve an attack of renal colic, you must enter
1) lasix
2) diphenhydramine
3) no-shpu
4) dibazol
! 3
№ 14
* 1 - one correct answer
Renal colic symptom
1) urinary incontinence
2) polyuria
3) acute pain in the lumbar region with irradiation along the ureter
4) stool and gas retention
! 3
№ 15
* 1 - one correct answer
Renal colic is a complication
1) hemangiomas of the bladder
2) urolithiasis
3) paranephritis
4) cystitis
! 2
№ 16
* 1 - one correct answer
Varicocele
1) an increase in the size of the testicle
2) varicose veins spermatic cord veins
3) cyst of the spermatic cord
4) inflammation of the spermatic cord
! 2
№ 17
* 1 - one correct answer
Differentiate urolithiasis with acute diseases of the abdominal organs allows
1) complete blood count
2) bladder catheterization
3) ultrasound of the abdominal cavity and urinary system
4) Kakovsky-Addis test
! 3
№ 18
* 1 - one correct answer
Diagnostic criterion for acute renal failure
1) growing edema
2) change in blood pressure
3) hourly urine output
4) hematuria
! 3
№ 19
* 1 - one correct answer
Urgent care for renal colic
1) antibiotics and bladder catheterization
2) diuretics and warmth
3) cold on the stomach and furagin
4) antispasmodics and warmth
! 4
№ 20
* 1 - one correct answer
The main diagnostic method for suspected kidney tumor
1) cystoscopy
2) renal angiography
3) plain urography
4) urine analysis according to Nechiporenko
! 2
№ 21
* 1 - one correct answer
Inflammation of the prostate gland is called
1) dropsy
2) prostatitis
3) epididymitis
4) varicocele
! 2
№ 22
* 1 - one correct answer
Phimosis is
1) inflammation foreskin
2) narrowing of the foreskin
3) infringement of the glans penis
4) damage to the foreskin
! 2

Kidney cancer

In the structure of oncological pathologies, renal cancer is a relatively rare disease, however, its danger cannot be underestimated, since, in addition to its own malignant nature, this type of tumor produces rapid metastasis.

Until now, doctors do not know the causes of this type of cancer. It is not clear why in some years the incidence in children increases sharply, while in others this is not observed. But, nevertheless, provoking factors have been known to doctors for a long time.

First of all, this is a hereditary pathology - how genetic diseasesand an unfavorable family history of cancer. The incidence of cancer increases in men over 40 years of age, as well as in the black race. Smoking doubles the risk of kidney cancer, as does working with toxic substances and petroleum products. The systematic use of certain drugs, including diuretics and blood pressure lowering drugs, as well as obesity, hypertension, or chronic kidney disease are also risk factors for renal cancer.

Symptoms and Treatment

Kidney cancer develops rather slowly, so there are practically no symptoms of the initial stages. A change in the color of urine due to the ingress of blood into it - hematuria - is noticed by patients by chance, just as this cancer is accidentally diagnosed by ultrasound or X-ray examination. Thus, hematuria is the leading symptom of kidney cancer. Later, pain in the side on the side of the affected kidney joins it; in thin people, you can palpate a change in the contours of the kidney and its consistency. Swelling and signs of hypertension appear. Then symptoms similar to those in cancer develop: emaciation, anemia, weakness, temperature fluctuations. Sometimes kidney cancer is detected by randomly detecting blood in general analysis urine. Therefore, even with complaints of pain in the kidney area, urine tests are first carried out and at the same time - ultrasound, renal angiography (X-ray examination with contrast agent), computed tomography. The role of biopsy in this case is insignificant - both because of the inaccessibility and because of the complexity of the operation. Most often, the diagnosis is clarified during treatment, which in this case is practically the same - surgical. This is due to the fact that cancer cells from the kidneys with blood and lymph flow spread throughout the body, causing distant and regional metastases, which are much more dangerous in terms of prognosis. than the primary tumor of the kidney. The rest of the treatment methods are used as palliative, that is, in advanced, inoperable cases.

Treatment:
With localized renal cell carcinoma of the kidney, nephrectomy is performed, after which the 5-year survival rate is 40-70%.
Nephrectomy is also performed in the presence of metastases in the lungs, and sometimes in the bones.
An indication for surgery in such a situation may be the possibility of removing a large tumor, relieving the patient of painful symptoms (hematuria, pain).

Drug therapy is sometimes effective.
Fluorobenzotef is used - 40 mg IV 3 times a week for 2-3 weeks; tamoxifen - 20 mg / day for a long time.
The effectiveness of reaferon (3,000,000 IU / m daily, 10 days, interval - 3 weeks) was established for lung metastases.
Tumor regression or long-term stabilization of the disease occurs in 40% of patients with small sizes of lung metastases.
Therefore, after nephrectomy, patients should be closely monitored with chest x-ray every 3 months for 2 years.
With early detection of metastases, treatment success can be expected to a greater extent.

"NURSING PROCESS IN CIRCULATION DISORDER SYNDROME".

The death of cells and tissues in a living organism is called necrosis or necrosis.

Gangrene - This is a form of necrosis in which death is caused by the cessation of blood supply.

Factors causing necrosis:

1. Mechanical (direct crushing or tissue destruction),

2. Thermal (impact tt more than 60 g and less than 10 g.),

3. Electric (impact of electric current, lightning),

4. Toxic (under the influence of waste products of microorganisms - toxins),

5. Circulatory (cessation of blood supply in a certain part of the body or organ),

6. Neurogenic (damage to nerves, spinal cord - leads to disruption of the trophic innervation of tissues),

7. Allergic (necrosis due to incompatibility, hypersensitivity and reactions to foreign tissues and substances).

Types of necrosis:

1. Heart attack - an area of \u200b\u200ban organ or tissue that has undergone necrosis due to a sudden cessation of its blood supply.

2. Gangrene: dry -mummified necrosis.

wet - necrosis with putrefactive decay.

3. Bedsores - skin death.

Role of m / s in the study of patients with vascular disease:

1. Preparing the patient for examination:

Carry out the survey in a warm room,

Free up symmetrical parts of the limbs for inspection.

2. Clarification of patient complaints:

Pain in the calf muscles when walking, which disappears at rest ("intermittent claudication"),

Muscle weakness that increases with physical activity,

Paresthesia (numbness, creeping feeling) or anesthesia (lack of all types of sensitivity),

The swelling is persistent or appears late in the day.

3. Visual inspection:

The severity of the venous pattern with varicose veins,

Skin coloration (pallor, cyanosis, marbling),

Muscle wasting due to arterial disease

Dystrophic changes in the skin (thinning, hair loss, dryness, cracks, hyperkeratosis), and nail plates (color, shape, fragility),

4. Palpation:

The examiner measures the local t of various areas of the skin with the back of the hand,

Comparison of pulsation of arteries in symmetrical parts of the limbs,

The presence of a seal along the superficial veins.

5. Measuring the volume of the extremities in symmetrical areas reveals the severity of edema.

Obliterating endarteritis:

More often in men 20-30 years old, more often on the lower limbs.

Factors contributing to development:

Smoking!

Prolonged hypothermia

Frostbite,

Lower limb injuries

Emotional shocks

Violation of autoimmune processes.

