Current Management of Extraperitoneal Bladder Injuries: Results from the Multi-Institutional Genito-Urinary Trauma Study (MiGUTS)

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 MukherjeePeter B. Thomsen, Bradley A. Erickson, Brandi D. Miller, Richard A. Santucci, La Donna 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

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)538-544
Number of pages7
JournalThe Journal of urology
Volume204
Issue number3
DOIs
StatePublished - Sep 1 2020

Keywords

  • epidemiology
  • multicenter study
  • trauma centers
  • urinary bladder
  • wounds and injuries

PubMed: MeSH publication types

  • Journal Article
  • Multicenter Study
  • Research Support, N.I.H., Extramural

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