Extraperitoneal Bladder Injuries Research Articles

Postoperative extraperitoneal bladder injury after metal pelvic osteosynthesis for pelvic injury

Postoperative extraperitoneal bladder injury after metal pelvic osteosynthesis for pelvic injury

Imaging Findings Associated with Failure of Conservative Management after Blunt Extraperitoneal Bladder Injury

ObjectivesTo identify risk factors for failure of conservative management (CM) for uncomplicated extraperitoneal bladder injuries (EBI). MethodsThe trauma registry at a single Level 1 trauma center was queried for patients presenting with a blunt EBI between 2004 and 2022. Patients with CM and follow-up through at least one postoperative cystogram or catheter removal were included. A univariable analysis for associations with a composite outcome of either persistent leakage or delayed cystorrhaphy was completed. ResultsEighty-four patients with an EBI underwent CM. Seventy-eight (93%) patients had an associated pelvic fracture and 17 of 84 (20%) underwent embolization for pelvic hemorrhage. Thirty-four (41%) patients also had delayed phase imaging, 17 (20%) of whom had extravasation from their bladder on delays. Six (7%) patients failed initial CM. There was no association between the composite outcome and pelvic fracture (p=0.35) or embolization (p=0.41). American Association for the Surgery of Trauma (AAST) grade 5 injuries (p=0.01) and the presence of extravasation on delayed-phase Computed Tomography (p=0.03) were associated with the composite outcome. ConclusionsContrast extravasation on initial delayed-phase imaging despite urethral catheter drainage and AAST injury grade were associated with failed CM after EBI. This may reflect injuries that mechanistically yield incomplete antegrade drainage with CM.

Factors Associated With Infection in Patients With Combined Pelvic Ring and Bladder Injuries.

To identify the infection rate in patients with combined pelvic ring and bladder injuries. Secondary aims included identifying treatment and injury factors associated with infection. Retrospective review. Single Level I Tertiary Academic Center. All patients over a 12-year period with combined pelvic ring and bladder injuries were evaluated. Exclusion criteria were nonoperative management of the pelvic ring, isolated posterior fixation, and follow-up <90 days. Primary outcome measured was deep infection of the anterior pelvis requiring surgical irrigation and debridement. In total, 106 patients with anterior stabilization of the pelvis in the setting of a bladder injury were included. Seven patients (6.6%) developed a deep infection and required surgical debridement within 90 days. Patients undergoing open reduction and internal fixation with plating of the anterior pelvis and acute concomitant bladder repair had an infection rate of 2.2% (1/43). Patients undergoing closed reduction and anterior fixation with either external fixation or percutaneous rami screw after bladder repair had an infection rate of 17.6% (3/17). There was a higher infection rate among patients with combined intraperitoneal (IP) and extraperitoneal (EP) bladder injuries (23%) when compared with those with isolated EP (3.8%) or IP (9.1%) bladder injuries (P = 0.029). Acute open reduction and internal fixation of the anterior pelvis in patients with combined pelvic ring and bladder injuries has a low infection rate. Patients with combined IP and EP bladder injuries are at increased risk of infection compared with those with isolated IP and EP injuries. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Management of Extraperitoneal Bladder Injuries in Patients With Pelvic Fractures.

The management of extraperitoneal bladder injuries (EBIs) when present with concomitant pelvic fractures is controversial. Current evidence is divided between supporting non-operative management with catheter drainage compared to operative management of bladder injury. The purpose of this study was to evaluate current management of EBI in the setting of pelvic fractures at our institution. We hypothesize there is no difference between operative and non-operative groups. Retrospective review of patients with concomitant bladder injuries and pelvic fractures at a level 1 trauma center from 2017 to 2022 was performed. Demographics, injury characteristics, management strategies, and complications were collected. Patients were stratified by management (cystorrhaphy vs non-operative) and compared. Of 90 patients with bladder injuries and pelvic fractures, 50 patients (56%) presented with EBI, 26 patients (29%) presented with only intraperitoneal injuries, and 14 patients (16%) presented with a combined injury. Of patients with EBI, 18 (36%) underwent cystorrhaphy and 32 (64%) underwent non-operative management. There was no difference in demographics, orthopedic pelvic operative intervention, length of stay, or mortality between groups. Patients in the operative cohort had more bladder leaks [7 (39%) vs 4 (13%), P = .0406], compared to those in the non-operative cohort. Composite complications [7 (39%) vs 7 (22%), P = .1984] were similar between groups. Patients with EBI and pelvic fractures who underwent cystorrhaphy had more bladder leaks on follow-up imaging, although there was no difference in composite complications, when compared to those who underwent non-operative management.