First, the arteries of the foot and lower leg are affected, then more often the large large arteries (popliteal, femoral, iliac). A sharp weakening of blood flow leads to tissue hypoxia, blood thickening, gluing of erythrocytes - the formation of blood clots - dystrophic changes in the tissues - necrosis.

Clinic:

Depending on the degree of insufficiency of the arterial blood supply, they are distinguished 4 stages of obliterating endarteritis:

Stage 1: stage of functional compensation... Characterized by chilliness, tingling and burning sensation in the fingertips, increased fatigue, fatigue. When cooled, the limbs become pale in color, become cold to the touch. When walking - "intermittent chromate" when walking 1000 m. PS on the arteries of the foot is weakened or absent.

Stage 2: stage of subcompensation. "Intermittent claudication" occurs after passing 200 m. The skin of the feet and legs is dry, peeling, hyperkeratosis (heels, sole), the growth of nails slows down, they are thickened, brittle, dull, matte. Atrophy of subcutaneous adipose tissue. PS is absent on the arteries of the foot.

Stage 3: decompensation stage... Pain in the affected limb at rest. The patient walks without stopping no more than 25-30 m. The skin is pale in a horizontal position, when lowering - purple-cyanotic. Minor injuries lead to the formation of cracks, painful ulcers. Muscle atrophy progresses. The ability to work is reduced.

Stage 4: stage of destructive changes... Pain in the feet and fingers becomes constant and unbearable. Sleep - sitting. Trophic ulcers are formed on the fingers, swelling of the foot and lower leg. PS is not defined throughout. The ability to work is completely lost. Gangrene of the fingers, feet, legs develops.

Treatment:

1. Elimination of the impact of adverse factors (quit smoking).

2. Elimination of vasospasm (antispasmodics - nikoshpan, galidor, etc.).

3. Drugs that improve metabolic processes in tissues (angioprotectors) - Actovegin, B vitamins, etc.

4. Antiplatelet agents to normalize coagulation processes (courantil, trental, aspirin).

5. Analgesics + novocaine blockade paravertebral ganglia - to relieve pain.

6. Surgical treatment - lumbar sympathectomy (removal of sympathetic lumbar nodes), which eliminates spasm.

7. With decompensation - amputation.

Varicose veins:

This is a disease of the veins, accompanied by an increase in length, the presence of serpentine tortuosity of the saphenous veins and a saccular expansion of their lumen. Women get sick 3 times more often than men. Age from 40 to 60 years old.

Factors:

1. Predisposing: insufficiency of the valve apparatus of the veins, a decrease in the tone of the walls of the veins during pregnancy, menopause, puberty.

2. Producers: raising pressure in the veins - professional (sellers, teachers, surgeons, movers; compression of the veins - constipation, cough, pregnancy.

Clinic: the severity of the venous pattern, in the standing position (swelling, tension, tortuosity). Patients are worried about a cosmetic defect, a feeling of heaviness in the limbs by the end of the day, cramps in the calf muscles at night. The disease progresses slowly - trophic disorders develop. Edema appears on the feet and legs, cyanosis and skin pigmentation, and its thickening.

Conservative treatment:

While sleeping and resting, keep your legs in an elevated position,

When forced to stand for a long time, change the position of the legs more often,

Bandaging with an elastic bandage or wearing elastic stockings,

Wearing comfortable shoes,

Restriction of physical activity, - water procedures - swimming, foot baths,

Exercise therapy for n / limbs,

Regular blood tests (clotting, prothrombin index),

Angioprotectors (Detralex, Troxevasin, Escuzan),

Locally - ointments (heparin, troxevasin).

Sclerotherapy: Varicocide, thrombovar, ethoxysclerol are injected into varicose veins, causing thrombosis and venous obliteration.

Surgery:

Phlebectomy - removal of varicose veins,

Correction of valves in case of their failure, using special spirals.

Features of nursing patient care after phlebectomy:

Observing that the patient adheres to strict bed rest,

Sublime position for the operated limb on the Beler splint,

Observing the bandage and appearance patient, blood pressure, PS?

Applying an elastic bandage from the 2nd day and walking on crutches,

Ensuring asepsis during dressings,

Providing daily stool,

Helping a doctor to remove stitches on day 7-8,

Ensure that the patient wears an elastic bandage for 8-12 weeks after surgery.

Bedsore (decubitus) - aseptic necrosis of soft tissues due to impaired microcirculation caused by prolonged compression.

Soft tissue are compressed between the surface of the bed and the underlying bone protrusion during prolonged forced stay of seriously ill patients in a supine position. Places of occurrence of bedsores: sacrum, shoulder blades, nape, heels, back surface of the elbow joints, greater trochanter of the thigh.

In their development, bedsores pass 3 stages :

1. Stage of ischemia (pallor skin, violation of sensitivity).

2. Stage of superficial necrosis (swelling, hyperemia with areas of black or brown necrosis in the center).

3. Stage of purulent inflammation (accession of infection, development of inflammation, the appearance of purulent discharge, the penetration of the process into the depths, up to the defeat of muscles and bones).

Pressure sores can occur not only on the body, but also in internal organs. Prolonged stay of the drainage in the abdominal cavity can cause necrosis of the intestinal wall, with prolonged presence of the naso-gastric tube in the esophagus, necrosis in the mucous membrane of the esophagus and stomach can form, necrosis of the tracheal wall is possible with prolonged intubation.

Bedsores can form from compression of tissue with bandages or splints.

Treatment of pressure sores:

Stage 1: the skin is treated with camphor alcohol, it dilates blood vessels, improves blood circulation.

Stage 2: the affected area is treated with a 5% solution of permanganate K or alcohol solution brilliant green, which have a tanning effect, contribute to the formation of a scab that protects the bedsore from necrosis.

In 3 stages: carry out treatment on the principle of a purulent wound in accordance with the phase of the wound process.

The role of m / s in the prevention of pressure ulcers:

1. Early activation of the patient (if possible, get up, or consistently turn the patient over in bed).

2. Use of clean, dry, wrinkle-free laundry.

3. Anti-decubitus mattress, in the sections of which the pressure is constantly changing.

4. The use of rubber circles, "bagels" (placed under the most frequent localization of pressure ulcers).

5. Conducting massage.

6. Hygiene of the skin.

7. Skin treatment with antiseptics.

Bedsores are easier to prevent than cure!

Dry (coagulation) gangrene:

This is a gradual drying of dead tissues with a decrease in their volume (mummification), the formation of a demarcation (dividing) line.

Conditions for the development of dry gangrene:

1. Violation of blood circulation in a small limited area of \u200b\u200btissue.

2. Gradual start of the process.

3. Absence of fluid-rich tissues in the affected areas (muscles, adipose tissue).

4. Absence of pathogenic microbes in the area of \u200b\u200bcirculatory disorders.

5. Absence of concomitant diseases in the patient. Dry necrosis develops more often in patients with low nutrition, stable immunity.

Local treatment:

1. Treatment of the skin around the necrosis with antiseptics,

2. Applying a bandage with ethyl alcohol, boric acid, chlorhexidine.

3. Drying of the necrosis zone with 5% KMrO4 or brilliant green.

4. Excision of non-viable tissues - necrectomy (amputation of a toe, foot).

General treatment :

1. Treatment of the underlying disease.

Wet (coliquation) gangrene:

This is the sudden development of edema, inflammation, an increase in organ volume, the presence of pronounced hyperemia around the focus of necrosis, the appearance of blisters filled with serous and hemorrhagic contents. The process extends over considerable distances. A purulent and putrefactive infection joins, symptoms of general intoxication are expressed.

