Genitourinary Injuries Research Articles

Pubic Hair Grooming Injuries Presenting to U.S. Emergency Departments

To describe the demographics and mechanism of genitourinary (GU) injuries related to pubic hair grooming in patients who present to U.S. emergency departments (EDs). The National Electronic Injury Surveillance System contains prospectively collected data from patients who present to EDs with consumer product-related injuries. The National Electronic Injury Surveillance System is a stratified probability sample, validated to provide national estimates of all patients who present to U.S. EDs with an injury. We reviewed the National Electronic Injury Surveillance System to identify incidents of GU injury related to pubic hair grooming for 2002-2010. The variables reviewed included age, race, gender, injury type, location (organ) of injury, hospital disposition, and grooming product. From 2002 to 2010, an observed 335 actual ED visits for GU injury related to grooming products provided an estimated 11,704 incidents (95% confidence interval 8430-15,004). The number of incidents increased fivefold during that period, amounting to an estimated increase of 247 incidents annually (95% confidence interval 110-384, P = .001). Of the cohort, 56.7% were women. The mean age was 30.8 years (95% confidence interval 28.8-32.9). Shaving razors were implicated in 83% of the injuries. Laceration was the most common type of injury (36.6%). The most common site of injury was the external female genitalia (36.0%). Most injuries (97.3%) were treated within the ED, with subsequent patient discharge. Most GU injuries that result from the use of grooming products are minor and involve the use of razors. The demographics of patients with GU injuries from grooming products largely paralleled observations about cultural grooming trends in the United States.

Mechanistic Relationship of All-terrain Vehicles and Pediatric Renal Trauma

To identify and discuss the mechanistic risk factors associated with genitourinary (GU) trauma in pediatric all-terrain vehicle (ATV) accidents. A retrospective analysis of all pediatric trauma admissions to a level 1 trauma center from 2005 to August 2011 was performed. We identified all pediatric patients who presented with GU trauma related to an ATV accident. The demographics, injury data, mechanism of injury, and treatment records of these children were investigated. A total of 304 pediatric patients were admitted with ATV-related injuries during the study period. Of these 304 patients, 10 (3.2%) had experienced GU injuries. An analysis of the mechanism revealed that 9 of the 10 had been thrown from the ATV; 1 event was described as a rollover accident. All 10 patients sustained renal trauma: 9 renal lacerations of various grades and 1 renal pedicle injury. Hematuria was observed in all cases. Spleen and liver lacerations were commonly associated injuries (40% and 30%, respectively). Pediatric ATV-related GU injuries remain an uncommon, yet serious, problem. Renal trauma is the most commonly encountered GU injury and can be suspected by the presence of hematuria. Analysis of the mechanism of injury suggests that ejection from the ATV places pediatric patients at the greatest risk of renal injury. Additional research is recommended concerning the mechanistic relationship of ATV-related GU trauma.

Lower Urinary Tract Injuries in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF)

WAR INJURIES The historical incidence of combat urologic injuries is 0.5 to 8.0%. Current conflicts in Operation Iraqi Freedom (OIF) or Operation Enduring Freedom (OEF) have resulted in greater than 50,000 American trauma casualties with over 16,000 trauma admission entries in the Joint Theater Trauma Registry (JTTR). In the study by Serkin et al, 819 patients (5%) had one or more genitourinary (GU) injuries for a total of 887 GU injuries in OIF/OEF from October 2001 to January 2008. Lower urinary tract (bladder and urethra) trauma accounts for approximately 30% of these GU injuries. It is crucial that these injuries are promptly recognized and appropriately managed in theater.

The incidence of vascular, genitourinary, and intestinal tract injuries in gynecologic oncology: An extensive, single institutional experience.

