Niels V Johnsen1, Jason B Young2, W Stuart Reynolds3, Melissa R Kaufman3, Douglas F Milam3, Oscar D Guillamondegui2, Roger R Dmochowski3. 1. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: niels.v.johnsen@vanderbilt.edu. 2. Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee. 3. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Abstract
PURPOSE: Catheter drainage has become a standard management strategy for extraperitoneal bladder rupture from blunt trauma. However, data are lacking critically comparing outcomes between operative and nonoperative management. In this study we evaluate management strategies and identify risk factors for complications. MATERIALS AND METHODS: Patients with uncomplicated extraperitoneal bladder rupture due to blunt trauma from 2000 to 2014 were identified from our trauma registry. Initial management consisted of early cystorrhaphy or catheter drainage. Outcomes analyzed were incidence of inpatient complications, length of stay and time to negative cystography. Subgroup analysis was performed comparing outcomes between patients who did vs did not undergo cystorrhaphy during nonurological operative intervention. RESULTS: A total of 56 patients treated with catheter drainage and 24 who underwent early cystorrhaphy were identified. All early cystorrhaphies were performed as secondary procedures during nonurological interventions. There was no difference in demographics, complications, median intensive care unit or median hospital length of stay between the groups. Subgroup analysis comparing patients who did vs did not undergo cystorrhaphy during nonurological operative intervention showed that patients without cystorrhaphy experienced higher rates of urological complications (p <0.05), increased intensive care unit (9.0 vs 4.0 days, p=0.0219) and hospital (18.9 vs 10.6 days, p=0.0229) length of stay, as well as prolonged time to negative cystography (25.5 vs 20.0 days, p=0.0262). CONCLUSIONS: Conservative management of simple extraperitoneal bladder rupture with catheter drainage alone results in equivalent outcomes relative to operative repair in most patients. However, for those undergoing operations for other indications, cystorrhaphy decreases the risk of complications and is associated with decreased intensive care unit and hospital length of stay.
PURPOSE: Catheter drainage has become a standard management strategy for extraperitoneal bladder rupture from blunt trauma. However, data are lacking critically comparing outcomes between operative and nonoperative management. In this study we evaluate management strategies and identify risk factors for complications. MATERIALS AND METHODS:Patients with uncomplicated extraperitoneal bladder rupture due to blunt trauma from 2000 to 2014 were identified from our trauma registry. Initial management consisted of early cystorrhaphy or catheter drainage. Outcomes analyzed were incidence of inpatient complications, length of stay and time to negative cystography. Subgroup analysis was performed comparing outcomes between patients who did vs did not undergo cystorrhaphy during nonurological operative intervention. RESULTS: A total of 56 patients treated with catheter drainage and 24 who underwent early cystorrhaphy were identified. All early cystorrhaphies were performed as secondary procedures during nonurological interventions. There was no difference in demographics, complications, median intensive care unit or median hospital length of stay between the groups. Subgroup analysis comparing patients who did vs did not undergo cystorrhaphy during nonurological operative intervention showed that patients without cystorrhaphy experienced higher rates of urological complications (p <0.05), increased intensive care unit (9.0 vs 4.0 days, p=0.0219) and hospital (18.9 vs 10.6 days, p=0.0229) length of stay, as well as prolonged time to negative cystography (25.5 vs 20.0 days, p=0.0262). CONCLUSIONS: Conservative management of simple extraperitoneal bladder rupture with catheter drainage alone results in equivalent outcomes relative to operative repair in most patients. However, for those undergoing operations for other indications, cystorrhaphy decreases the risk of complications and is associated with decreased intensive care unit and hospital length of stay.
Authors: B Phillips; S Holzmer; L Turco; M Mirzaie; E Mause; A Mause; A Person; S W Leslie; D L Cornell; M Wagner; R Bertellotti; J A Asensio Journal: Eur J Trauma Emerg Surg Date: 2017-07-20 Impact factor: 3.693
Authors: 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; Jeremy B Myers Journal: J Urol Date: 2020-04-07 Impact factor: 7.450
Authors: Lisanne Grünherz; Xenia Startseva; Marko Kozomara-Hocke; Borna K Barth; Hans-Peter Simmen; Ladislav Mica; Thomas Rauer Journal: Int J Surg Case Rep Date: 2017-07-22