TREATMENT COMPLICATIONS ASSOCIATED WITH EXTRAPERITONEAL BLADDER INJURIES: RESULTS FROM THE MULTI-INSTITUTIONAL AAST STUDY OF BLADDER TRAUMA

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) (MP04)1 Apr 2019MP04-03 TREATMENT COMPLICATIONS ASSOCIATED WITH EXTRAPERITONEAL BLADDER INJURIES: RESULTS FROM THE MULTI-INSTITUTIONAL AAST STUDY OF BLADDER TRAUMA Jacob Lucas*, Jeremy Myers, Sorena Keihani, Rachel Moses, Yizhe Xu, Bradley Morris, Sarah Majercik, Timothy Hewitt, Frank Burks, Ian Schwartz, Sean Elliott, Cullen Black, Kaushik Mukherjee, Brenton Sherwood, Bradley Erickson, Brandi Miller, Richard Santucci, Jurek Kocik, Brian Smith, Joshua Piotrowski, Christopher Dodgion, Erik Desoucy, Scott Zakaluzny, Nima Baradaran, Benjamin Breyer, Angela Presson, James Hotaling, Raminder Nirula, Amir Patel, and Jay Simhan Jacob Lucas*Jacob Lucas* More articles by this author , Jeremy MyersJeremy Myers More articles by this author , Sorena KeihaniSorena Keihani More articles by this author , Rachel MosesRachel Moses More articles by this author , Yizhe XuYizhe Xu More articles by this author , Bradley MorrisBradley Morris More articles by this author , Sarah MajercikSarah Majercik More articles by this author , Timothy HewittTimothy Hewitt More articles by this author , Frank BurksFrank Burks More articles by this author , Ian SchwartzIan Schwartz More articles by this author , Sean ElliottSean Elliott More articles by this author , Cullen BlackCullen Black More articles by this author , Kaushik MukherjeeKaushik Mukherjee More articles by this author , Brenton SherwoodBrenton Sherwood More articles by this author , Bradley EricksonBradley Erickson More articles by this author , Brandi MillerBrandi Miller More articles by this author , Richard SantucciRichard Santucci More articles by this author , Jurek KocikJurek Kocik More articles by this author , Brian SmithBrian Smith More articles by this author , Joshua PiotrowskiJoshua Piotrowski More articles by this author , Christopher DodgionChristopher Dodgion More articles by this author , Erik DesoucyErik Desoucy More articles by this author , Scott ZakaluznyScott Zakaluzny More articles by this author , Nima BaradaranNima Baradaran More articles by this author , Benjamin BreyerBenjamin Breyer More articles by this author , Angela PressonAngela Presson More articles by this author , James HotalingJames Hotaling More articles by this author , Raminder NirulaRaminder Nirula More articles by this author , Amir PatelAmir Patel More articles by this author , and Jay SimhanJay Simhan More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000554955.00904.80AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: There are no clear treatment algorithms with strong evidence base for the management of extraperitoneal bladder injuries (EBI). Accordingly, patients can be managed either surgically or conservatively with Foley catheter drainage and healing by secondary intention. We analyzed treatment failures and complications associated with EBI management using a large, multi-institutional cohort of traumatic bladder injuries. METHODS: A prospective study of bladder injury was performed from 2014-2017 at 16 Level-1 trauma centers. Patients with EBI were included in the study. All intraperitoneal and combined intraperitoneal/extraperitoneal injuries were excluded. Patient characteristics and complications were compared between those receiving initial conservative management (CM) and surgery (S). Treatment failure for CM was considered on the basis of need for definitive surgical repair of EBI for any reason following an initial period of catheter drainage. RESULTS: Of 205 traumatic bladder injuries, 90 EBI were identified (mean age 43.5 yrs, 62.3% male). Of the EBI patients, 53 were managed in the initial period with Foley catheter drainage (CM) while 37 underwent surgery (S) (Table 1). In the CM group, 15.1% (8/53) failed an initial period of catheter drainage and required definitive surgery at a mean of 10.4 days from time of injury. Although the rate of complications between CM and S cohorts were similar (22.6% vs. 24.3%, p=1.0), initial S recipients who developed complications had significantly higher AAST bladder injury scores than CM counterparts (3.9 vs. 2.6, p=0.02). On multivariate analysis, AAST bladder trauma score was the only predictor of a urologic complication (OR 19.7, CI 3.0-129.4, p=0.002). CONCLUSIONS: This analysis of a large multi-institutional database reveals a greater than 1 in 5 complication rate in patients presenting with low severity EBI who are managed with initial Foley catheterization. Conversely, patients who undergo initial surgery have a similar complication rate that seems to occur in patients with significantly higher risk bladder injuries as determined by AAST bladder score. While further investigation is necessary, initial surgery performance in lower risk EBI patients may offer improved patient morbidity. Source of Funding: None Philadelphia, PA; Salt Lake City, UT; Murray, UT; Royal Oak, MI; Minneapolis, MN; Loma Linda, CA; Iowa City, IA; Detroit, MI; Tyler, TX; Philadelphia, PA; Milaukee, WI; Sacramento, CA; San Francisco, CA; Salt Lake City, UT; Philadelphia, PA© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e30-e31 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jacob Lucas* More articles by this author Jeremy Myers More articles by this author Sorena Keihani More articles by this author Rachel Moses More articles by this author Yizhe Xu More articles by this author Bradley Morris More articles by this author Sarah Majercik More articles by this author Timothy Hewitt More articles by this author Frank Burks More articles by this author Ian Schwartz More articles by this author Sean Elliott More articles by this author Cullen Black More articles by this author Kaushik Mukherjee More articles by this author Brenton Sherwood More articles by this author Bradley Erickson More articles by this author Brandi Miller More articles by this author Richard Santucci More articles by this author Jurek Kocik More articles by this author Brian Smith More articles by this author Joshua Piotrowski More articles by this author Christopher Dodgion More articles by this author Erik Desoucy More articles by this author Scott Zakaluzny More articles by this author Nima Baradaran More articles by this author Benjamin Breyer More articles by this author Angela Presson More articles by this author James Hotaling More articles by this author Raminder Nirula More articles by this author Amir Patel More articles by this author Jay Simhan More articles by this author Expand All Advertisement PDF downloadLoading ...