Current Management of Extraperitoneal Bladder Injuries: Results from the Multi-Institutional Genito-Urinary Trauma Study (MiGUTS)
2020; Lippincott Williams & Wilkins; Volume: 204; Issue: 3 Linguagem: Inglês
10.1097/ju.0000000000001075
ISSN1527-3792
AutoresRoss Anderson, Sorena Keihani, Rachel A. Moses, Alexander P. Nocera, J. Patrick Selph, Clara M. Castillejo Becerra, Nima Baradaran, Katie Glavin, Joshua A. Broghammer, Chirag Arya, Rachel Sensenig, Michael E. Rezaee, Bradley J. Morris, Sarah Majercik, Timothy Hewitt, Frank Burks, Ian Schwartz, Sean P. Elliott, Xian Luo‐Owen, Kaushik Mukherjee, Peter B. Thomsen, Bradley A. Erickson, Brandi D. Miller, Richard A. Santucci, LaDonna Allen, Scott H. Norwood, Cameron Fick, Brian P. Smith, Joshua Piotrowski, Christopher Dodgion, Erik S. DeSoucy, Scott Zakaluzny, Dennis Y. Kim, Benjamin N. Breyer, Barbara U. Okafor, Reza Askari, Jacob Lucas, Jay Simhan, Seyyed Saeed Khabiri, Raminder Nirula, Jeremy B. Myers,
Tópico(s)Abdominal Trauma and Injuries
ResumoNo AccessJournal of UrologyAdult Urology1 Sep 2020Current Management of Extraperitoneal Bladder Injuries: Results from the Multi-Institutional Genito-Urinary Trauma Study (MiGUTS)This article is commented on by the following:Editorial CommentEditorial Comment Ross E. Anderson, Sorena Keihani, Rachel A. Moses, Alexander P. Nocera, J. Patrick Selph, Clara M. Castillejo Becerra, Nima Baradaran, Katie Glavin, Joshua A. Broghammer, Chirag S. Arya, Rachel L. Sensenig, Michael E. Rezaee, Bradley J. Morris, Sarah Majercik, Timothy Hewitt, Frank N. Burks, Ian Schwartz, Sean P. Elliott, Xian Luo-Owen, Kaushik Mukherjee, Peter B. Thomsen, Bradley A. Erickson, Brandi D. Miller, Richard A. Santucci, LaDonna Allen, Scott Norwood, Cameron N. Fick, Brian P. Smith, Joshua Piotrowski, Christopher M. Dodgion, Erik S. DeSoucy, Scott Zakaluzny, Dennis Y. Kim, Benjamin N. Breyer, Barbara U. Okafor, Reza Askari, Jacob W. Lucas, Jay Simhan, Seyyed Saeed Khabiri, Raminder Nirula, and Jeremy B. Myers Ross E. AndersonRoss E. Anderson Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah , Sorena KeihaniSorena Keihani *Correspondence: Division of Urology, Department of Surgery, University of Utah School of Medicine, 30 North 1900 East, Salt Lake City, Utah 84132 telephone: 801-213-2700; FAX: 801-213-2700; E-mail Address: [email protected] Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah , Rachel A. MosesRachel A. Moses Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire , Alexander P. NoceraAlexander P. Nocera Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama , J. Patrick SelphJ. Patrick Selph Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama , Clara M. Castillejo BecerraClara M. Castillejo Becerra Department of Urology, The Ohio State University Wexner Medical Center, Columbus, Ohio , Nima BaradaranNima Baradaran Department of Urology, The Ohio State University Wexner Medical Center, Columbus, Ohio , Katie GlavinKatie Glavin University of Kansas Medical Center, Kansas City, Kansas , Joshua A. BroghammerJoshua A. Broghammer University of Kansas Medical Center, Kansas City, Kansas , Chirag S. AryaChirag S. Arya Division of Trauma, Department of Surgery, Cooper University Hospital, Camden, New Jersey , Rachel L. SensenigRachel L. Sensenig Division of Trauma, Department of Surgery, Cooper University Hospital, Camden, New Jersey , Michael E. RezaeeMichael E. Rezaee Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire , Bradley J. MorrisBradley J. Morris Division of Trauma and Surgical Critical Care, Intermountain Medical Center, Murray, Utah , Sarah MajercikSarah Majercik Division of Trauma and Surgical Critical Care, Intermountain Medical Center, Murray, Utah , Timothy HewittTimothy Hewitt Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan , Frank N. BurksFrank N. Burks Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan , Ian SchwartzIan Schwartz Department of Urology, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota , Sean P. ElliottSean P. Elliott Department of Urology, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota , Xian Luo-OwenXian Luo-Owen Division of Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, California , Kaushik MukherjeeKaushik Mukherjee Division of Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, California , Peter