Real-World Practice Patterns Favor Minimally Invasive Methods over Ureteral Reconstruction in the Initial Treatment of Severe Blunt Ureteral Trauma: A National Trauma Data Bank Analysis.

Abstract

We utilized the National Trauma Data Bank® database to report practice patterns in managing blunt traumatic ureteral injuries and assess the consistency with current guidelines/literature. Between 2007 and 2016 all National Trauma Data Bank database patients with blunt traumatic ureteral injuries were identified using ICD-9 and Abbreviated Injury Scale codes. Penetrating trauma and missing data were excluded. Patients were unstable if Injury Severity Score was above 15 or systolic blood pressure was 90 mmHg or less. Abbreviated Injury Scale severity score 2 or less was a low severity ureteral injury. Treatment options were minimally invasive methods or ureteral reconstruction. Patients who underwent laparotomy for associated injuries were identified. Chi-square, Fisher exact or 2-tailed t-test was utilized to evaluate differences. Univariable logistic regression identified independent variables that favored a specific treatment. A total of 147 blunt traumatic ureteral injuries were used for analysis. Of the patients 98 (66.7%) were unstable and 51 (34.7%) had a high severity ureteral injury. Patients with low and high severity ureteral injuries were treated more frequently with minimally invasive methods over ureteral reconstruction. Laparotomy for associated injuries resulted in a higher frequency of ureteral reconstruction (15 of 55, 27.3%) vs laparotomy for ureteral reconstruction alone (9 of 55, 16.4%; p=0.0012). On univariable analysis patients who underwent exploratory laparotomy or underwent an associated injury repair that facilitated retroperitoneal exploration had significantly higher odds of receiving ureteral reconstruction over minimally invasive methods. Contrary to guidelines, practice patterns favor treating severe blunt traumatic ureteral injuries with minimally invasive methods over ureteral reconstruction. Ureteral reconstruction is favored when patients undergo laparotomy for associated injuries.