Conditions for the development of wet gangrene:

1. The emergence of OAN in a large area of \u200b\u200btissues (thrombosis).

2. Acute onset of the process (embolism, thrombosis).

3. The presence of fluid-rich tissues in the affected area (fat, muscles).

4. Accession of infection.

5. The presence of concomitant diseases in the patient (immunodeficiency states, diabetes, foci of infection in the body).

Local treatment:

1. washing the wound with 3% hydrogen peroxide solution.

2. Opening of streaks, pockets, drainage.

3. Applying bandages with antiseptics (chlorhexidine, furacilin, boric acid).

4. Mandatory medical immobilization (plaster splints).

General treatment:

1. AB (v \\ v, v \\ a).

2. Detoxification therapy.

3. Angioprotectors.

Trophic ulcers - This is a long-term non-healing superficial defect of the skin or mucous membrane with possible damage to deeper tissues.

4315 0

Damage to the ureter

Injuries to the ureter are the rarest of urinary tract injuries in external trauma. In blunt trauma, a rupture may occur at the site of the ureteral discharge from the pelvis (or just below) as a result of overextension or tearing of the lower end of the ureter, fixed to the bladder triangle. With a penetrating wound, contusion of the ureter is possible, as well as its partial or complete rupture.

Contusion can occur in a gunshot wound if the bullet passes near the ureter, resulting in vascular damage to the ureteral wall, including bleeding or thrombosis. Revision of the wound shows that the bullet has passed the ureter, while its wall appears intact or slightly damaged. In case of vascular thrombosis in the wall of the ureter, necrosis is subsequently observed with the formation of a urinary fistula.

Damage to the bladder

In children, the bladder is an intra-abdominal organ, while in adults it is located much lower and is surrounded by the pelvic bones, which protects it from the most severe injuries from trauma to the abdomen and pelvis. Bladder injuries are the second most common injury after kidney injury and are usually associated with a fracture of the pelvic bones.

Bladder contusion

A contusion of the bladder is understood as a violation of the integrity of its wall with hemorrhage. On the cystogram, the contours of the bladder are not changed. With a fracture of the pelvic bones, there is often an extensive hematoma within the bone pelvis, which leads to a displacement of the bladder either upward or to the side. Treatment in such cases is conservative, since the violation is resolved without deformation of the bladder wall.

Intraperitoneal bladder rupture

This damage is the result of an injury to the abdomen or pelvis at the moment when the bladder is filled with urine; at the same time, the bubble dome ruptures with urine flowing into the abdominal cavity. On the cystogram, extravasation of contrast along the colon and between the loops of the intestine is noted. A revision of the abdominal cavity with the elimination of the rupture of the dome of the bladder is required.

Extraperitoneal rupture of the bladder

On the cystogram, contrast flow is determined along the lateral wall of the pelvis and below the bladder. It is most advisable to obtain an X-ray after washing the bladder if extravasation occurs mainly behind the bladder and the picture is unclear on the cystogram with a filled bladder. Until recently, in such cases, exploitation was performed with the elimination of the extraperitoneal rupture. However, with a single extraperitoneal rupture and minor extravasation, drainage (only) of the bladder through a catheter is successfully used. The catheter is left for 14 days; before its extraction, a repeated cystography is performed.

Damage to the urethra

Distinguish between damage to the posterior (prostate-membranous) and anterior (bulbous and spongy) parts of the urethra.

Damage to the back of the urethra

Injuries to the posterior urethra are usually associated with a fracture of the pelvis, while injuries to the anterior urethra are the result of a direct impact (falling on sharp objects with legs wide apart, falling prone). With digital rectal examination and examination of the perineum, a perineal hematoma or a highly mixed prostate gland is found, which indicates a complete rupture of the urethra. Examination of the perineum reveals the classic "butterfly mottling" caused by a hematoma that is confined to the fascia lata.

In the case of a complete rupture in the posterior part of the urethra, conflicting opinions are expressed regarding the advisability of primary restoration of the integrity of the urethra with suprapubic cystostomy; some clinicians limit themselves to suprapubic cystostomy. In the initial restoration of the integrity of the urethra, the bladder is left open and the urethra is sutured using the "rail coupling technique" (two linked probes are used to pull the Foley catheter into the bladder). When the catheter is pulled, the ends of the ruptured urethra are brought closer together.

Healing of the urethra occurs within a few weeks. If only cystostomy is used. then the pelvic hematoma resolves, allowing the prostate gland to take a normal position. With both methods, the urethra heals, but with the formation of a stricture; the incidence of impotence and urinary incontinence is the same in both cases.

Bruised urethra

In such cases, there is a discharge of blood from the external opening of the urethra, while the urethrogram remains normal. Urethral contusion is treated conservatively with or without a catheter.

Partial rupture of the urethra

The urethrogram reveals a limited extravasation of contrast at the site of injury with the passage of contrast medium into the bladder. In the treatment of partial ruptures, either only urethral catheterization (performed by a urologist) or catheterization in combination with suprapubic cystostomy is used. Healing occurs within a few weeks.

Complete rupture of the urethra

On the urethrogram, a significant extravasation of contrast at the site of injury is determined in the absence of the passage of contrast medium into the bladder. Such damage is repaired surgically in the anterior part of the urethra: suprapubic drainage is performed through a catheter, an epicystostomy is applied to drain urine, and a small urethral dilator is used to immobilize the anastomotic area.

Damage to the genitals

Testicles

Testicular mobility, contraction of the levator muscle, and the presence of a strong testicular capsule contribute to infrequent testicular damage in car accidents. A direct blow with pressing the testicle to the pubic articulation leads to damage - bruise or rupture. In both cases, the sac of the vaginal membrane fills with blood (hematocele), resulting in extensive and intense cyanotic swelling of the scrotum. Early revision with evacuation of blood clots and suturing of testicular rupture promotes faster normalization of testicular function than is observed with conservative treatment; at the same time, complications such as infection of the hematoma and testicular atrophy are less common.

The stripped testicle should be covered with the remaining skin, even if there is tension in the suture area during reconstruction. Usually the scrotum acquires its almost normal sizes after a few months.

Penis

Self-mutilation injuries include vacuuming and blade cuts. With the help of a vacuum cleaner, extensive damage is inflicted in the region of the glans penis, as well as the urethra, which require excision of dead tissue and reconstruction. Blade cuts range from superficial wounds of the preputial sac to complete amputation of the glans penis. When the penis is amputated, replantation or local reconstruction of the external opening of the urethra is performed. In the presence of a distal part of the penis, good tissue condition and duration of ischemia less than 18 hours, replantation is preferable.

Traumatic rupture of the corpus cavernosum or a fracture of the penis occurs when the penis is struck hard against a hard object (pubic joint or pelvic floor of a sexual partner), as well as when a direct blow is applied to the penis or when it is excessively flexed. At this moment, a crepitant sound is heard, then pain in the penis appears; swelling rapidly increases, skin color changes, penile curvature occurs. With such injuries, an immediate operation is necessary to remove blood clots and restore the integrity of the damaged tunica albuginea of \u200b\u200bthe corpus cavernosum.