B. ThomsenPeter B. Thomsen Department of Urology, University of Iowa, Iowa City, Iowa , Bradley A. EricksonBradley A. Erickson Department of Urology, University of Iowa, Iowa City, Iowa , Brandi D. MillerBrandi D. Miller Department of Urology, Detroit Medical Center, Detroit, Michigan , Richard A. SantucciRichard A. Santucci Department of Urology, Detroit Medical Center, Detroit, Michigan , LaDonna AllenLaDonna Allen Department of Surgery, Health Tyler, Tyler, Texas , Scott NorwoodScott Norwood Department of Surgery, Health Tyler, Tyler, Texas , Cameron N. FickCameron N. Fick Division of Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania , Brian P. SmithBrian P. Smith Division of Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania , Joshua PiotrowskiJoshua Piotrowski Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin , Christopher M. DodgionChristopher M. Dodgion Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin , Erik S. DeSoucyErik S. DeSoucy Department of Surgery, University of California Davis Medical Center, Sacramento, California , Scott ZakaluznyScott Zakaluzny Department of Surgery, University of California Davis Medical Center, Sacramento, California , Dennis Y. KimDennis Y. Kim Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor- Medical Center, California , Benjamin N. BreyerBenjamin N. Breyer Department of Urology, University of California—San Francisco, San Francisco, California , Barbara U. OkaforBarbara U. Okafor Division of Trauma, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts , Reza AskariReza Askari Division of Trauma, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts , Jacob W. LucasJacob W. Lucas Department of Urology, Einstein Healthcare Network, Philadelphia, Pennsylvania , Jay SimhanJay Simhan Department of Urology, Einstein Healthcare Network, Philadelphia, Pennsylvania , Seyyed Saeed KhabiriSeyyed Saeed Khabiri Department of Orthopedic Surgery, Kermanshah University of Medical Sciences, Kermanshah, Iran , Raminder NirulaRaminder Nirula Department of Surgery, University of Utah, Salt Lake City, Utah , and Jeremy B. MyersJeremy B. Myers Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah in conjunction with the Trauma and Urologic Reconstruction Network of Surgeons View All Author Informationhttps://doi.org/10.1097/JU.0000000000001075AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We studied the current management trends for extraperitoneal bladder injuries and evaluated the use of operative repair versus catheter drainage, and the associated complications with each approach. Materials and Methods: We prospectively collected data on bladder trauma from 20 level 1 trauma centers across the United States from 2013 to 2018. We excluded patients with intraperitoneal bladder injury and those who died within 24 hours of hospital arrival. We separated patients with extraperitoneal bladder injuries into 2 groups (catheter drainage vs operative repair) based on their initial management within the first 4 days and compared the rates of bladder injury related complications among them. Regression analyses were used to identify potential predictors of complications. Results: From 323 bladder injuries we included 157 patients with extraperitoneal bladder injuries. Concomitant injuries occurred in 139 (88%) patients with pelvic fracture seen in 79%. Sixty-seven patients (43%) initially underwent operative repair for their extraperitoneal bladder injuries. The 3 most common reasons for operative repair were severity of injury or bladder neck injury (40%), injury found during laparotomy (39%) and concern for pelvic hardware contamination (28%). Significant complications were identified in 23% and 19% of the catheter drainage and operative repair groups, respectively (p=0.55). The only statistically significant predictor for complications was bladder neck or urethral injury (RR 2.69, 95% 1.21–5.97, p=0.01). Conclusions: In this large multi-institutional cohort, 43% of patients underwent surgical repair for initial management of extraperitoneal bladder injuries. We found no significant difference in complications between the initial management strategies of catheter drainage and operative repair. The most significant predictor for complications was concomitant urethral or bladder neck injury. References 1. : Current