e15500 Background: Iatrogenic vascular, genitourinary, and intestinal tract injuries are an unfortunate consequence in gynecologic surgery because the uterus and ovaries are adjacent to critical pelvic structures. The incidence of these complications in general gynecology reportedly varies from 0.3-8.0%; conversely, in gynecologic oncology, the rate is presumably higher although the outcomes are not well documented. Methods: We reviewed the charts of gynecologic oncology patients treated at a single medical institution from January 2003 to February 2011. The following study variables were noted for evaluation: patient characteristics (age, body mass index (BMI)), medical history, cancer origin (e.g., ovarian, uterine), disease pathology, previous pelvic surgery, injury type (genitourinary, vascular or intestinal tract) and injury diagnosis (intra- or post-operative). Descriptive analyses were initially employed, followed by further evaluation of the clinicopathologic parameters via logistic regression, ANOVA and Cox proportional-hazard ratios. Results: In the current, retrospective investigation, 810 gynecologic cancer patients were identified; from this group, there were 25 (3.1%) intestinal tract, 10 (1.2%) genitourinary and 20 (2.5%) vascular injuries encountered. The logistic regression model classified correctly 84% of the injuries. Moreover, a Cox proportional hazard model revealed that cancer origin (p=0.023), previous pelvic surgery (p=.003), BMI (p=0.002) and disease stage (p < 0.01) were surrogate markers for operative injury occurrence. Conclusions: The incidence of vascular, genitourinary and intestinal tract injuries in this large group of gynecologic oncology patients was quite reasonable. Fortunately, when these conditions arise, gynecologic oncologists have extensive surgical experience and are well prepared to address them. Additional study of the clinicopathologic factors that may predispose these cancer patients to a surgical complication is necessary.

Outcomes of Endoscopic Realignment of Pelvic Fracture Associated Urethral Injuries at a Level 1 Trauma Center

We examined the success of early endoscopic realignment of pelvic fracture associated urethral injury after blunt pelvic trauma. A retrospective review was performed of patients with pelvic fracture associated urethral injury who underwent early endoscopic realignment using a retrograde or retrograde/antegrade approach from 2004 to 2010 at a Level 1 trauma center. Followup consisted of uroflowmetry, post-void residual and cystoscopic evaluation. Failure of early endoscopic realignment was defined as patients requiring urethral dilation, direct vision internal urethrotomy, posterior urethroplasty or self-catheterization after initial urethral catheter removal. A total of 19 consecutive patients (mean age 38 years) with blunt pelvic fracture associated urethral injury underwent early endoscopic realignment. Twelve cases of complete urethral disruption, 4 of incomplete disruption and 3 of indeterminate status were noted. Mean time to realignment was 2 days and mean duration of urethral catheterization after realignment was 53 days. One patient was lost to followup after early endoscopic realignment. Using an intent to treat analysis early endoscopic realignment failed in 15 of 19 patients (78.9%). Mean time to early endoscopic realignment failure after catheter removal was 79 days. The cases of early endoscopic realignment failure were managed with posterior urethroplasty (8), direct vision internal urethrotomy (3) and direct vision internal urethrotomy followed by posterior urethroplasty (3). Mean followup for the 4 patients considered to have undergone successful early endoscopic realignment was 2.1 years. Early endoscopic realignment after blunt pelvic fracture associated urethral injury results in high rates of symptomatic urethral stricture requiring further operative treatment. Close followup after initial catheter removal is warranted, as the mean time to failure after early endoscopic realignment was 79 days in our cohort.

Obstetric and gynecological outcome in a patient with traumatic pelvic fracture and perineal injuries

A 19-year-old woman presented with pelvic trauma following a road accident. She was hemodynamically stable. Examination revealed perineal injuries and type C pelvic fracture, which was stabilized with an external fixator. The broken ends of the pubic bone were brought together by an orthopedic wire. The detached vaginal wall and torn anal sphincter were surgically repaired after making a diverting colostomy. The postoperative period was uneventful. Colostomy was reversed after 3 months. Postoperatively the patient developed a cystocele, dyspareunia and vaginal pain. She conceived spontaneously and was planned for an elective cesarean at 37 weeks gestation; however, she presented in labor at 36 weeks and had a normal vaginal delivery. Pelvic fractures may be associated with genitourinary and anal sphincter injuries, which require management by a multidisciplinary team. On recovery the patient may develop prolapse, dyspareunia and persistent local pain. Spontaneous conception and normal vaginal delivery are nevertheless possible.