Restoration of the skin lost during separation or as a result of a burn is carried out by transplanting split flaps onto a cleaned and uninfected wound of the penis. Torn skin should not be stitched back, as it will inevitably become infected and necrotic; later it has to be removed.

Penile damage also occurs when the skin of the preputial sac enters the zipper of the trousers. The manipulation of the snake to extract the skin is usually prolonged and painful. In this case, it is better to use a pair of wire cutters to separate the middle link (or lock) of the snake, which will release the restrained skin. Penile turnstile syndrome due to compression or squeezing, such as by a hair, ring, steel washer, or metal nut, manifests early emergence pain and swelling of the head. The crushing object must be removed or cut.

Summary

Injury to the organs of the genitourinary system significantly complicates the treatment of patients with multiple injuries. The physician of the PNP should have a good knowledge of the radiological methods to assist in determining the damage, as well as possible treatment options. The use of CT scanning in the assessment of retroperitoneal damage is becoming more widespread, displacing HSV. However, in cases where rapid assessment of renal function is required, intravenous pyelography is still indispensable.

A. S. Kess, K. S. Smith

Bladder - important organ urinary system. Any damage to it can lead to serious health consequences. Therefore, it is necessary to remember the first signs of injury and the features of therapy.

Features of bladder injury

Injury to the bladder means any violation of the integrity of its wall. This happens as a result of external influences. Such injuries are difficult for the victims and can have critical consequences. Therefore, when the first symptoms are found, it is necessary to immediately seek help from specialists.

This organ is not protected by anything, so even a slight blow to the stomach can damage it. Recovery will take a long time. Treatment will be carried out in a hospital setting.

Damage classification

All bladder injuries can be divided into several categories depending on the location of the damaged area:

1. Intra-abdominal. Such injuries often result from the bladder being full at the time of injury. In this case, the contents are poured over the abdominal cavity.
2. Extra-abdominal. These injuries occur with fractures of the pelvic bones. No urine enters the abdominal cavity.
3. Combined. If, with a fracture of the pelvic bones, the bladder was filled, and its damage occurred in several areas at once, then urine spills over the abdominal cavity.

If we consider all injuries from the point of view of the type of injury, then the following types can be distinguished:

1. Closed trauma. In this case, injury and rupture of the skin and nearby tissues do not occur. Internal organs are not in contact with the external environment.
2. Open trauma. It is characterized by skin lesions and contact of organs with external factors.

Bladder injuries can be classified according to their severity. In this case, the following groups are distinguished:

1. Complete rupture of the organ.
2. Incomplete rupture of the organ wall.
3. Injury. Such damage does not imply damage to the integrity of the bladder.

In some cases, not only the bladder itself is damaged, but also nearby organs. Based on this characteristic, injuries are divided into several categories:

1. Isolated. Only the bladder itself is damaged.
2. Combined. Along with the bladder, nearby organs are also injured.

The treatment program will be developed by a specialist based on the type and characteristics of the injury. In this case, the patient will have to spend some time in the hospital.

How does the disease manifest itself?

In order to correctly determine the treatment method, it is necessary to pay attention to the symptoms that accompany the problem. Among them are:

1. Pain in the lower abdomen.
2. Loss of the ability to urinate.
3. Detection of blood impurities in urine.
4. Frequent urge to use the toilet, but no urination occurs. Small amounts of blood may be released.
5. Shows signs of internal bleeding, such as a fall blood pressure, pale skin, palpitations.
6. There are signs of developing peritonitis. This phenomenon occurs when urine enters the abdominal cavity. These symptoms include: pain that subside only in the half-sitting position, fever, increased muscle tone in the abdominal cavity, bouts of vomiting and nausea, bloating.
7. If the injury is of the extra-abdominal type, then swelling may appear in the lower abdomen, as well as blue discoloration of the skin in this area.

If such symptoms appear, it is necessary to undergo an examination as soon as possible and begin treatment. Delay in such a situation is fraught with grave consequences.

The main causes of injury

You can get injured in the following situations:

1. When falling from a height onto any object.
2. During a stabbing or gunshot wound.
3. If you jump too fast. This often happens if the bladder was full during the jump.
4. When the blow struck lower part belly.
5. When carrying out the procedure for catheterization of the bladder. When the tube is inserted into the organ in order to ensure a full outflow of urine, damage to the walls of the bladder is possible.
6. During bougienage of the urethra. This procedure involves widening the canal by inserting metal pins into it.
7. Surgical intervention for fractures of the pelvic bones.
8. Diseases can also become the cause of injury: prostate adenoma, narrowing of the urethra, prostate cancer.

Often, injuries occur while intoxicated. At the same time, the urge to urinate is dulled.

Basic diagnostic techniques

To make an accurate diagnosis, the specialist conducts several diagnostic measures. They include:

1. Examination of the patient and collection of anamnesis. The doctor asks the victim for complaints, receiving similar injuries earlier, using any drugs.
2. General blood analysis. Allows to determine the presence of bleeding, the level of hemoglobin and erythrocytes is determined.
3. Analysis of urine. During the study, the presence of red blood cells in the sample is revealed.
4. Ultrasound. Research is being conducted not only on the bladder, but also on the kidneys. This allows you to assess the size and structure of the organ, to identify the presence of blood clots, impaired passage of urine. In addition, an ultrasound scan of the entire abdomen may be performed. This helps detect bleeding in the abdominal cavity.
5. Retrograde cystography. A special substance is injected into the bladder, which is clearly manifested on an x-ray. The pictures will clearly show the features of the damage and the condition of the pelvic bones.
6. Urography. The victim is injected with a drug that enters the kidneys. After that, an X-ray examination is performed. This technique allows you to determine the localization of the injury, as well as the degree of its severity.
7. MRI. This method is highly accurate. It allows you to study the bladder in different projections. Thanks to this, you can find out the nature of the damage, the severity, as well as injuries to nearby organs.
8. Laparoscopy. Small incisions are made in the lower abdomen. A probe with a camera is introduced through them. Such examination allows to determine the presence of bleeding and its intensity, the location of the wound and the presence of concomitant injuries.
9. CT scan. This is an X-ray examination method that allows you to obtain a three-dimensional image. With its help, you can accurately determine the nature of the damage, the severity, and the intensity of bleeding.

The choice of a specific technique is carried out based on the equipment available in the medical institution, the characteristics of the patient's body.

Treatment rules

Modern medicine offers the following therapeutic techniques:

1. Medication. The use of drugs is permissible only with minor injuries: bruise or small tear of the bladder wall. Hemostatic and anti-inflammatory drugs, antibiotics are prescribed. In the presence of severe pain, pain relievers are prescribed. In this case, the patient must adhere to bed rest.
2. Suturing of the bladder laparoscopically or through an incision.
3. Cystostomy. This procedure is used for men. A small rubber tube is inserted into the bladder to allow urine to drain.

If urine spills into the abdomen, drainage will be required. The specific treatment technique is selected based on the severity of the injury.

What are the complications of trauma?

