Current Management of Extraperitoneal Bladder Injuries: Results from the Multi-Institutional Genito-Urinary Trauma Study (MiGUTS)
| Autor: | Michael E. Rezaee, Peter B. Thomsen, Clara M. Castillejo Becerra, Alexander P. Nocera, La Donna Allen, Brian P. Smith, Rachel Moses, Rachel L. Sensenig, Jay Simhan, Sarah Majercik, Katie Glavin, Erik S. DeSoucy, Ross E. Anderson, J. Patrick Selph, Brandi Miller, Bradley A. Erickson, Sorena Keihani, Sean P. Elliott, Raminder Nirula, Joshua A. Broghammer, Timothy Hewitt, Reza Askari, Xian Luo-Owen, Cameron N. Fick, Dennis Y. Kim, Christopher M. Dodgion, Scott Zakaluzny, Kaushik Mukherjee, Ian Schwartz, Chirag S. Arya, Seyyed Saeed Khabiri, Richard A. Santucci, Benjamin N. Breyer, Barbara U. Okafor, Joshua Piotrowski, Jeremy B. Myers, Jacob Lucas, Bradley J. Morris, Frank Burks, Scott H. Norwood, Nima Baradaran |
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| Rok vydání: | 2020 |
| Předmět: |
Male
030232 urology & nephrology Wounds Penetrating Wounds Nonpenetrating Penetrating trauma centers 0302 clinical medicine Epidemiology Medicine Prospective Studies Drainage Prospective cohort study Urinary bladder Injuries and accidents Middle Aged Urology & Nephrology medicine.anatomical_structure Current management Wounds Female epidemiology Patient Safety 6.4 Surgery urinary bladder Urologic Diseases Adult medicine.medical_specialty Physical Injury - Accidents and Adverse Effects Urology Urinary system Urinary Bladder Clinical Sciences Renal and urogenital wounds and injuries 03 medical and health sciences Clinical Research Catheter drainage Nonpenetrating Humans Pelvic Bones Multiple Trauma business.industry Evaluation of treatments and therapeutic interventions United States Surgery multicenter study Multicenter study business |
| Zdroj: | The Journal of urology, vol 204, iss 3 |
| ISSN: | 1527-3792 0022-5347 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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