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 Mukherjee; Peter 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

doi:10.1097/JU.0000000000001075

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

Urology

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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 language	English (US)
Pages (from-to)	538-543
Number of pages	6
Journal	Journal of Urology
Volume	204
Issue number	3
DOIs	https://doi.org/10.1097/JU.0000000000001075
State	Published - Sep 1 2020

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© 2020 Lippincott Williams and Wilkins. All rights reserved.

Keywords

epidemiology
multicenter study
trauma centers
urinary bladder
wounds and injuries

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Anderson, R. E., Keihani, S., Moses, R. A., Nocera, A. P., Selph, J. P., Becerra, C. M. C., Baradaran, N., Glavin, K., Broghammer, J. A., Arya, C. S., Sensenig, R. L., Rezaee, M. E., Morris, B. J., Majercik, S., Hewitt, T., Burks, F. N., Schwartz, I., Elliott, S. P., Luo-Owen, X., ... Myers, J. B. (2020). Current Management of Extraperitoneal Bladder Injuries: Results from the Multi-Institutional Genito-Urinary Trauma Study (MiGUTS). Journal of Urology, 204(3), 538-543. https://doi.org/10.1097/JU.0000000000001075

Anderson, RE, Keihani, S, Moses, RA, Nocera, AP, Selph, JP, Becerra, CMC, 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, LD, 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 2020, 'Current Management of Extraperitoneal Bladder Injuries: Results from the Multi-Institutional Genito-Urinary Trauma Study (MiGUTS)', Journal of Urology, vol. 204, no. 3, pp. 538-543. https://doi.org/10.1097/JU.0000000000001075

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

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.",

keywords = "epidemiology, multicenter study, trauma centers, urinary bladder, wounds and injuries",

author = "Anderson, {Ross E.} and Sorena Keihani and Moses, {Rachel A.} and Nocera, {Alexander P.} and Selph, {J. Patrick} and Becerra, {Clara M.Castillejo} and Nima Baradaran and Katie Glavin and Broghammer, {Joshua A.} and Arya, {Chirag S.} and Sensenig, {Rachel L.} and Rezaee, {Michael E.} and Morris, {Bradley J.} and Sarah Majercik and Timothy Hewitt and Burks, {Frank N.} and Ian Schwartz and Elliott, {Sean P.} and Xian Luo-Owen and Kaushik Mukherjee and Thomsen, {Peter B.} and Erickson, {Bradley A.} and Miller, {Brandi D.} and Santucci, {Richard A.} and Allen, {La Donna} and Scott Norwood and Fick, {Cameron N.} and Smith, {Brian P.} and Joshua Piotrowski and Dodgion, {Christopher M.} and Desoucy, {Erik S.} and Scott Zakaluzny and Kim, {Dennis Y.} and Breyer, {Benjamin N.} and Okafor, {Barbara U.} and Reza Askari and Lucas, {Jacob W.} and Jay Simhan and Khabiri, {Seyyed Saeed} and Raminder Nirula and Myers, {Jeremy B.}",

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doi = "10.1097/JU.0000000000001075",

language = "English (US)",

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T1 - Current Management of Extraperitoneal Bladder Injuries

T2 - Results from the Multi-Institutional Genito-Urinary Trauma Study (MiGUTS)

AU - Anderson, Ross E.

AU - Keihani, Sorena

AU - Moses, Rachel A.

AU - Nocera, Alexander P.

AU - Selph, J. Patrick

AU - Becerra, Clara M.Castillejo

AU - Baradaran, Nima

AU - Glavin, Katie

AU - Broghammer, Joshua A.

AU - Arya, Chirag S.

AU - Sensenig, Rachel L.

AU - Rezaee, Michael E.

AU - Morris, Bradley J.

AU - Majercik, Sarah

AU - Hewitt, Timothy

AU - Burks, Frank N.

AU - Schwartz, Ian

AU - Elliott, Sean P.

AU - Luo-Owen, Xian

AU - Mukherjee, Kaushik

AU - Thomsen, Peter B.

AU - Erickson, Bradley A.

AU - Miller, Brandi D.

AU - Santucci, Richard A.

AU - Allen, La Donna

AU - Norwood, Scott

AU - Fick, Cameron N.

AU - Smith, Brian P.

AU - Piotrowski, Joshua

AU - Dodgion, Christopher M.

AU - Desoucy, Erik S.

AU - Zakaluzny, Scott

AU - Kim, Dennis Y.

AU - Breyer, Benjamin N.

AU - Okafor, Barbara U.

AU - Askari, Reza

AU - Lucas, Jacob W.

AU - Simhan, Jay

AU - Khabiri, Seyyed Saeed

AU - Nirula, Raminder

AU - Myers, Jeremy B.

PY - 2020/9/1

Y1 - 2020/9/1

N2 - 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.

AB - 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.

KW - epidemiology

KW - multicenter study

KW - trauma centers

KW - urinary bladder

KW - wounds and injuries

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JO - Journal of Urology

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

Abstract

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