In severe cases, complications of the disease may develop. Among them are:

1. Urosepsis. An open wound can become infected with microorganisms. As a result, the inflammatory process starts.
2. Shock due to profuse blood loss. This manifests itself in loss of consciousness, heart palpitations, shallow breathing, and a drop in blood pressure.
3. Purulent process in the bladder.
4. Osteomyelitis. This is an inflammation of the pelvic bones.
5. Fistula formation. Suppuration of blood and urine occurs near the bladder. This provokes the destruction of part of the organ wall. The result is a canal through which urine can flow into the abdominal cavity.
6. Peritonitis. Appears when urine enters the abdominal cavity.

When such consequences appear, it will be required additional complex therapeutic measures. The program is developed by the treating specialist based on the characteristics of the disease.

How can you prevent injury?

In order to avoid serious health consequences, you must adhere to the following recommendations:

1. Timely identification and treatment of prostate diseases.
2. Try to avoid traumatic situations.
3. Give up bad habits, especially from drinking alcoholic beverages.
4. Regularly monitor the level of prostate-specific antigen. Its concentration increases with diseases of the prostate gland.

If the injury did occur, then within three months after the end of treatment, it is necessary to be observed by a urologist.

Timely diagnosis and correct therapy injury will help avoid serious health consequences. At the first warning signs, see your doctor.

The human body is an intelligent and fairly balanced mechanism.

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Hepatic colic is a typical manifestation of gallstone disease.

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There are no people in the world who have never had ARVI (acute respiratory viral diseases) ...

Healthy body a person is able to assimilate so many salts obtained with water and food ...

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First aid for bladder injury

Emergency care for anuria

With postrenal anuria, the patient needs urgent hospitalization in the urology department. The most common cause of this anuria is a kidney or ureteric stone. For pain in the lumbar region, the appointment of antispasmodic and analgesics is indicated.

Urgent care for kidney injury

The provision of emergency care at the pre-hospital stage with signs of traumatic shock and internal bleeding is reduced to anti-shock measures and the introduction of hemostatics (adroxonium, vicasol), as well as cardiovascular agents. With isolated kidney damage, subcapsular therapeutic measures on the spot are reduced to the introduction of antispasmodics, and sometimes promedol and other narcotic drugs, cardiovascular drugs. These activities can be continued in an ambulance. With severe kidney damage with ruptures, its bleeding continues. It is necessary to start the drip injection of blood-substituting and anti-shock solutions, which must be continued in the hospital, where blood transfusion is also possible.

In a hospital, surgical tactics are twofold. It depends on the severity of the injury. In case of subcapsular damage, conservative therapy (hemostatic and antibacterial drugs) is performed, and strict bed rest is prescribed for 3 weeks. In case of a ruptured kidney, an urgent surgical intervention is performed, the volume of which depends on the degree of damage (nephrectomy, resection of the lower pole, primary suture).

The main task of the ambulance doctor is to timely deliver the victim to the hospital, where there is a urological department. During transportation, anti-shock measures are taken.

Urgent care for bladder injuries

The provision of first aid begins immediately with anti-shock and hemostatic measures. They can continue during the transportation of the patient. The main task of an ambulance doctor is to quickly deliver a patient to a surgical hospital on duty, or better to such an institution where there is a duty urological service. It is very important to make a correct diagnosis, as this immediately orients the emergency room doctor on duty to carry out emergency diagnostic and treatment measures. The main diagnostic method carried out in the hospital is ascending cystography with the introduction of a contrast agent into the bladder cavity. At the same time, on the roentgenograms, it flows into the abdominal cavity or into the perineal tissue are clearly visible. Treatment of ruptures and injuries of the bladder is operative: suturing the wound of the bladder, applying an opicistostomy, draining the pelvis. In case of intraperitoneal injuries, the operation begins with a laparotomy and revision of the abdominal organs.

Urgent care for urethral trauma

Based clinical symptoms and objective research there is every opportunity to diagnose damage to the urethra. The introduction of a catheter into the urethra is completely contraindicated. Therapeutic measures are aimed at combating shock and internal bleeding. They should start immediately and not stop during transport. Before transporting over a long distance, especially under difficult road conditions, it is advisable to perform a capillary puncture of the bladder.

The main task of the ambulance doctor is the urgent delivery of the victim to the hospital, where there is a surgical or urological department.

Patients with severe pelvic injuries and multiple body injuries are transported on a shield to the trauma department. In the hospital, epicystostomy is the method of choice. With the timely delivery of the patient and the successful conduct of anti-shock therapy at a young and middle age, in the absence of multiple injuries and concomitant diseases, primary plastic surgery is possible, which is performed after recovery from shock during the first 1 - 2 days. For this, special urological studies must be performed: excretory urography and urethrography.

In case of open injuries (wounds), an aseptic bandage is applied. Persons with injuries to the pelvic bones should be placed on a plate with a roller under the legs bent at the knees. With hematuria without signs of internal bleeding and shock, it is possible to transport patients while sitting, with profuse hematuria with severe anemization and a drop in blood pressure - on a stretcher. For pain and shock, anti-shock measures are taken.

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Bladder injury symptoms and treatment

Bladder injuries are most often the result of fractures of the pelvic bones, which occur in a car accident, fall, shock, or home injury. Injuries can be closed and open, intraperitoneal and extraperitoneal. Moreover, in 80% of cases, damage occurs as a result of closed injuries. But open injuries of the bladder are much more dangerous than closed ones, as they are complicated by damage to neighboring organs and the introduction of various infections.

Bladder Injury Treatment

First Aid Treatment for Bladder Injury

Here are some valuable tips for providing first aid to a bladder injury victim:

If there is a wound, an aseptic dressing is required.

Lay the injured person on his back, raising his head and placing rollers under his knees. Provide complete rest. In case of signs of traumatic shock, he should be laid on his back at an angle of 45 ° so that the pelvis is raised in relation to the head.

Put cold on the lower abdomen, and warm the victim himself.

Urgently deliver him to the hospital for treatment.

In connection with the severe pain in the bladder, which the victim experiences, painful shock occurs. Therefore, the provision of medical care must begin with anti-shock measures and surgical treatment of the wound, which will make it possible to determine the nature of the injury and the volume of surgery.

Treatment of bladder injuries is extremely rapid. Only slight minor damage does not require surgical intervention... In this case, antibiotic therapy is carried out and, if necessary, a catheter is inserted.

Bladder Injury Symptoms

The main symptoms of a bladder injury

With a closed bladder injury, internal bleeding begins, the victim feels severe pain in the lower abdomen, he is unable to empty the bladder on his own, blood appears in the urine, and bloating is observed.

With open injuries of the bladder, the following symptoms are observed: pain in the lower abdomen, which gradually spreads throughout the abdomen or the perineal region, frequent but unsuccessful urge to urinate, leakage of urine mixed with blood from the wound.

With extraperitoneal bladder injury, the symptoms are as follows: blood in the urine, pain in the lower abdomen, muscle tension above the pubis and in the iliac regions, which does not disappear even with an empty bladder.

With intraperitoneal ruptures of the bladder, urination disorders, the release of blood or bloody urine are observed, then signs of peritonitis appear.

