Lawrence L Yeung1, Amy A McDonald, John J Como, Bryce Robinson, Jennifer Knight, Michael A Person, Jane K Lee, Philipp Dahm. 1. From the Department of Urology (L.L.Y.), College of Medicine, University of Florida, Gainesville, Florida; Department of Surgery (A.A.M), Cleveland VAMC, Case Western Reserve University; Department of Surgery (J.J.C.), MetroHealth Medical Center, Cleveland, Ohio; Department of Surgery (B.R.), Harborview Medical Center, University of Washington, Seattle, Washington; Department of Surgery (J.K.), West Virginia University, Morgantown, West Virginia; Department of Surgery (M.A.P.), University of South Dakota, Sanford School of Medicine, Vermillion, South Dakota; Department of Surgery (J.K.L.), University of Illinois at Chicago, Illinois; and Department of Urology (P.D.), Minneapolis VAMC, University of Minnesota, Minneapolis, Minnesota.
Abstract
BACKGROUND: The diagnostic evaluation and clinical management of bladder injuries caused by blunt force trauma are variable. We aim to formulate a practice management guideline using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. METHODS: The working group, patient, intervention, comparator, outcome (PICO), formulated four questions regarding the following topics: (1) diagnostic evaluation based on patient baseline risk of bladder injury (computed tomography cystography vs. no imaging); (2) management of intraperitoneal bladder injuries (operative versus nonoperative); (3) management of extraperitoneal bladder injuries based on complexity of injury (operative vs. nonoperative); and (4) diagnostic follow-up of bladder injuries based on complexity of repair (cystography vs. no cystography). A systematic review of the MEDLINE database for English language articles with adult patients was undertaken. RevMan 5 (Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) and GRADEpro (GRADEpro GDT: GRADEpro Guideline Development Tool [Software]. McMaster University, 2015) software were used. Recommendations were voted on by working group members. Consensus was obtained for each recommendation. RESULTS: Three hundred ninety-three articles were screened, resulting in a full-text review of 64 articles. Seventeen articles were used to formulate the recommendations of this guideline. Several recommendations are made. The need for initial computed tomography cystography after trauma depends on characteristics of the trauma itself, but it is not recommended in patients without gross hematuria. In general, patients with intraperitoneal bladder ruptures should undergo operative repair. This is not routinely necessary in those with extraperitoneal ruptures unless the injury is complex. The need for follow-up cystography after bladder repair depends on the risk of urine leak. Those with low risk of urine leak do not require a follow-up study. CONCLUSION: Using the GRADE process, the panel made nine recommendations based on four PICO questions concerning the evaluation and management of blunt force bladder injuries.
BACKGROUND: The diagnostic evaluation and clinical management of bladder injuries caused by blunt force trauma are variable. We aim to formulate a practice management guideline using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. METHODS: The working group, patient, intervention, comparator, outcome (PICO), formulated four questions regarding the following topics: (1) diagnostic evaluation based on patient baseline risk of bladder injury (computed tomography cystography vs. no imaging); (2) management of intraperitoneal bladder injuries (operative versus nonoperative); (3) management of extraperitoneal bladder injuries based on complexity of injury (operative vs. nonoperative); and (4) diagnostic follow-up of bladder injuries based on complexity of repair (cystography vs. no cystography). A systematic review of the MEDLINE database for English language articles with adult patients was undertaken. RevMan 5 (Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) and GRADEpro (GRADEpro GDT: GRADEpro Guideline Development Tool [Software]. McMaster University, 2015) software were used. Recommendations were voted on by working group members. Consensus was obtained for each recommendation. RESULTS: Three hundred ninety-three articles were screened, resulting in a full-text review of 64 articles. Seventeen articles were used to formulate the recommendations of this guideline. Several recommendations are made. The need for initial computed tomography cystography after trauma depends on characteristics of the trauma itself, but it is not recommended in patients without gross hematuria. In general, patients with intraperitoneal bladder ruptures should undergo operative repair. This is not routinely necessary in those with extraperitoneal ruptures unless the injury is complex. The need for follow-up cystography after bladder repair depends on the risk of urine leak. Those with low risk of urine leak do not require a follow-up study. CONCLUSION: Using the GRADE process, the panel made nine recommendations based on four PICO questions concerning the evaluation and management of blunt force bladder injuries.
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