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

BackgroundWhile 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.MethodsThis 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.ResultsLocal: 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).ConclusionsMost 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.

Relevant Clinical Findings of Patients with Extraperitoneal Bladder Injury Associated with Pelvic Fracture Who Underwent Operative Management: A 6-Year Retrospective Study

Relevant Clinical Findings of Patients with Extraperitoneal Bladder Injury Associated with Pelvic Fracture Who Underwent Operative Management: A 6-Year Retrospective Study

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

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.

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

We studied the current management trends for extraperitoneal bladder injuries and evaluated the use of operative repair versus catheter drainage, and the associated complications with each approach. We prospectively collected data on bladder trauma from 20 level 1 trauma centers across the United States from 2013 to 2018. We excluded patients with intraperitoneal bladder injury and those who died within 24 hours of hospital arrival. We separated patients with extraperitoneal bladder injuries into 2 groups (catheter drainage vs operative repair) based on their initial management within the first 4 days and compared the rates of bladder injury related complications among them. Regression analyses were used to identify potential predictors of complications. From 323 bladder injuries we included 157 patients with extraperitoneal bladder injuries. Concomitant injuries occurred in 139 (88%) patients with pelvic fracture seen in 79%. Sixty-seven patients (43%) initially underwent operative repair for their extraperitoneal bladder injuries. The 3 most common reasons for operative repair were severity of injury or bladder neck injury (40%), injury found during laparotomy (39%) and concern for pelvic hardware contamination (28%). Significant complications were identified in 23% and 19% of the catheter drainage and operative repair groups, respectively (p=0.55). The only statistically significant predictor for complications was bladder neck or urethral injury (RR 2.69, 95% 1.21-5.97, p=0.01). In this large multi-institutional cohort, 43% of patients underwent surgical repair for initial management of extraperitoneal bladder injuries. We found no significant difference in complications between the initial management strategies of catheter drainage and operative repair. The most significant predictor for complications was concomitant urethral or bladder neck injury.

MP29-14 OPERATIVE REPAIR OF BLUNT AND PENETRATING INJURIES TO THE BLADDER

INTRODUCTION AND OBJECTIVE: External bladder trauma can be caused by blunt or penetrating injuries. Traditional dogma requires repair of intraperitoneal injuries; extraperitoneal injuries can be managed by catheter drainage unless complicated by associated injuries or associated exploratory surgery. METHODS: We examined patients >18 years old presenting with a bladder injury from 2007-2016 in the National Trauma Data Bank. Exclusions: patients with urethral, rectal or vaginal injury. Four separate groups were studied independently based on injury types: blunt intraperitoneal, blunt extraperitoneal, penetrating intraperitoneal and penetrating extraperitoneal injuries. Propensity score matching was performed within each study group between the repaired and non-repaired groups for: age, race, gender, year of presentation, insurance status, Charlson Comorbidity Index, presentation to an academic center, Injury Severity Score, concomitant abdominal surgeries, pelvic fracture status and concomitant intrabdominal organ injuries. Only patients with complete information were included. Logistic regression modeling was performed to evaluate for effect of bladder repair on in-hospital mortality while adjusting for the above-mentioned variables RESULTS: A total of 21,264 patients experienced bladder trauma between 2007-2016. Overall mortality rate for this population was 7.7%. Propensity score matching resulted in 4 injury groups, each with an equal number of patients undergoing operative and non-operative treatment: blunt intraperitoneal (n=703), blunt extraperitoneal (n=3712), penetrating intraperitoneal (n=2882), and penetrating extraperitoneal (n=1105). On logistic regression modeling, operative repair was associated with lower risk of mortality in each of the following groups: blunt and intraperitoneal (odds ratio-OR- 0.33; 95% confidence interval-CI-0.15 to 0.66, p=0.002), penetrating and intraperitoneal (OR = 0.24; 95% CI: 0.15-0.40, p<0.001), blunt and extraperitoneal (OR = 0.40; 95% CI: 0.33-0.50, p<0.001) CONCLUSIONS: Operative repair of blunt and penetrating intraperitoneal bladder injuries is associated with lower in-hospital mortality. Importantly, we found this strong protective association extends to repair of blunt extraperitoneal injuries as well. These findings are particularly noteworthy given that we controlled for associated exploratory surgery and excluded patients with the usual indications for operative repair of extraperitoneal bladder injury: associated urethral, rectal or vaginal injury Source of Funding: none

Management of Extraperitoneal Bladder Injury with Pelvic Fracture

Management of Extraperitoneal Bladder Injury with Pelvic Fracture

MP04-03 TREATMENT COMPLICATIONS ASSOCIATED WITH EXTRAPERITONEAL BLADDER INJURIES: RESULTS FROM THE MULTI-INSTITUTIONAL AAST STUDY OF BLADDER TRAUMA

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 eith...

