Faculty Collaboration Database

Current Management of Extraperitoneal Bladder Injuries: Results from the Multi-Institutional Genito-Urinary Trauma Study (MiGUTS). J Urol 2020 Sep;204(3):538-544

Date

04/08/2020

Pubmed ID

32259467

Pubmed Central ID

PMC8717861

DOI

10.1097/JU.0000000000001075

Scopus ID

2-s2.0-85087028232 (requires institutional sign-in at Scopus site)   14 Citations

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.

Author List

Anderson RE, Keihani S, Moses RA, Nocera AP, Selph JP, Castillejo Becerra CM, Baradaran N, Glavin K, Broghammer JA, Arya CS, Sensenig RL, Rezaee ME, Morris BJ, Majercik S, Hewitt T, Burks FN, Schwartz I, Elliott SP, Luo-Owen X, Mukherjee K, Thomsen PB, Erickson BA, Miller BD, Santucci RA, Allen L, Norwood S, Fick CN, Smith BP, Piotrowski J, Dodgion CM, DeSoucy ES, Zakaluzny S, Kim DY, Breyer BN, Okafor BU, Askari R, Lucas JW, Simhan J, Khabiri SS, Nirula R, Myers JB

Author

Christopher M. Dodgion MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Drainage
Female
Humans
Male
Middle Aged
Multiple Trauma
Pelvic Bones
Prospective Studies
United States
Urinary Bladder
Wounds, Nonpenetrating
Wounds, Penetrating