epidemiology of genitourinary trauma. Urol Clin North Am 2013; 40: 323. Google Scholar 2. : Genitourinary injuries in pelvic fracture morbidity and mortality using the National Trauma Data Bank. J Trauma 2009; 67: 1033. Google Scholar 3. : Epidemiology of blunt lower urinary tract trauma with and without pelvic fracture. Urology 2017; 102: 234. Google Scholar 4. : The association between operative repair of bladder injury and improved survival: results from the National Trauma Data Bank. J Urol 2011; 186: 151. Link, Google Scholar 5. : Trauma to the bladder and ureter: a review of diagnosis, management, and prognosis. Eur J Trauma Emerg Surg 2017; 43: 763. Google Scholar 6. : Urotrauma: AUA guideline. J Urol 2014; 192: 327. Link, Google Scholar 7. : The role of surgery in the management of complex extraperitoneal bladder injury. Curr Trauma Rep 2017; 3: 265. Google Scholar 8. : Management of the ruptured bladder: seven years of experience with 111 cases. J Trauma 1986; 26: 830. Google Scholar 9. : Evaluating the role of operative repair of extraperitoneal bladder rupture following blunt pelvic trauma. J Urol 2016; 195: 661. Link, Google Scholar 10. : The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974; 14: 187. Google Scholar 11. : Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 2007; 165: 710. Google Scholar 12. : Repair of pediatric bladder rupture improves survival: results from the National Trauma Data Bank. J Pediatr Surg 2012; 47: 1677. Google Scholar 13. : Morbidity associated with nonoperative management of extraperitoneal bladder injuries. J Trauma 1995; 38: 895. Google Scholar 14. : Management of blunt force bladder injuries: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2019; 86: 326. Google Scholar 15. : Process improvement in trauma: traumatic bladder injuries and compliance with recommended imaging evaluation. J Trauma Acute Care Surg 2013; 74: 264. Google Scholar 16. : Bladder injuries. In: Campbell-Walsh Urology, 11th ed. Edited by . Philadelphia: Elsevier 2016; p 2387. Google Scholar 17. : Pelvic ring fractures. In: Rockwood and Green's Fractures in Adults, 8th ed. Edited by . Philadelphia: Wolters Kluwer Health 2015; p 1816. Google Scholar 18. : Multi-disciplinary update on pelvic fracture associated bladder and urethral injuries. Injury 2012; 43: 1242. Google Scholar No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Supported by the University of Utah Study Design and Biostatistics Center, with funding from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 5UL1TR001067-05 (formerly 8UL1TR000105 and UL1RR025764). Editor's Note: This article is the fifth of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 626 and 627. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited BySmith J (2020) This Month in Adult UrologyJournal of Urology, VOL. 204, NO. 3, (403-405), Online publication date: 1-Sep-2020.Related articlesJournal of UrologyJun 23, 2020, 12:00:00 AMEditorial CommentJournal of UrologyJun 23, 2020, 12:00:00 AMEditorial Comment Volume 204Issue 3September 2020Page: 538-544 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordswounds and injuriesurinary bladdermulticenter studyepidemiologytrauma centersMetricsAuthor Information Ross E. Anderson Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah More articles by this author Sorena Keihani Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah *Correspondence: Division of Urology, Department of Surgery, University of Utah School of Medicine, 30 North 1900 East, Salt Lake City, Utah 84132 telephone: 801-213-2700; FAX: 801-213-2700; E-mail Address: [email protected] More articles by this author Rachel A. Moses Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire More articles by this author Alexander P. Nocera Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama More articles by this author J. Patrick Selph Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama More articles by this author Clara M. Castillejo Becerra Department of Urology, The Ohio State University Wexner Medical Center, Columbus, Ohio More articles by this author Nima Baradaran Department of Urology, The Ohio State University Wexner Medical Center, Columbus, Ohio More articles by this author Katie Glavin University of Kansas Medical Center, Kansas City, Kansas More articles by this