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Bladder injury

In case of closed injuries of the bladder, in case of incomplete rupture, a cold compress on the lower abdomen, strict bed rest, anti-inflammatory drugs and hemostatics are prescribed to the patient for 7 - 8 days. A two-way catheter is placed in the bladder. In case of complete rupture of the bladder, surgical treatment is prescribed. In case of intraperitoneal ruptures, a laparotomy is prescribed, which includes suturing the defect in the bladder wall, draining the abdominal cavity and cystostomy. With extraperitoneal rupture, suturing of the bladder rupture is performed through the cystostomy access, in addition, drainage of the small pelvis according to Buyalsky is prescribed (in the case of urinary infiltration of the pelvic tissue). For open injuries of the bladder, surgical treatment should be urgent. In case of intraperitoneal rupture, laparotomy with suturing of the gap is performed, and in case of extraperitoneal rupture, cystostomy with suturing by cystostomy access of the rupture. Drainage of the small pelvis according to Buyalsky is carried out according to indications. There are closed and open injuries of the bladder. Among the closed ones, there are contusion of the bladder wall, separation from the urethra, complete, incomplete and two-stage rupture. More than three quarters of cases are extraperitoneal ruptures, which are almost always accompanied by fractures of the pelvic bones (with intraperitoneal ruptures, such fractures are rare). Intraperitoneal bladder ruptures in 70 - 80% of cases occur in persons who are intoxicated. In peacetime, open injuries of the bladder are often stab and cut wounds, in wartime - gunshot wounds. Open injuries of the bladder are divided into intra- and extraperitoneal, through, mixed and blind. They are manifested by abdominal pain, shock, symptoms of urinary peritonitis, urinary infiltration, impaired urination, tenesmus, hematuria, and urine discharge from the wound.

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The scope of care for injuries of the genitourinary system at the stages of medical evacuation

In case of closed kidney damage, first medical aid includes anti-shock measures, the introduction of antibiotics, and catheterization of the bladder with acute urinary retention.

Qualified medical care. In case of mass admission, victims with closed injury kidneys are sent to the hospital ward for conservative treatment (hemostatic agents, infusion therapy, analgesics, anti-inflammatory drugs). Conservative treatment is carried out in cases where general state the wounded was satisfactory, there were no profuse hematuria, symptoms of ongoing internal bleeding and an increasing perirenal urohematoma. Indications for surgical treatment are combined injuries of the abdominal organs, ongoing internal bleeding, increasing urohematoma, profuse hematuria (with a large number of blood clots).

The kidney is removed in cases of crushing of the renal parenchyma, with deep ruptures of the kidney body, penetrating into the pelvis, as well as damage to the vessels of the renal pedicle.

In case of gunshot wounds to the kidney, first medical aid includes the correction and replacement of the dressing, anti-shock measures, the administration of antibiotics and tetanus toxoid for injuries, and catheterization of the bladder with acute urinary retention.

Qualified medical care. With open kidney injuries, the wounded with signs of ongoing internal bleeding and profuse hematuria are immediately sent to the operating room, with II-III degree shock without bleeding signs - to the anti-shock ward, agonizing in hospital wards, all other wounded with possible kidney damage - to the operating room in the first place ...

Surgical intervention begins with a laparotomy, removes damage to the abdominal organs, examines the kidney and performs the necessary operation. The damaged kidney must be revised after the tourniquet is placed on the pedicle. After removal of the kidney or other operation, a counteropening is applied in the lumbar region and the wound is drained through it. The posterior layer of the peritoneum above the removed kidney is sutured.

Indications for nephrectomy are: crushing of the entire renal parenchyma, multiple and single deep ruptures of the kidney that penetrate into the pelvis, crushing of one of the ends of the kidney with deep cracks reaching the hilum of the kidney or pelvis. Nephrectomy is also indicated for damage to the renal pedicle.

Before removing the damaged kidney, it is necessary to find out the presence of a second kidney, which is achieved by preoperative intravenous urography or ultrasound examination, as well as by palpation of the kidney during revision of the abdominal cavity. The presence and function of the second kidney can be established as follows: the ureter of the damaged kidney is clamped, 5 ml of a 0.4% indigo carmine solution is injected intravenously, and after 5-10 minutes it is determined in the urine obtained by catheterization of the bladder.

From organ-preserving operations, suturing of kidney wounds and resection of its ends are used. Surgical treatment of kidney wounds is performed by economical excision of crushed areas of the parenchyma with removal foreign bodies and blood clots, by carefully suturing the bleeding vessels. To stop bleeding, a temporary soft clamp is applied to the vascular pedicle for a period of no more than 10 minutes. A renal wound is best sutured using U-shaped stitches.

It is more expedient to perform resection of the ends of the kidney using a ligature method. Suturing of kidney wounds, ligature resection of its ends must be combined with the imposition of a nephrostomy. Drainage of the retroperitoneal space is carried out through the lumbar region by bringing out 2-3 tubes. The wound of the lumbar region is sutured before the drains.

Injuries to the ureters in the provision of qualified surgical care rarely diagnosed during surgery. If a ureter is injured, the latter is sutured on a thin PVC tube, which is led out through the renal pelvis and parenchyma through the renal pelvis and parenchyma through the lumbar region along with the perirenal and peri-ureteric drainages. If the surgeon has an internal stent, it is advisable to suture the ureteral wound after stent placement. With a significant defect of the ureter (over 5 cm), its central end is sutured into the skin, and the ureter is intubated with a polyvinyl chloride tube. Reconstructive operations are performed in a specialized hospital for wounded in the chest, abdomen, and pelvis.

Specialized urological care for closed injuries and gunshot wounds of the kidneys includes performing delayed surgical interventions, reconstructive and restorative operations, treatment of complications (suppuration, fistulas, pyelonephritis, narrowing of the urinary tract) and elimination of manifestations of renal failure.

When the bladder is injured, the first medical aid includes a temporary stop of bleeding, anesthesia, intravenous infusion of polyglucin, cardiac drugs, administration of antibiotics and tetanus toxoid. In case of overstretching of the bladder, its catheterization or capillary puncture is performed. The wounded with bladder damage are evacuated, first of all, in the supine position.

Qualified medical care. Wounded with bladder injuries are subject to surgical treatment... With continued bleeding and shock, anti-shock measures are carried out in the operating room, where the wounded are delivered immediately after admission. The operation is urgent.

In case of intraperitoneal damage to the bladder, an emergency laparotomy is performed. The bladder wound is sutured with a double-row suture using absorbable material. Extraperitonization is performed. The abdominal cavity, after removal of the outflowing urine, is washed with saline. The urinary bladder is drained using a cystostomy, and the peri-vesicular space is drained through the operating wound with several tubes.

The technique of superimposing a suprapubic urinary fistula is as follows. An incision 10–12 cm long is made along the midline between the navel and the bosom, the skin, tissue and aponeurosis are dissected, the rectus and pyramidal muscles are pushed apart. In a blunt way in the proximal direction, the prevesical tissue is separated from the bladder together with the peritoneal fold. On the wall of the bladder at the very top, two provisional sutures are applied, for which the bladder is pulled into the wound. Having isolated the peritoneum and tissue with tampons, the bladder is dissected between the stretched ligatures. After making sure that the bubble is opened, a drainage tube with a lumen diameter of at least 9 mm is introduced into it. The end of the tube inserted into the bubble must be cut obliquely (the cut edges are rounded), a hole is made on the side wall equal to the diameter of the tube lumen. The tube is inserted first to the bottom of the bladder, then pulled back by 1.5–2 cm and sewn to the wound of the bladder with catgut thread.