The management of an extraperitoneal bladder injury associated with a pelvic fracture.

The management of an extraperitoneal bladder injury associated with a pelvic fracture.

Management of blunt force bladder injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma.

The diagnostic evaluation and clinical management of bladder injuries caused by blunt force trauma are variable. We aim to formulate a practice management guideline using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The working group, patient, intervention, comparator, outcome (PICO), formulated four questions regarding the following topics: (1) diagnostic evaluation based on patient baseline risk of bladder injury (computed tomography cystography vs. no imaging); (2) management of intraperitoneal bladder injuries (operative versus nonoperative); (3) management of extraperitoneal bladder injuries based on complexity of injury (operative vs. nonoperative); and (4) diagnostic follow-up of bladder injuries based on complexity of repair (cystography vs. no cystography). A systematic review of the MEDLINE database for English language articles with adult patients was undertaken. RevMan 5 (Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) and GRADEpro (GRADEpro GDT: GRADEpro Guideline Development Tool [Software]. McMaster University, 2015) software were used. Recommendations were voted on by working group members. Consensus was obtained for each recommendation. Three hundred ninety-three articles were screened, resulting in a full-text review of 64 articles. Seventeen articles were used to formulate the recommendations of this guideline. Several recommendations are made. The need for initial computed tomography cystography after trauma depends on characteristics of the trauma itself, but it is not recommended in patients without gross hematuria. In general, patients with intraperitoneal bladder ruptures should undergo operative repair. This is not routinely necessary in those with extraperitoneal ruptures unless the injury is complex. The need for follow-up cystography after bladder repair depends on the risk of urine leak. Those with low risk of urine leak do not require a follow-up study. Using the GRADE process, the panel made nine recommendations based on four PICO questions concerning the evaluation and management of blunt force bladder injuries.

The Role of Surgery in the Management of Complex Extraperitoneal Bladder Injury

This review focuses on the evolving role of surgical management for complex extraperitoneal bladder injuries. Despite recommendations from both the AUA and EAU advocating bladder drainage for the treatment of most extraperitoneal bladder injuries, there appears to be an increasing role for early operative intervention in select cases of extraperitoneal bladder injury. Although there is a paucity of contemporary data regarding surgical outcomes, both simple and complex extraperitoneal bladder injuries are wrought with short- and long-term sequelae that may warrant early closure. Catheter drainage of bladder injuries is most appropriate for carefully selected, simple extraperitoneal bladder injuries. Bladder injuries, however, with complex parameters including those with intravesical bony fragments, concomitant internal pelvic fixation, involvement of bladder neck, rectum, and/or vagina, or those undergoing exploratory laparotomy for non-GU injuries, can benefit from early cystorraphy to avoid deleterious short- and long-term complications.

Double Whammy: Severe Necrotizing Soft Tissue In fection in the Setting of Extrap eritoneal Bladder Injury from Prolonged Urinary Bladder Catheterization

Double Whammy: Severe Necrotizing Soft Tissue In fection in the Setting of Extrap eritoneal Bladder Injury from Prolonged Urinary Bladder Catheterization

