97 EXTRAPERITONEAL BLADDER RUPTURES: COMPLICATIONS ASSOCIATED WITH OPERATIVE VERSUS NON-OPERATIVE MANAGEMENT AT THE TIME OF ANTERIOR PELVIC FIXATION OR ABDOMINAL EXPLORATION FOR OTHER INJURIES

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery1 Apr 201197 EXTRAPERITONEAL BLADDER RUPTURES: COMPLICATIONS ASSOCIATED WITH OPERATIVE VERSUS NON-OPERATIVE MANAGEMENT AT THE TIME OF ANTERIOR PELVIC FIXATION OR ABDOMINAL EXPLORATION FOR OTHER INJURIES Michael Taylor, William Brant, Chad Wallis, Molly McFadden, Mark Stevens, Jay Bishoff, Raminder Nirula, and Jeremy Myers Michael TaylorMichael Taylor Salt Lake City, UT More articles by this author , William BrantWilliam Brant Salt Lake City, UT More articles by this author , Chad WallisChad Wallis Salt Lake City, UT More articles by this author , Molly McFaddenMolly McFadden Salt Lake City, UT More articles by this author , Mark StevensMark Stevens Murray, UT More articles by this author , Jay BishoffJay Bishoff Murray, UT More articles by this author , Raminder NirulaRaminder Nirula Salt Lake City, UT More articles by this author , and Jeremy MyersJeremy Myers Salt Lake City, UT More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.162AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We sought to understand whether complication rates, in patients with extraperitoneal bladder rupture, were influenced by the management of these injuries with either an operative versus a non-operative approach at the time of anterior pelvis fixation or abdominal exploration for other injuries. METHODS Patients with bladder injury were identified from the prospective trauma registry from all designated trauma 1 hospitals in Utah from 1996–2010. Multiple patient data points were collected pertaining to injury presentation, management, and outcomes. Patients were excluded from our study if they had any component of intraperitoneal bladder injury. RESULTS A total of 259 patients were identified with possible lower urinary tract injury, 121 of these patients had bladder injury, and 73 of these bladder injuries were extraperitoneal. The mean age of the patients was 38.4 years. The predominant mechanism of injury was blunt trauma (93.2%) and the mean injury severity score was 24.3. Concomitant injuries included pelvic fracture in 64 (87.7%), solid organ injury in 19 (26.0%), and urethral injury in 10 (13.7%). 63 patients had bladder specific followup to rule out persistent urinary leak; the remaining patients died or had no radiologic follow up of their injury. The rate of persistent leak, in all patients with extraperitoneal injuries, with operative versus conservatively managed cases, was 5.6% (1/18) and 17.7% (8/45) (p=0.04). At the time of anterior pelvic fixation, operative versus conservative management was associated with persistent leak in 12.5% (1/8) and 20.0% (2/10) (P=1.0). During abdominal exploration for other injuries, operative versus conservative management of bladder injury was associated with persistent leak in 0% (0/6) and 16.7% (1/6) (P=0.44). CONCLUSIONS Extraperitoneal bladder injuries had a non-significant trend to have lower rates of persistent urinary leak when they were managed operatively. This trend was found in the entire cohort, as well as at the time of anterior pelvic fixation or abdominal exploration for other injuries. This finding was the stimulus for an ongoing multi-institutional analysis of bladder injury to determine if this trend is significant with a greater number of patients. Given this finding, trauma surgeons should consider operative management of extraperitoneal bladder injury at the time of anterior pelvic fixation or abdominal exploration. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e41 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Taylor Salt Lake City, UT More articles by this author William Brant Salt Lake City, UT More articles by this author Chad Wallis Salt Lake City, UT More articles by this author Molly McFadden Salt Lake City, UT More articles by this author Mark Stevens Murray, UT More articles by this author Jay Bishoff Murray, UT More articles by this author Raminder Nirula Salt Lake City, UT More articles by this author Jeremy Myers Salt Lake City, UT More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...