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 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

University of Utah
Dartmouth-Hitchcock Medical Center
University of Alabama at Birmingham
Ohio State University
University of Kansas
Cooper University Health Care
Primary Children's Medical Center
Oakland University
University of Minnesota Twin Cities
Loma Linda University Health
University of Iowa
Detroit Medical Center
UT Health Tyler
University of Pennsylvania
Medical College of Wisconsin
University of California at Davis
University of California at Los Angeles
University of California at San Francisco
Brigham and Women's Hospital
Einstein Healthcare Network
Kermanshah University of Medical Sciences

Research output: Contribution to journal › Article › peer-review

25 Scopus 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.

Original language	English
Pages (from-to)	538-544
Number of pages	7
Journal	Journal of Urology
Volume	204
Issue number	3
DOIs	https://doi.org/10.1097/JU.0000000000001075
State	Published - Sep 1 2020

Keywords

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

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10.1097/JU.0000000000001075

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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), 538-544. https://doi.org/10.1097/JU.0000000000001075

@article{268ec55f3d4844ffbd3b8d6b7ab39786,

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

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.\}",

year = "2020",

month = sep,

day = "1",

doi = "10.1097/JU.0000000000001075",

language = "English",

volume = "204",

pages = "538--544",

journal = "Journal of Urology",

issn = "0022-5347",

publisher = "Wolters Kluwer Health",

number = "3",

}

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. 538-544. https://doi.org/10.1097/JU.0000000000001075

TY - JOUR

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 - Adult

KW - Drainage

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Multiple Trauma

KW - Pelvic Bones/injuries

KW - Prospective Studies

KW - United States

KW - Urinary Bladder/injuries

KW - Wounds, Nonpenetrating/surgery

KW - Wounds, Penetrating/surgery

UR - https://www.scopus.com/pages/publications/85089301048

U2 - 10.1097/JU.0000000000001075

DO - 10.1097/JU.0000000000001075

M3 - Article

C2 - 32259467

AN - SCOPUS:85089301048

SN - 0022-5347

VL - 204

SP - 538

EP - 544

JO - Journal of Urology

JF - Journal of Urology

IS - 3

ER -

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

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Keywords

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