1199 PEDIATRIC GENITOURINARY INJURIES TREATED IN US EMERGENCY DEPARTMENTS FROM 2002 – 2010: RESULTS FROM THE NATIONAL ELECTRONIC INJURY SURVEILLANCE SYSTEM DATABASE

You have accessJournal of UrologyPediatrics: Reconstructive Surgery - Diversion, Endourology & Transplantation, Trauma1 Apr 20121199 PEDIATRIC GENITOURINARY INJURIES TREATED IN US EMERGENCY DEPARTMENTS FROM 2002 – 2010: RESULTS FROM THE NATIONAL ELECTRONIC INJURY SURVEILLANCE SYSTEM DATABASE Gregory Tasian, Herman Bagga, Patrick Fisher, Nadya Cinman, Charles McCulloch, Jack McAninch, and Benjamin Breyer Gregory TasianGregory Tasian Philadelphia, PA More articles by this author , Herman BaggaHerman Bagga San Francisco, CA More articles by this author , Patrick FisherPatrick Fisher San Francisco, CA More articles by this author , Nadya CinmanNadya Cinman San Francisco, CA More articles by this author , Charles McCullochCharles McCulloch San Francisco, CA More articles by this author , Jack McAninchJack McAninch San Francisco, CA More articles by this author , and Benjamin BreyerBenjamin Breyer San Francisco, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1466AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The epidemiology of pediatric genitourinary injuries in the United States (US) is unknown. We describe the epidemiologic features of genitourinary injuries sustained by children that presented to US emergency departments (EDs). METHODS We analyzed the National Electronic Injury Surveillance System (NEISS) to identify and characterize genitourinary injuries sustained by children 18 years and younger from 2002 to 2010 (n = 10,130). Estimates and standard errors were calculated using data included in NEISS, which is a stratified probability sample of hospital EDs in the United States and its territories validated to produce national estimates of all patients who present to US EDs with an injury. RESULTS Between 2002 and 2010, an estimated 252,392 children (95% CI 205,579 – 299,194) presented to US EDs with genitourinary injuries. These children had a mean age of 7.4 years (median 6 years, IQR 4 – 10 years). Forty-five percent of the injured children were boys. The yearly incidence of genitourinary injuries was stable across the time period studied. The most commonly injured organs were female external genitalia (37.7%), penises (21.6%), and testicles (12%). The rates of female external genitalia, penile, and testicular injuries per 1000 person years of follow-up were 0.13, 0.08, and 0.04, respectively. The most common diagnoses were contusions (35.5%) and lacerations (32.9%). Fall was the most common mechanism of injury (n=114,017), accounting for 45.2% of the reported injuries. Genitourinary injuries were most commonly associated with sporting and exercise equipment (35.7%), clothing items (15.5%), and playground equipment (6%). Ninety-one percent of patients were treated in the ED and then discharged. CONCLUSIONS Genitourinary injuries are an important cause of pediatric morbidity. The stability of the injuries across the time period studied suggests that potential preventative measures to decrease risk of genitourinary injury have not been identified or implemented. Further studies should be conducted to identify which products pose the greatest hazard to children in hopes of increasing awareness and developing safety mechanisms to decrease risk of traumatic genitourinary injury. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e485-e486 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gregory Tasian Philadelphia, PA More articles by this author Herman Bagga San Francisco, CA More articles by this author Patrick Fisher San Francisco, CA More articles by this author Nadya Cinman San Francisco, CA More articles by this author Charles McCulloch San Francisco, CA More articles by this author Jack McAninch San Francisco, CA More articles by this author Benjamin Breyer San Francisco, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