author Joshua A. Broghammer University of Kansas Medical Center, Kansas City, Kansas More articles by this author Chirag S. Arya Division of Trauma, Department of Surgery, Cooper University Hospital, Camden, New Jersey More articles by this author Rachel L. Sensenig Division of Trauma, Department of Surgery, Cooper University Hospital, Camden, New Jersey More articles by this author Michael E. Rezaee Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire More articles by this author Bradley J. Morris Division of Trauma and Surgical Critical Care, Intermountain Medical Center, Murray, Utah More articles by this author Sarah Majercik Division of Trauma and Surgical Critical Care, Intermountain Medical Center, Murray, Utah More articles by this author Timothy Hewitt Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan More articles by this author Frank N. Burks Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan More articles by this author Ian Schwartz Department of Urology, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota More articles by this author Sean P. Elliott Department of Urology, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota More articles by this author Xian Luo-Owen Division of Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, California More articles by this author Kaushik Mukherjee Division of Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, California More articles by this author Peter B. Thomsen Department of Urology, University of Iowa, Iowa City, Iowa More articles by this author Bradley A. Erickson Department of Urology, University of Iowa, Iowa City, Iowa More articles by this author Brandi D. Miller Department of Urology, Detroit Medical Center, Detroit, Michigan More articles by this author Richard A. Santucci Department of Urology, Detroit Medical Center, Detroit, Michigan More articles by this author LaDonna Allen Department of Surgery, Health Tyler, Tyler, Texas More articles by this author Scott Norwood Department of Surgery, Health Tyler, Tyler, Texas More articles by this author Cameron N. Fick Division of Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania More articles by this author Brian P. Smith Division of Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania More articles by this author Joshua Piotrowski Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin More articles by this author Christopher M. Dodgion Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin More articles by this author Erik S. DeSoucy Department of Surgery, University of California Davis Medical Center, Sacramento, California More articles by this author Scott Zakaluzny Department of Surgery, University of California Davis Medical Center, Sacramento, California More articles by this author Dennis Y. Kim Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor- Medical Center, California More articles by this author Benjamin N. Breyer Department of Urology, University of California—San Francisco, San Francisco, California More articles by this author Barbara U. Okafor Division of Trauma, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts More articles by this author Reza Askari Division of Trauma, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts More articles by this author Jacob W. Lucas Department of Urology, Einstein Healthcare Network, Philadelphia, Pennsylvania More articles by this author Jay Simhan Department of Urology, Einstein Healthcare Network, Philadelphia, Pennsylvania More articles by this author Seyyed Saeed Khabiri Department of Orthopedic Surgery, Kermanshah University of Medical Sciences, Kermanshah, Iran More articles by this author Raminder Nirula Department of Surgery, University of Utah, Salt Lake City, Utah More articles by this author Jeremy B. Myers Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah More articles by this author Expand All No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Supported by the University of Utah Study Design and Biostatistics Center, with funding from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 5UL1TR001067-05 (formerly 8UL1TR000105 and UL1RR025764). Editor's Note: This article is the fifth of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 626 and 627. Advertisement Loading ...
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