Ross E Anderson1, Sorena Keihani1, Rachel A Moses2, Alexander P Nocera3, J Patrick Selph3, Clara M Castillejo Becerra4, Nima Baradaran4, Katie Glavin5, Joshua A Broghammer5, Chirag S Arya6, Rachel L Sensenig6, Michael E Rezaee2, Bradley J Morris7, Sarah Majercik7, Timothy Hewitt8, Frank N Burks8, Ian Schwartz9, Sean P Elliott9, Xian Luo-Owen10, Kaushik Mukherjee10, Peter B Thomsen11, Bradley A Erickson11, Brandi D Miller12, Richard A Santucci12, LaDonna Allen13, Scott Norwood13, Cameron N Fick14, Brian P Smith14, Joshua Piotrowski15, Christopher M Dodgion15, Erik S DeSoucy16, Scott Zakaluzny16, Dennis Y Kim17, Benjamin N Breyer18, Barbara U Okafor19, Reza Askari19, Jacob W Lucas20, Jay Simhan20, Seyyed Saeed Khabiri21, Raminder Nirula22, Jeremy B Myers1. 1. Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah. 2. Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire. 3. Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama. 4. Department of Urology, The Ohio State University Wexner Medical Center, Columbus, Ohio. 5. University of Kansas Medical Center, Kansas City, Kansas. 6. Division of Trauma, Department of Surgery, Cooper University Hospital, Camden, New Jersey. 7. Division of Trauma and Surgical Critical Care, Intermountain Medical Center, Murray, Utah. 8. Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan. 9. Department of Urology, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota. 10. Division of Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, California. 11. Department of Urology, University of Iowa, Iowa City, Iowa. 12. Department of Urology, Detroit Medical Center, Detroit, Michigan. 13. Department of Surgery, Health Tyler, Tyler, Texas. 14. Division of Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 15. Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin. 16. Department of Surgery, University of California Davis Medical Center, Sacramento, California. 17. Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor- Medical Center, California. 18. Department of Urology, University of California-San Francisco, San Francisco, California. 19. Division of Trauma, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts. 20. Department of Urology, Einstein Healthcare Network, Philadelphia, Pennsylvania. 21. Department of Orthopedic Surgery, Kermanshah University of Medical Sciences, Kermanshah, Iran. 22. Department of Surgery, University of Utah, Salt Lake City, Utah.
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.
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.
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: Jeremy B Myers; Michael B Taylor; William O Brant; William Lowrance; M Chad Wallis; Angela P Presson; Stephen E Morris; Raminder Nirula; Mark H Stevens Journal: J Trauma Acute Care Surg Date: 2013-01 Impact factor: 3.313