232 EPIDEMIOLOGY OF SPORTS RELATED GENITO-URINARY INJURIES PRESENTING TO EMERGENCY ROOMS

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery III1 Apr 2012232 EPIDEMIOLOGY OF SPORTS RELATED GENITO-URINARY INJURIES PRESENTING TO EMERGENCY ROOMS Patrick B. Fisher, Herman S. Bagga, MD Gregory E. Tasian, MD MSc Nadya M. Cinman, MD Charles E. McCulloch, PhD Jack W. McAninch, andMD Benjamin N. BreyerMD MAS Patrick B. FisherPatrick B. Fisher San Francisco, CA More articles by this author , Herman S. BaggaHerman S. Bagga San Francisco, CA More articles by this author , Gregory E. TasianGregory E. Tasian Philadelphia, PA More articles by this author , Nadya M. CinmanNadya M. Cinman San Francisco, CA More articles by this author , Charles E. McCullochCharles E. McCulloch San Francisco, CA More articles by this author , Jack W. McAninchJack W. McAninch San Francisco, CA More articles by this author , and Benjamin N. BreyerBenjamin N. Breyer San Francisco, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.287AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To study the epidemiology of sports-related genito-urinary (GU) injuries presenting to emergency departments (ED) in the US. METHODS A retrospective analysis was conducted of the National Electronic Injury Surveillance System (NEISS) of the United States Consumer Product Safety Commission between 2002 – 2010. The NEISS is a stratified probability sample of hospital emergency departments in the United States and its territories. Data collected from the NEISS sample can be used to produce national estimates of the number of consumer products-related injuries treated in hospital EDs. A total of 4,563 sports related ED visits were documented over nine years. Data were analyzed using Stata (Ver 12.0) to accommodate the complex sample survey design, grouped by theme and coded to describe and compare case characteristics. RESULTS Between 2002 and 2010, an estimated 133,706 (95% CI 109,252-158,161) individuals presented to the ED with GU injuries related to sports. Of those affected, 69% were male and 31% were female. An estimated 90,314 (95% CI 72,885-107,745) children sustained sports-related GU injuries, the most common of which involved bicycles (33%), swimming/diving (11%), football (6%), sporting vehicles including scooters (6%) and basketball (5%). The majority of injuries were sustained in the 4-7 year old (30%), 8-11 year old (28%) and 12-15 year old (23%) age categories. In the adult population, an estimated 43,391 injuries were sustained (95% CI 33,880-52,903). The most common causes of injury were bicycles (25%), sports vehicles including scooters and ATVs (11%), basketball (6.4%), baseball/softball (5%) and swimming/diving (5%). Of adult sports injuries the majority occurred in the 19-28 year old (49%) and 28-45 (34%) age categories. In all age groups the most common mechanism of injury was contusion (34%) followed by laceration (22%). The most commonly injured organs were the testicles (27%), female external genitalia (21%), and scrotum (13%). More injuries were observed between April and September relative to the winter months. CONCLUSIONS Our results suggest that GU injuries related to sports are prevalent in both the adult and pediatric populations. Bicycles, in particular, account for the majority of sports-related GU injuries in both populations with swimming, sporting vehicles and common team sports accounting for a significant proportion of injuries. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e96 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick B. Fisher San Francisco, CA More articles by this author Herman S. Bagga San Francisco, CA More articles by this author Gregory E. Tasian Philadelphia, PA More articles by this author Nadya M. Cinman San Francisco, CA More articles by this author Charles E. McCulloch San Francisco, CA More articles by this author Jack W. McAninch San Francisco, CA More articles by this author Benjamin N. Breyer San Francisco, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V243 TRANSVAGINAL SACROSPINOUS HYSTEROPEXY

You have accessJournal of UrologyFemale Voiding Dysfunction (Pelvic Reconstruction and Incontinence)1 Apr 2012V243 TRANSVAGINAL SACROSPINOUS HYSTEROPEXY Alana Murphy and Howard Goldman Alana MurphyAlana Murphy Cleveland, OH More articles by this author and Howard GoldmanHoward Goldman Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.299AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While a number of transvaginal hysteropexy techniques have been described over the years, the sacrospinous hysteropexy is the best studied technique and the literature reports favorable data regarding anatomic and functional outcomes. The sacrospinous hysteropexy is also a timely technique in an era of increasing interest in uterine preservation. Women who choose to forego a hysterectomy and elect a transvaginal repair benefit from decreased operative times and decreased morbidity in the form of less blood loss and reduced risk of lower genitourinary tract injury. Uterine sparing procedures do require careful patient selection. Specifically, women with a history of post-menopausal bleeding, endometrial hyperplasia and cervical dysplasia may not be appropriate candidates. METHODS The featured patient is a 73 year old woman with symptomatic pelvic organ prolapse. Her physical exam revealed anterior predominant stage III pelvic organ prolapse. On exam with valsalva, her anterior vaginal wall extended 3cm beyond the hymen and her cervix was at the level of the hymen. She was not noted to have significant posterior compartment prolapse. She wishes to resume sexual activity after prolapse repair and to preserve her uterus. After counseling, she elected to undergo a transvaginal sacrospinous hysteropexy, anterior repair with mesh, given her high stage cystocele, and a retropubic midurethral sling. RESULTS The procedure was completed with minimal blood loss and a total operative time of less than 90 minutes, including the anterior repair and the midurethral sling. The patient was successfully discharged home on postoperative day #1. CONCLUSIONS In conclusion, a properly performed sacrospinous hysteropexy provides excellent apical and cervical support and obviates the need for any significant use of mesh. The transvaginal procedure provides a proven method for the management of vaginal vault suspension in women who prefer a uterine sparing technique. The extraperitoneal approach and preservation of the uterus leads to reduced morbidity, and provides an attractive option for both the patient and the surgeon well versed in transvaginal surgery. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e99-e100 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alana Murphy Cleveland, OH More articles by this author Howard Goldman Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

