【AUA指南】泌尿系損傷（UROTRAUMA）

Guideline Statements

|本文件於2017年4月修訂

Renal Trauma

腎損傷

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.臨床醫生應使用靜脈（IV）對比增強計算機斷層掃描（CT）對患有肉眼血尿或鏡下血尿和收縮壓<90mmHG的穩定性鈍性創傷患者進行診斷性成像。(標準;證據強度：B級)

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.臨床醫生應對穩定創傷患者使用靜脈（IV）對比增強計算機斷層掃描（CT）進行診斷性成像，包括損傷機制或腎損傷的體格檢查結果（如快速減速、側翼明顯打擊、肋骨骨折、明顯的側瘀斑、腹部、側翼或下胸部穿透性損傷）。(推薦；證據強度：C級)

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.當懷疑有腎損傷時，臨床醫師應做增強腹部/盆腔CT靜脈造影，包括即時和延遲圖像。(臨床原則)

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

4.臨床醫生應使用無創的策略管理血液動力學穩定的患者腎損傷。 (標準；證據強度：B 級)

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.對於血液動力學不穩定的患者，手術團隊必須立即進行乾預（手術或血管栓塞治療）。 (標準；證據強度：B 級)

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

6.臨床醫生可以初步觀察腎實質損傷和尿外滲的患者。（臨床原則）

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.臨床醫生應對有以下併發症（如發燒、腰痛加重、持續失血、腹脹）的腎外傷患者進行隨訪CT檢查。結果為：（a）深度撕裂傷（AAST等級IV-V）；或（b）臨床癥狀（如發熱、腰痛加劇、持續出血、腹脹）。(推薦；證據強度：C級)

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.臨床醫生應在出現尿性囊腫、發熱、疼痛加重、腸梗阻、瘺管或感染等併發症時進行引流。(推薦；證據強度：C級)引流應該通過輸尿管支架來實現，也可以通過經皮腎造瘺或兩者同時進行。(專家意見)

Ureteral Trauma

輸尿管損傷

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.臨床醫生應該對疑似輸尿管損傷的穩定創傷患者行靜脈（IV）對比腹部/盆腔CT增強掃描，並進行延遲成像(項目)。(推薦；證據強度：C級)

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

9b.臨床醫生應在無術前影像學檢查懷疑輸尿管損傷的患者開腹手術中直接檢查輸尿管。(臨床原則)

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

10a.術者應在手術穩定的患者中修補外傷性輸尿管裂傷。(推薦；證據強度：C級)

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

10b.外科醫師可能處理不穩定患者的輸尿管損傷臨時尿液引流，然後延遲最終治療。 (臨床原則)

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.外科醫生應根據輸尿管的存活性和臨床情況，在開腹手術、切除或一期修復的同時處理外傷性輸尿管挫傷。(專家意見)

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.對於手術後診斷不完全或延遲放置輸尿管損傷的患者，外科醫生應嘗試放置輸尿管支架。(推薦；證據強度：C級)

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.當支架置入不成功或不可能時, 外科醫生應進行經皮腎造口術, 並根據需要延遲修復。(推薦；證據強度：C 級)

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.臨床醫生最初可能使用支架置入來治療輸尿管陰道瘺患者。如果支架置入失敗，臨床醫生可能會採取額外的手術乾預。(專家意見)

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.如果可能的話，外科醫師應該修複位於髂血管附近的輸尿管損傷，並通過輸尿管支架進行一期修復。(推薦；證據強度：C級)

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.如果可能的話，外科醫師應該用輸尿管再植或者在輸尿管支架上進行一次修復，來修複位於髂血管遠端的輸尿管損傷。(推薦；證據強度：C級)

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

13a.如果可能的話，外科醫生應該用輸尿管支架和/或經皮腎造口置管來處理輸尿管損傷。(推薦；證據強度：C級)

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.當內鏡或經皮腎造瘺不可能或不能適當地將尿液改道時，外科醫生可以通過開放修補術來處理內鏡輸尿管損傷。(專家意見)

Bladder Trauma

膀胱損傷

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.臨床醫生必須對穩定性大血尿和骨盆骨折的患者進行逆行性膀胱造影（平片或CT）檢查。 (標準；證據強度：B 級)

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.對於穩定性血尿和膀胱損傷的患者，以及骨盆環骨折和膀胱破裂臨床指標患者，臨床醫生應進行膀胱逆行造影檢查。(推薦；證據強度：C級)

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.外科醫生必須在鈍器或穿透性外傷的情況下對腹膜內膀胱破裂進行外科修復。 (標準；證據強度：B 級)

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

16.對於無併發症的腹膜外膀胱損傷，臨床醫生應採用導尿管引流治療。(推薦；證據強度：C級)

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

17.對於有複雜腹膜外膀胱損傷的患者，外科醫師應進行手術修復。(推薦；證據強度：C級)

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.在膀胱損傷修復後，臨床醫師應在不行恥骨上膀胱造瘺的情況下行導尿管引流。 (標準； 證據強度：B 級)

Urethral Trauma

尿道損傷

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

19.臨床醫師應對骨盆外傷後尿道口出血患者行逆行尿道造影。(推薦；證據強度：C級)

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

20.對於骨盆骨折伴尿道損傷的患者，臨床應及時建立引流。(推薦；證據強度：C級)

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

21.在骨盆骨折行切開複位內固定（ORIF）的患者中，外科醫生可以放置恥骨上管（SPTs）。(專家意見)

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.對於骨盆骨摺合並尿道損傷的血流動力學穩定患者，臨床醫生可能會進行初步的重新校準（PR）。（期權；證據強度：C級）對於骨盆骨折伴尿道損傷的患者，臨床醫生不應進行長時間的內鏡修復。（臨床原則）

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.尿道損傷後, 臨床醫生應監測患者的併發症 (如狹窄形成、勃起功能障礙、尿失禁) 至少一年。(推薦；證據強度：C 級)

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

24.對於無併發症的前尿道穿透性損傷，外科醫生應及時進行手術修復。(專家意見)

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

25.臨床醫師應在前尿道損傷患者中及時建立尿液引流。(推薦；證據強度：C級)

Genital Trauma

生殖創傷

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.當陰莖出現瘀斑、腫脹、破裂或咬合聲音，以及立即消腫時，臨床醫生必須懷疑陰莖骨折。(標準；證據強度：B 級)

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.對於陰莖骨折急性體征和癥狀的患者，外科醫生應及時進行手術探查和修復。 (標準；證據強度：B 級)

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

28.臨床醫生可以對有不明確體征和陰莖骨折癥狀的患者進行超聲檢查。(專家意見)

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.臨床醫生必須對陰莖骨折或穿透性外傷患者並發尿道損傷進行評估，這些患者在尿道口處有血尿，肉眼血尿或無法排尿。 (標準；證據強度：B 級)

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. 外科醫生應在疑似睾丸破裂的患者中進行陰囊探查和清創, 並進行手術治療 (如有可能) 或睾丸切除術 (當無挽救可能時)。（標準；證據強度：B級）

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.對於因感染、剪傷或燒傷（熱、化學、電）而導致生殖器皮膚大面積損失或損傷的患者，外科醫生應進行探查和有限的組織清創。(標準；證據強度：B 級)

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.在陰莖離斷傷時，手術者應及時行陰莖再植，同時將切除的附件用鹽水紗布包裹，放在塑膠袋內，並在運輸過程中加冰敷。（臨床原則）

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.臨床醫生應該開始輔助的心理，人際，和/或生殖諮詢和治療生殖創傷的患者，預計失去性，泌尿系統和/或生殖功能損傷時。(專家意見)

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