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

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

doi:10.1097/ju.0000000000001075

Cited by 16 publications

(14 citation statements)

References 9 publications

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“…13 We also recently reported our outcomes in a multi-institutional study including 157 EBI patients from 20 level-1 trauma centers in the United States and found no difference in orthopedic complications between surgical repair and catheter drainage EBI cohorts. 10 In this study, a total of 57 patients underwent ORIF and 7 had orthopedic complications including nonunion, hardware infection, or pelvic osteomyelitis; the rate of complications after ORIF was not different in the surgical vs. catheter drainage cohorts (18.5 vs. 6.7%, P = .23). Some of the studies more frequently referenced for higher complication risk after nonoperative management of EBIs are from 1980s and 1990s and do not directly report ORIF outcomes or orthopedic complications.…”

mentioning

confidence: 65%

“…At the same time, concern for pelvic hardware contamination was among the leading reasons for surgical repair of EBIs in both cohorts. 10,13 Although under ideal circumstances bladder repair can be a reasonable approach when concomitant surgeries such as ORIF are planned, 17,30 current evidence does not support avoiding ORIF if bladder repair is not possible, for example, when lack of access to a surgeon with experience in repairing the bladder or if other injuries make bladder repair complicated. Additionally, many patients with pelvic fractures have concomitant injuries and will be assigned high injury severity scores, and according to damage control orthopedics principles, open interventions might be delayed usually to after day 4.…”

Section: Reviewmentioning

confidence: 99%

“…3,9 However, for extraperitoneal bladder injuries (EBIs), nonoperative management with catheter drainage is a viable alternative and is utilized in 22-43% of patients depending on the population studied and the injury mechanism. 7,[10][11][12][13][14][15] Appropriate patient selection is the key for successful nonoperative management of EBIs. Patients with a complex EBI should undergo immediate repair of bladder injuries, given the high complication rates such as fistula formation, abscess, incontinence, and delayed healing.…”

mentioning

confidence: 99%

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Extraperitoneal Bladder Injuries Associated With Pelvic Fracture Requiring Internal Fixation: What Is the Evidence?

Khabiri

Keihani

Myers

2020

The American Surgeon™

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Traumatic bladder injuries are commonly associated with pelvic fractures. While the majority of intraperitoneal bladder injuries are surgically repaired, extraperitoneal bladder injuries (EBIs) can be managed nonoperatively in the absence of complex injury patterns such as bladder neck injury or presence of bone spicules in the bladder. Concern for pelvic hardware contamination is one of the most common reasons for repairing EBIs at the time of orthopedic interventions for pelvic fracture (usually open reduction and internal fixation). However, given the inconsistent and limited evidence, practice patterns are different and largely depend on surgeon preferences and institutional management. In this review, we explore the roots for this concern and summarize the current evidence on risk of pelvic hardware infection with nonoperative management of EBIs.

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confidence: 65%

Section: Reviewmentioning

confidence: 99%

mentioning

confidence: 99%

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Extraperitoneal Bladder Injuries Associated With Pelvic Fracture Requiring Internal Fixation: What Is the Evidence?

Khabiri

Keihani

Myers

2020

The American Surgeon™

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“…In some studies, the mechanism is not specified. If there are any penetrating injuries, they are grouped together with blunt [ 12 – 16 ]. There are few examples in the literature focused on PBI.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive management versus open surgery in the treatment of penetrating bladder injuries: a retrospective cohort study

2021

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Background While blunt extra-peritoneal bladder injury is typically treated non-operatively or with minimally invasive management, the treatment for penetrating bladder injury is generally open surgery. We identify a group of patients with penetrating bladder injury who were treated with minimally invasive management and compare the results with those who underwent traditional open surgical treatment. Methods This retrospective cohort study analyzes penetrating bladder injuries from a single trauma center from 2012 through 2019, and from the National Trauma Data Bank for 2016 and 2017. Mortality, complications, and length of stay were compared for minimally invasive management versus open surgery. We used Chi square to test significance for categorical variables, Mann–Whitney U test for ordinal variables, and T-test for continuous variables. Multivariate analysis was performed with multiple logistic, ordinal, and linear regression. Results Local: 117 (0.63%) had a bladder injury; 30 (25.6%) were penetrating. 6 (20.0%) were successfully treated with minimally invasive management with no complication versus 24 complications in 11 patients (45.8%) for open surgery (p = 0.047). Open surgical management was not a significant independent predictor of mortality or hospital length of stay. National Trauma Data Bank: 5330 (0.27%) had a bladder injury; 963 (19.5%) were penetrating. 97 (10.1%) were treated with minimally invasive management. The minimally invasive management group had 12 complications in 5 patients (4.9%) versus 280 complications in 169 patients (19.7%) for open surgery (p = < 0.001). Open surgery was a significant independent predictor of complications (OR 1.57, p = 0.003) and longer hospital length of stay (B = 5.31, p < 0.001). Conclusions Most penetrating bladder injury requires open surgery, however a small proportion can safely be managed with minimally invasive management. Minimally invasive management is associated with lower total complications and shorter hospital length of stay in select patients.

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“…Twenty level I trauma centers participated in this analysis of bladder trauma management by Anderson et al (page 538). 4 Of 323 patients 157 had extraperitoneal bladder injury, 88% had concomitant injury and 79% had a pelvic fracture. Overall 67 patients (43%) had initial repair of the injury in the operating room with the most common indications being severity of injury, injury found during laparotomy or concern for pelvic hardware contamination.…”

Section: Current Management Of Extraperitoneal Bladder Injuriesmentioning

confidence: 99%

This Month in Adult Urology

Smith¹

2020

Journal of Urology

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

Cited by 16 publications

References 9 publications

Extraperitoneal Bladder Injuries Associated With Pelvic Fracture Requiring Internal Fixation: What Is the Evidence?

Extraperitoneal Bladder Injuries Associated With Pelvic Fracture Requiring Internal Fixation: What Is the Evidence?

Minimally invasive management versus open surgery in the treatment of penetrating bladder injuries: a retrospective cohort study

This Month in Adult Urology

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