High Rates of Sexual and Urinary Dysfunction After Surgically Treated Displaced Pelvic Ring Injuries

Pelvic ring injuries may be associated with genitourinary injury (GUI) and result in urinary or sexual dysfunction. We determined (1) incidence of new sexual and urinary dysfunction after surgically treated pelvic ring injuries, (2) association of sexual or urinary dysfunction to fracture type and GUI, and (3) incidence and association between new sexual and urinary dysfunction in male and female patients without GUI. We retrospectively studied 151 patients by postal questionnaire after pelvic reconstruction. Presence, type, and severity of new sexual dysfunction and urinary dysfunction were related to GUI and type of pelvic fracture using the Young and Burgess classification. Minimum followup was 1 year (median, 5 years; range, 1-12 years). New sexual dysfunction occurred in 61 of 143 (43%) and urinary dysfunction in 61 of 150 (41%) responding patients. Neither new sexual nor urinary dysfunction was associated with sex or GUI. In patients with no GUI, new sexual dysfunction was associated with chronologic age (odds ratio [OR], 1.04/year; 95% CI, 1.01-1.07) and pelvic fracture type. Lateral compression injury was less likely to result in new sexual or urinary dysfunction compared with AP type (sexual OR, 1.73; 95% CI, 0.67-4.47; urinary OR, 2.97; 95% CI, 1.15-7.66) and vertical shear type (sexual OR, 2.60; 95% CI, 1.02-6.64; urinary OR, 4.6; 95% CI, 1.81-11.73). Our data suggest new sexual and urinary dysfunction occur at relatively high rates after pelvic fracture in patients with or without GUI. We recommend early assessment and referral for specialist treatment. Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Evolution of Orthopaedic Reconstructive Care

The patterns and severity of injury sustained by service members have continuously evolved over the past 10 years of combat in Iraq and Afghanistan. The 2010 surge of combat troops into Afghanistan, combined with a transition to counterinsurgency tactics with an emphasis on dismounted operations, resulted in increased exposure of US service members to improvised explosive devices and a new pattern of injury termed dismounted complex blast injury. This constellation of injuries typically includes multiple extremity injuries, high bilateral transfemoral amputations, amputated or mangled upper extremities, open pelvis fractures, and injury to the perineal and/or genital regions. These polytraumatized patients frequently present with head, abdominal, and genitourinary injuries, as well. Traditional methods of reconstruction must be optimized because tissue availability may be limited.

Evaluation of urogenital injuries in patients with trauma at the emergency department

The aim of this study was to investigate the characteristics of the patients admitted to the Emergency Department with urogenital system trauma and the factors affecting morbidity and mortality. In this prospective, cross-sectional descriptive study, the demographic characteristics, trauma types, laboratory and radiologic results, hospitalization states, and the outcomes of patients with urogenital trauma were investigated. A total of 153 patients [108 (70.6%) male; 45 (29,4%) female] with major trauma were included in this study. Twenty-three (15.03%) had penetrating trauma and 130 (84.96%) blunt trauma. Seventy-nine presented with motor vehicle accidents, 42 with falls, 10 with gunshot wounds, and 10 with stab wounds. There were pelvic fractures in 60 patients, renal injuries in 35 patients, and bladder injuries in 4 patients. Twenty-one of the patients underwent surgery for any reason and 17 patients died. There was a significant relationship between hematuria and renal injury. Urogenital injuries are frequently seen with other system injuries, and deaths generally occur due to the other system injuries. The timely identification and management of genitourinary injuries with an in-depth clinical evaluation are important for preventing deaths due to urogenital region trauma.