FRII-02 THE MANAGEMENT OF GENITOURINARY TRAUMA IN WORLD WAR II

You have accessJournal of UrologyHistory of Urology: History Forum II1 Apr 2016FRII-02 THE MANAGEMENT OF GENITOURINARY TRAUMA IN WORLD WAR II Joseph Sterbis, Ronald Caras, John Musser, and Ryan Speir Joseph SterbisJoseph Sterbis More articles by this author , Ronald CarasRonald Caras More articles by this author , John MusserJohn Musser More articles by this author , and Ryan SpeirRyan Speir More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2923AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES During the course of World War II, the United States lost over 400,000 service members, with more than 600,000 wounded. Genitourinary injury accounted for approximately 0.5% of those wounded. Our intent is to review the injuries and treatment modalities from that time, allowing for contemporary comparison. METHODS Primary and secondary literature sources were reviewed from World War II and the post-war era. These sources were surveyed to determine the organ-specific incidences of injury, the nature of combat-related genitourinary trauma, and the surgical and medical therapies utilized in both forward and rear echelons. RESULTS Reports of organ-specific injury rates demonstrate varied incidences: Kidney: 25-40%, External Genitalia: 30-56%, Bladder: 12-15%, Ureter: 1-3%. Reports following the war that discuss treatment modalities focus on immediate control of hemorrhage, urinary drainage, and infection control. Preoperative imaging of the kidney was considered of great importance when feasible, with authors recommending a one-shot intravenous pyelogram as a minimum. Conservative management of blunt renal trauma was advocated. Renorraphy was performed when feasible in penetrating trauma. Vascular repair was also considered, though no reported cases were identified. Upper ureteral injuries were managed with early repair over a catheter, while lower injuries were reimplanted. The Davis intubated ureterotomy, first reported in 1946, was advocated as a means for management of post-traumatic stricture. Extraperitoneal bladder injuries were managed conservatively or with repair if surgery for other injuries was planned. Intraperitoneal bladder injuries were managed with repair and suprapubic cystostomy. Posterior urethral injuries were managed via suprapubic diversion and early surgical approximation, the nature of which was ill-defined. Neurogenic bladder from spinal cord injury was generally managed with suprapubic cystostomy, with authors very clear that such injuries were not to be managed with intermittent catheterization. CONCLUSIONS With this year marking the 71st anniversary of the conclusion of World War II, review of historic data provides perspective informing our contemporary combat trauma management. With the notable exception of neurogenic bladder, many management principles have been preserved over time. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e521 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Joseph Sterbis More articles by this author Ronald Caras More articles by this author John Musser More articles by this author Ryan Speir More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prospective evaluation of the utility of routine postoperative cystogram after traumatic bladder injury

The value of routinely testing bladder repair integrity with a cystogram before urinary catheter removal is unclear. The purpose of this study was to prospectively evaluate the utility of routine postoperative cystogram after traumatic bladder injury. All patients sustaining a bladder injury requiring operative repair at two Level I trauma centers were prospectively enrolled during a 62-month study period ending on January 2011. Injury demographics, imaging data, and outcomes were extracted. All patients were evaluated with either a plain or a computed tomography cystogram. A total of 127 patients were enrolled (mean [SD] age, 30.4 [13.5] years; blunt trauma, 63.8%, mean [SD] Injury Severity Score [ISS], 17.7 [10.6]). A total of 75 patients (59.1%) had an intraperitoneal (IP) bladder injury, 44 (34.6%) had an extraperitoneal (EP) bladder injury, and 8 had a (6.3%) combined IP/EP bladder injury. All patients with IP and IP/EP injuries (n = 83) underwent operative repair and a postoperative cystogram at 8.6 (1.8) days (range, 5-13 days). Sixty-nine IP injuries (83.1%) were simple (dome or body disruption/penetrating injury), while 14 (16.9%) were complex (trigone/requiring ureter implantation). There were no deaths during the follow-up period. With the exception of one patient (1.2%) with a complex injury requiring ureteric implantation, there were no leaks demonstrated on postoperative cystogram, and the urinary catheters were successfully removed. In this prospective evaluation of the role of bladder evaluation after operative repair, routine use of follow-up cystograms for simple injuries did not impact clinical management. For complex repairs to the trigone or those requiring ureter implantation, a follow-up cystogram should be obtained before catheter removal. Diagnostic study, level II.

Conservative treatment of concomitant extraperitoneal bladder rupture and intrabladder blood clot formation: Case report of application of ureteral catheterization

Most extraperitoneal bladder ruptures can be treated conservatively with catheter drainage only. However, in patients with concomitant intra bladder blood clot formation and extraperitoneal bladder rupture, surgery for blood clot evacuation and bladder repair are usually needed due to occlusion of the urinary catheter. In our patient, we used a ureteral catheter to bypass the clots in the bladder to provide adequate urinary drainage. This procedure serves as a valuable tool in the conservative treatment of extraperitoneal bladder injury.

Conservative treatment of concomitant extraperitoneal bladder rupture and intrabladder blood clot formation: Case report of application of ureteral catheterization.

Most extraperitoneal bladder ruptures can be treated conservatively with catheter drainage only. However, in patients with concomitant intrabladder blood clot formation and extraperitoneal bladder rupture, surgery for blood clot evacuation and bladder repair are usually needed due to occlusion of the urinary catheter. In our patient, we used a ureteral catheter to bypass the clots in the bladder to provide adequate urinary drainage. This procedure serves as a valuable tool in the conservative treatment of extraperitoneal bladder injury.

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

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 ...