PD46-04 BLADDER NECK TRAUMA: 14 YEARS OF EXPERIENCE MANAGING A RARE AND SIGNIFICANT INJURY AT A LEVEL 1 TRAUMA CENTER

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II (PD46)1 Apr 2020PD46-04 BLADDER NECK TRAUMA: 14 YEARS OF EXPERIENCE MANAGING A RARE AND SIGNIFICANT INJURY AT A LEVEL 1 TRAUMA CENTER Alexander Skokan*, Jonathan Wingate, Catalina Hwang, Christopher Loftus, Hunter Wessells, and Judith Hagedorn Alexander Skokan*Alexander Skokan* More articles by this author , Jonathan WingateJonathan Wingate More articles by this author , Catalina HwangCatalina Hwang More articles by this author , Christopher LoftusChristopher Loftus More articles by this author , Hunter WessellsHunter Wessells More articles by this author , and Judith HagedornJudith Hagedorn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000933.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Traumatic lower urinary tract injuries involving the bladder neck are rare but pose functionally devastating consequences without repair. There currently exists very limited information on the presentation, early management, and long-term outcomes in patients suffering bladder neck injuries. We present the Harborview Medical Center experience with trauma involving the bladder neck. METHODS: A retrospective review was conducted of a prospectively collected database including all patients treated for traumatic genitourinary injuries from 2005 – 2019 at a single level 1 trauma center. All patients identified on radiographic studies or intraoperatively to have an injury involving the bladder neck were included. Patient demographics, injury characteristics, surgical care, complications, and follow-up data were reviewed. RESULTS: From a cohort of 533 patients with lacerations involving the bladder or urethra, 24 suffered an injury involving the bladder neck. Patient demographics and injury characteristics are summarized in Table 1. The median Injury Severity Score among patients was high at 42 (IQR 37-50), and 2 patients died of complications from their non-urologic injuries. The median time from injury to bladder neck repair was 1 day (IQR 0-4 days) and the median length of hospital stay was 20.5 days (IQR 13-34 days). Most patients (83.3%, 20/24) were repaired primarily, 3 required some form of diversion, and 1 was too unstable for early operative repair. After bladder neck repair, patients underwent catheter drainage for a median 18 days (IQR 14-21 days) and 30% (6/20) had a prolonged urine leak requiring an extended duration of drainage. There were no identified predictors of prolonged leak in this small cohort. CONCLUSIONS: A successful primary repair is feasible in most patients with traumatic bladder neck injuries, although prolonged urine leak requiring continued catheterization is not uncommon. These injuries predominantly occur in the setting of devastating multisystem injury complexes, and up to 20% of patients may have bladder injuries not amenable to primary closure. Further study is needed to understand long-term outcomes after repair of these severe injuries. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e920-e920 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Skokan* More articles by this author Jonathan Wingate More articles by this author Catalina Hwang More articles by this author Christopher Loftus More articles by this author Hunter Wessells More articles by this author Judith Hagedorn More articles by this author Expand All Advertisement PDF downloadLoading ...