Gunshot wounds to the scrotum: a large single‐institutional 20‐year experience

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Penetrating trauma to the scrotum often requires operative intervention, with testicular salvage only possible when enough testicular tissue can be re-approximated in the traumatic setting. The present report represents the largest series of gunshot wound trauma to the scrotum in the literature. Further, it validates recommendations of the European Association of Urology guidelines on urological trauma that advocate operative intervention due to minimal rates of patient morbidity and the inherent limitations of scrotal ultrasonography in discerning testicular compromise. To report our 20-year experience of gunshot wounds (GSWs) to the scrotum and outline the management of this traumatic injury. We queried our institutional database for patients presenting with GSWs to the scrotum between 1985 and 2006. All patients underwent the standard trauma evaluation upon presentation, including physical examination of the external genitalia. Management was dictated by the presence or absence of a penetrating injury to the scrotum and associated traumatic injuries. Nonoperative and operative management of traumatic injury to the scrotum were used. Testicular salvage was performed when anatomically feasible. If testicular salvage was not feasible, an orchiectomy was performed. Scrotal exploration was performed in 91 (94%) patients while six (6%) patients were treated nonoperatively. Testicular injury was found in 44 (48%) patients undergoing exploration, six (7%) of whom had bilateral testicular injuries, which gave a total of 50 injured testicles. Of the injured testicles, 24 (48%) could not be salvaged and required orchiectomy, while 26 (52%) were debrided and repaired. The most common associated genitourinary (GU) injuries were to the corpora cavernosum (n= 20 [21%]) and urethra (n= 10 [10%]). Soft tissue injury of the extremities occurred in 54 patients (56%), representing the most common non-GU-associated injury. Postoperative complications occurred infrequently: one patient (1%) returned for abscess drainage and one (1%) for haematoma evacuation. The present report confirms that any patient with a penetrating injury to the scrotum should undergo immediate scrotal exploration. A low clinical suspicion for performing additional studies to rule out associated urethral and/or penile injury is clinically warranted. Testicular loss occurs in ≈50% of injured testicles.

Bicycle-related Genitourinary Injuries

To use the National Trauma Data Bank (NTDB) to evaluate bicycling-related genitourinary (GU) injury. Bicycling is a popular recreational and competitive sport with recognized risks. GU injuries associated with bicycling is unknown. Patient cases were extracted from the NTDB, version 9.1, using the mechanism of injury Ecode for pedal cyclist and ICD-9 codes for GU injuries. The type of GU injuries, patient demographics, Injury Severity Score, surgical management, outcomes, and disposition were analyzed. Of 635,013 trauma cases evaluated, 16,585 were identified as trauma because of bicycle injury. GU injuries were sustained in 358 (2%) patients; 86% were male, with a mean age of 29 years. The most commonly injured GU organ was the kidney (75%), followed by bladder and urethra (15%), and penis and scrotum (10%). These injuries resulted in nephrectomy (0.4%), cystorrhaphy (11.3%), scrotorrhaphy (42.1%), testicular repair (3.1%), and penile repair (7.5%). Most common associated injuries included vertebral fracture (35%), pelvic fracture (25%), spleen (19%), and open head wound (15%). Patients who sustained a vertebral fracture commonly sustained a concomitant bladder and urethra (37.7%) or a renal injury (22.6%). GU injury is an infrequent occurrence with bicycle trauma, occurring in 2% of bicycle injuries, with kidneys being the most commonly injured GU organ. Physicians treating bicyclists who sustained a vertebral fracture should be aware of a possible concomitant renal or bladder injury. Young males appear to be principally at risk for GU injury.