The wall of the bladder is sutured with a double-row suture with absorbable sutures. A rubber graduate is injected into the pre-bladder tissue. The wound is sutured in layers, and a drainage tube is additionally fixed with one of the skin sutures.

With extraperitoneal injuries of the bladder, the wounds available for suturing are sutured with double-row catgut (vicryl) sutures; wounds in the area of \u200b\u200bthe bladder neck and bottom are sutured from the side of the mucous membrane with catgut; if it is impossible to suture them, the edges of the wounds are brought together with catgut, from the outside, drainages are brought to the wound site. The diversion of urine from the bladder is carried out using a cystostomy and a urethral catheter. In case of extraperitoneal injuries, drainage of the pelvic tissue is mandatory not only through the anterior abdominal wall, but also through the perineum. For this, after suturing the bladder wall from the wound abdominal wall forceps bluntly pass from the perineal tissue to the perineum through the obturator opening (according to I.V. Buyalsky-McWorter) or under the pubic articulation on the side of the urethra (according to P.A. tube.

If drainage of the pelvic tissue during the initial intervention was not performed, with the development of urinary leakage, the pelvic tissue is opened with a typical access according to I.V.Buyalsky-McWarter. The wounded is laid on his back with the knees bent and hip joint foot. An 8-9 cm incision is made on the antero-inner surface of the thigh, parallel to the femoral-perineal fold and 2-3 cm below it. The adductor muscles of the thigh are bluntly stratified and approach the pelvic obturator opening. At the descending branch of the pubic bone, along the fibers, the external obturator muscle and the obturator membrane are dissected. Spreading muscle fibers with a forceps, they penetrate into the sciatic-rectal fossa. Stupidly pushing the muscle that lifts the anus, they enter the pre-vesicular tissue, where blood and urine accumulate. The presence of 2-3 tubes in the pre-vesical space provides drainage of pelvic tissue, prevention and treatment of urinary leakage, thrombophlebitis and other dangerous complications.

In the provision of specialized surgical care, the treatment of complications that developed after damage to the bladder is carried out. Intraperitoneal injuries are complicated by peritonitis, abdominal abscesses. Extraperitoneal damage can lead to the formation of urinary infiltration, urinary and purulent leaks with the transition to the phlegmon of the pelvic and retroperitoneal tissue. In the future, osteomyelitis of the pelvic bones, thrombophlebitis, cystitis, pyelonephritis, urosepsis may occur.

Success in the treatment of urethral injuries depends on the correct choice of tactics and consistent implementation of therapeutic measures. The amount of assistance at the stages of medical evacuation with closed injuries is the same as with injuries of the urethra.

First aid comes down to measures to prevent and combat shock and bleeding, the introduction of antibiotics, tetanus toxoid. With urinary retention, a suprapubic capillary puncture of the bladder is performed.

Qualified medical care. The victim continues to take anti-shock measures. Urine diversion (excluding bruises and tangential wounds without damaging the mucous membrane) is performed by imposing a cystostomy. Perform surgical treatment wounds, hematomas, and urinary leaks drain. In case of damage to the posterior urethra pelvic tissue it is drained according to I.V.Buyalsky-McWarter or P.A.Kupriyanov. If the surgeon has the appropriate skills, it is advisable to tunnel the urethra with a silicone tube 5–6 mm in diameter. The primary suture of the urethra is strictly prohibited. The restoration of the urethra is carried out in the long term after the final scarring and elimination of inflammation. PVC soft catheter can be installed only in the case of its free, non-violent passage through the urethra into the bladder. Closed injuries in the form of a bruise or incomplete rupture of the urethral wall without significant urethrorrhagia, with the remaining ability to urinate and in a satisfactory condition, are treated conservatively (antispasmodics, tranquilizers; with urethrorrhagia - vicasol, calcium chloride; sodium ethamsylate; antibiotics for prophylactic purposes). If urethral injury is accompanied by urinary retention, a soft catheter is inserted for 4–5 days or a suprapubic bladder puncture is performed. Damage in the form of a complete rupture, break or crush of the urethral wall is treated surgically.

Specialized urological care consists in the surgical treatment of wounds according to indications, the imposition of a suprapubic urinary fistula, extensive drainage of the pelvic tissue, perineum and scrotum, surgery to restore the integrity of the urethra, treatment of wound infectious complications. Plastic surgeries are performed after special studies to assess the degree and nature of urethral damage. The primary suture is possible only with injuries to the hanging part of the urethra without a large diastasis of the ends. It is advisable to restore the anterior part of the urethra by applying secondary sutures, and in case of damage to the posterior part - if the wounded person is in good condition - immediately after admission or after scarring and elimination of inflammation. In a serious condition, the operation is postponed to a later date.

Operations to restore the integrity of the urethra are performed with the obligatory diversion of urine through the suprapubic urinary fistula.

In case of damage to the scrotum, first medical aid includes stopping ongoing bleeding from the edges of the wound by ligating blood vessels, administering antibiotics, tetanus toxoid, and further anti-shock therapy.

Qualified and specialized medical care for wounded with damage to the scrotum and its organs is reduced to the primary surgical treatment of the wound, during which only obviously non-viable tissues are removed and bleeding is stopped. Depending on the type of injury, surgical treatment of testicular wounds, its epididymis, and spermatic cord is performed. When the scrotum is torn off, the testicles are immersed under the skin of the thighs. Indications for the removal of the testicle are its complete crushing or separation of the spermatic cord. In case of multiple ruptures of the testicle, its fragments are washed with a 0.25-0.5% solution of novocaine with the addition of an antibiotic and sutured with rare catgut (vicryl) sutures. All operations end with wound drainage.

With bruises of the scrotum, conservative treatment is carried out. The presence of an intravaginal hematoma is an indication for surgical intervention.

In case of penile injuries, qualified medical care includes primary surgical treatment of the wound, which boils down to the final stop of bleeding, economical excision of obviously non-viable tissues, and infiltration of tissues with an antibiotic solution. In case of lacerated wounds, the skin flaps are not excised, but by applying guide sutures they cover the defect with them. Damage to the cavernous bodies is sutured with catgut with the capture of the tunica albuginea in the transverse direction. In the presence of combined damage to the urethra, a suprapubic urinary-cystic fistula is applied.

When providing specialized medical care make economical surgical treatment of wounds and plastic surgeries to replace extensive skin defects in early dates or after cleansing wounds from necrotic tissue and the appearance of granulations. Surgical treatment of impaired functions of the corpora cavernosa and operations to restore the penis are carried out after the elimination of all inflammatory phenomena in the area of \u200b\u200bthe scar. The suppression of erections that occur after surgery on the penis is achieved by the appointment of drugs, estrogens, bromine preparations and antipsychotic mixtures.

Military Surgery Guidelines

Anatoly Shishigin

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Quite often, as a result of a careless fall or for other reasons, a person is injured to the urinary organs. Any injury to organs in the urinary system is fraught with damage due to mechanical impact from the outside.

Based on which organ is affected, injury to the bladder, injury to the ureter or kidney may occur. Other components of the system are not considered, since their location differs in depth, and they are extremely rarely damaged.