UP-03.132 Long-Term Evolution of Missed Genitourinary Trauma Injuries in Serious Polytraumatized Patients: Importance of Tertiary Trauma Survey

UP-03.132 Long-Term Evolution of Missed Genitourinary Trauma Injuries in Serious Polytraumatized Patients: Importance of Tertiary Trauma Survey

Neurosurgical Considerations After Bull Goring During Festivities in Spain and Latin America

Bullfighting is a highly popular activity during festivities in Spain and Latin America. A scientific society for bullfight injuries, Congreso Internacional de Cirugía Taurina, was founded on November 24, 1974, in recognition of the distinctive pattern of injury that results from bull goring, and a subspecialty of general surgical trauma with emphasis on the acute surgical management of bull-goring injuries has emerged. Injuries to the head and neck are less frequent than genitourinary, inguinal, and abdominal injuries, but are more severe and more likely to result in death. This report reviews the primary venues in which bull goring and associated injuries occur, including the bullfight and the running of the bulls. The biomechanics of the primary and secondary goring injuries are reviewed, with an emphasis on those with the potential to result in neurosurgical injuries. This results in a very unique and devastating pattern of injury that combines penetrating and blunt mechanisms and results in polytrauma. Neurosurgical expertise should be immediately available on-site in the event of a life-threatening neurological injury.

Outcomes in Geriatric Genitourinary Trauma

Geriatric trauma patients (GTPs) are the fastest growing segment of patients admitted to trauma centers. We examined the characteristics and outcomes of genitourinary (GU) trauma sustained by GTPs compared with nongeriatric trauma patients (NGTPs). The National Trauma Data Bank v8.0 was searched by ICD-9 CM codes for GU injuries in GTPs 65 years or older compared with NGTPs aged 18 to 64 years. The incidence of GU trauma, mechanism of injury, Injury Severity Score (ISS), surgical intervention, pre-existing comorbidities, hospital complications, discharge disposition, and mortality were analyzed. Chi-square test was used to compare the distribution for categorical variables and t-test was used to compare means of continuous variables between GTPs and NGTPs. Of the 9,470 patients with GU trauma, 852 patients (9.0%) were 65 years old or older, and 8,618 patients (91.0%) were 18 to 64 years. GTPs were more likely to sustain injury to the bladder or urethra (28.9% vs 20.5% p < 0.001), and less likely to the penis (0.5% vs 3.4% p < 0.001) and scrotum or testes (1.5% vs 7.7% p < 0.001). Rates of injury to the kidney (67.5% vs 65.9%) were similar. GTPs more commonly sustained blunt trauma (92.8% vs 74.4% p < 0.0001). Although the mean Injury Severity Scores for GTPs and NGTPs were similar (17.7 vs 18.1), GTPs were more commonly admitted to the ICU (41.8% vs 31.6% p < 0.001) and had a longer ICU stay (6.6 vs 5.7 days p = 0.02). Renal embolization, nephrectomy, and nonoperative management of renal injuries were similar in both cohorts. GTPs had significantly more comorbidities and hospital complications. The mortality rate was significantly higher for GTPs (18.5% vs 9.9%, p < 0.0001). GTPs sustain a significant number of GU injuries. Penetrating GU injuries are less common in GTPs. Although GTPs and NGTPs had similar mean Injury Severity Scores, GTPs had more ICU admissions, longer ICU stays, and twice the mortality rate when compared with NGTPs.

206 PELVIC FRACTURES AND ASSOCIATED GENITOURINARY INJURIES DURING OPERATION IRAQI FREEDOM AND OPERATION ENDURING FREEDOM

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery1 Apr 2011206 PELVIC FRACTURES AND ASSOCIATED GENITOURINARY INJURIES DURING OPERATION IRAQI FREEDOM AND OPERATION ENDURING FREEDOM Hsiang Chi Cathy McLaughlin, Daniel Stinner, Jack Walter, and Joseph Hsu Hsiang Chi Cathy McLaughlinHsiang Chi Cathy McLaughlin San Antonio, TX More articles by this author , Daniel StinnerDaniel Stinner San Antonio, TX More articles by this author , Jack WalterJack Walter San Antonio, TX More articles by this author , and Joseph HsuJoseph Hsu San Antonio, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2614AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES As combat operations medical evacuation improves, urologists are encountering more devastating injuries that were previously not survivable. These injuries frequently involve pelvic fractures and lower urinary tract injuries not encountered in civilian medical centers. With continued improvements in battlefield medical care, we anticipate seeing more severe injuries. We investigated the lower urinary tract injuries associated with pelvic fractures in fatalities. We also delineated the association between specific genitourinary injuries and pelvic fracture type. METHODS A data base of all United States service members fatally injured in Operation Enduring Freedom and Operation Iraqi Freedom was queried. In 2008, 91 deceased service members sustained a pelvic fracture. Autopsies were performed on each service member documenting type of pelvic fracture, injury mechanism, associated genitourinary injuries, and other injuries. RESULTS Complete data was available for all service members. Pelvic fractures were categorized by the Tile classification. The majority of bladder, testicular, and penile injuries were associated with Tile C pelvic fracture (70%, 69%, and 66% respectively). Penetrating trauma and blunt trauma accounted for 66 %( 60 subjects) and 34% (31 subjects) respectively. Overall, concomitant bladder injury occurred in 24% of patients, testicular injury in 27%, penile injury in 6%, and prostatic injury in 6%. The majority (77% bladder, 80% testicular, 66% penile, 83% prostate) of concomitant genitourinary injuries were associated with penetrating trauma. CONCLUSIONS Significant genitourinary trauma occurs in current combat operations. The injuries sustained are unique due to their severity. The higher incidence of bladder injury associated with pelvic fracture is likely due to the mechanism and severity of injury. Additionally, wounds that may have previously been fatal are now survivable as medical evacuation improves. We describe the currently fatal genitourinary injuries that our service members sustain to make known what injuries we may encounter and have to manage in the future. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e85 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hsiang Chi Cathy McLaughlin San Antonio, TX More articles by this author Daniel Stinner San Antonio, TX More articles by this author Jack Walter San Antonio, TX More articles by this author Joseph Hsu San Antonio, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Profiling genitourinary injuries in United Arab Emirates

Background:The epidemiology of genitourinary (GU) organ injury following general trauma is not well-studied especially in the Middle East.Patients and Methods:All patients with GU injuries from the Trauma Registry of Al-Ain Hospital were studied. The registry data was prospectively collected from March 2003 to March 2006.Results:Out of 2573 patients in the registry, 22 had GU injuries (incidence: 0.9%, 2.0 per 100,000 inhabitants per year). Road traffic collision was the most frequent mechanism of injury (50% of all cases). 41% of injuries were renal. In 73% of patients, GU injuries were associated with other organ injuries, the most frequent of which were injuries to the other abdominal and pelvic organs (94%). The mean Injury Severity Score, mean total hospital stay, the percentage of patients who required intensive care unit (ICU) admission were higher in patients with GU injuries compared to non-GU patients (17.1 vs. 5.5 (P 0.001), 15.4 vs. 9.2 days (P 0.040) and 43% vs. 8%, (P 0.0001), respectively.Conclusions:The incidence of trauma-related GU injuries in the current study appears to be comparable to those reported from the West. Patients with GU organ injuries tend to have more severe trauma compared to other patients. Road traffic collision was the most common mechanism of injury and the kidney was the most frequently injured organ.

Genitourinary system trauma after 2003 Bam earthquake in Kerman, Iran

Background:Natural disasters, especially earthquakes, result in many health problems all over the world, of which urological injuries should not be underestimated. Car accidents and falling from a height are the most common causes of genitourinary system injury. The lack of specific data in the literature regarding the outcome of earthquake-related genitourinary system trauma prompted us to undertake this study.Methods:We retrospectively evaluated the genitourinary system injury in patients who had survived the Bam earthquake. In this study, all patients admitted to two main back-up hospitals of Kerman were included. Of 256 patients who had been referred to Kerman hospitals, 28 cases were found to have urologic damage on physical examination, intravenous pyelography, abdominopelvic X-ray, and ultrasonography.Results:Of 28 patients with urologic damage, 22 (78.5%) were male and six (21.5%) were female. Their age ranged from 18 to 65 years. The injures included urethral disruption in 21 cases (75.5%), vesicovaginal fistula in four cases (14%), kidney rupture in two cases (7%) and bladder neck disruption accompanied with total right ureteral disruption and vesicovaginal fistula in a female patient (3.5%).Conclusion:We have evaluated the incidence of genitourinary injuries after an earthquake disaster for the first time. The most and least common urologic injury in our patients was urethral disruption and ureteral injury, respectively.