What are the reasons for injuries of the urinary system?

The most common cause of kidney damage is a blunt blow to the lower back. This could be from a fall from a bike, skateboard or snowboard. Also, a kidney defect is often detected in a street fight, when a bruise can be applied tangentially.

The reasons for a bladder injury lie in a blow to the area above the pubis, and if the organ is overflowing with urine, then it ruptures. If the bladder was empty, then only a hematoma will appear in the area of \u200b\u200bthe mucous membranes, which resolves on its own without treatment within a couple of weeks.

A special injury is considered to be a rupture of the urethra. This happens when you fall onto a bicycle frame or into an open sewer hatch.

Reasons that caused closed or blunt injuries can also provoke open injuries. These are cut or lacerated wounds, punctured or resulting from a gunshot wound. In the case of participation in hostilities, multiple injuries to the genitourinary organs, as well as others, occurred due to mine ruptures, when fragments penetrated the urethra or bladder and ruptured them.

The main symptoms of blunt trauma to the renal system are severe back pain, problems urinating, and blood clots in the urine. Acute pain is felt from the side of the blow. With physical exertion, it grows, just like with urination. In some cases, a large hematoma appears in this area, taking completely different shapes and sizes. With deurination, the amount of urine can be reduced, the patient feels frequent urge, which may not even lead to the release of urine and wear a purely imperative form. Manifestations of hematuria range from a slight sediment in the fluid to large blood clots indicating profuse bleeding in such injuries.

Renal hypertension in the artery is often noted by doctors, a characteristic sign of kidney damage. This phenomenon often has a malignant etiology and is poorly treated.

Trauma to the bladder, if it ruptures, causes urine to leak into the abdominal cavity. This can provoke the development of urinary peritonitis. In the absence of proper treatment, such a disease leads to the death of the patient. The person feels intense sharp pains in the abdomen, the walls of the peritoneum are strongly tense, and there is no urge to empty the bladder at all. If a certain amount of urine is released, then most often it appears along with blood and purulent discharge.

If the trauma of the bladder is not accompanied by its rupture, then the manifestation of symptoms in such acute form not. The patient feels some soreness in the area above the pubis, as well as insignificant difficulties in urination. Sometimes traces of blood may appear in the secreted urine, hematuria in this case is more often microhematuria.

In case of injuries to the lower back or small pelvis, you should immediately seek help from a urologist. Even minor causes can cause organ damage, the symptoms of which will appear after a while. It is the urologist who must determine the degree of injury and the danger of this phenomenon for human health.

Initially, when diagnosing injuries of the genitourinary organs, a survey radiography of all organs located in the abdominal cavity is performed. With the help of such a survey, you can identify the presence foreign objects and traumatic substances inside and behind the peritoneum.

To obtain more detailed data, an additional examination is performed - excretory urography. Even if it does not show changes in the structure of the renal parenchyma, it will display the functionality of the organ under study as much as possible. Usually, when the kidney is injured, there is a failure in the filtration of one of their organs, and when the urethra ruptures, the contrast agent goes beyond the investigated limits.

Ultrasound examination of the peritoneal cavity organs can determine the morphology of the kidneys and their condition. Particular attention is paid to the capsule, which can be completely torn or torn. In order to confirm the ultrasound tests, a specialist can perform a renal angiography to study blood flow in the organ.

In case of rupture of the bladder, a voiding cystography is done, which consists in the introduction of a contrast agent into the urethra cavity. The area of \u200b\u200bthe urethral part is X-rayed, and the contrast preparation reveals the most clearly problem areas. If there is no X-ray, organ rupture can be detected with a ball catheter inserted into the peritoneum. If there is a pathology, then blood clots or bloody sediment will be released along with the urine.

For the diagnosis of the organs of the genitourinary system when they are injured, there is the most effective, computed tomography with a contrast agent. It is with such an examination that the results will be especially accurate, while on ultrasound and excretory urography, multiple disadvantages are noted.

If there are open injuries to the organs of the urinary system, a canal with a wound, then a special technique is used - fistulography. The process is characterized by filling this wound canal with solutions of brilliant green or methylene blue and detailed examination.

How is urinary trauma treated?

All patients with urinary tract injuries of any etiology must necessarily be hospitalized in specialized clinics. Only in a hospital setting is it possible to be examined and monitored by doctors and specialized specialists for the occurrence of complications and the correctness of the chosen treatment scheme in women and men. The prescribed treatment can be both conservative and surgical intervention.

For kidney ruptures, surgical intervention is used, in which the organ defect is sutured or completely removed. The operation ends with a nephrostomy, the purpose of which is to evacuate urine that constantly penetrates the wound surface after the operation. During the operation, a complete revision of all tissues near the organ is performed for the presence of foreign objects, especially in cases of kidney injury.

Treatment for a ruptured bladder is carried out in the form of an operation, during which the resulting defect must be eliminated by suturing. Surgeons make a suture in two rows, which tightly seals the organ cavity. After the operation, it is important to ensure complete and sufficient evacuation of urine from the inside so that there is no increased pressure inside the cavity. This is necessary for the integrity of the seams on its walls.

Surgical treatment of a ruptured urethra and urethra is carried out in the traditional way. With the intervention, suturing of the arisen defect of the urethra is also done and high-quality drainage is provided.

The conservative regimen for treating injuries of the urinary system is carried out in conditions of antibacterial treatment and pain relief of the spasms that have arisen. The drugs Ofloxacin, Gatifloxacin and Ceftriaxone must fight bacteria and inflammation. Pain relief is achieved with the help of Ketans, Diclofenac and Analgin. The duration of the course depends on the severity of the disease and the patient's condition.

Treatment with folk remedies

A compress on the damaged area can give a positive result. In this case, the pain syndrome is removed, the resorption of the hematoma is accelerated. If there is a rupture and open bleeding, then such methods can be dangerous, since they will postpone the call of a specialized specialist. For these reasons, it is necessary to consult a urologist, and only then apply compresses and other methods recommended by traditional medicine.

Restrict the patient's nutrition in case of damage to the bladder or adjacent organs only in the case of surgical intervention. The prescribed diet is number zero, which means complete starvation on the eve of manipulation. This is important so that during anesthesia, the patient does not have an emetic effect that complicates the beginning of the operation.

Postoperative period

Patients are prescribed physical therapy throughout the recovery period after surgery. UHF and darsonvalization are extremely useful, according to experts, for tissue restoration and skin healing. It is imperative to drink antibacterial drugs and a course of drugs that restore the intestinal microflora.

Possible complications

The most dangerous of possible complications - peritonitis and open or internal bleeding. Ruptures of blood vessels can occur with injuries to any of the organs, if a large vessel is damaged. All the blood that is released enters the bladder cavity or the area behind the peritoneum.

The development of peritonitis occurs with perforation of the urinary wall, when urine penetrates through the defects and fills all the available space inside the peritoneum. Such a process starts acute inflammation and can be fatal.

Prevention of injuries of the genitourinary system

According to experts, the most dangerous and vulnerable to injury professions are builders and motocross racers. During work, they especially strictly need to follow the rules safely and use all possible means of protection.

Just as often, kidney or bladder injuries occur in car accidents. The presence of airbags in the car and the increased comfort of the model are one of the preventive measures against damage to the urinary system.