Genitourinary Trauma Research Articles

The Outcomes of Pelvic Fracture Urethral Injuries Stratified by Urethral Injury Severity: A Prospective Multi-institutional Genitourinary Trauma Study (MiGUTS)

ObjectiveTo determine patient outcomes across a range of pelvic fracture urethral injury (PFUI) severity. PFUI is a devastating consequence of a pelvic fracture. No study has stratified PFUI outcomes based on severity of the urethral distraction injury. MethodsAdult male patients with blunt-trauma-related PFUI were followed prospectively for a minimum of six months at 27 US medical centers from 2015-2020. Patients underwent retrograde cystourethroscopy and retrograde urethrography to determine injury severity and were categorized into three groups: (1) major urethral distraction, (2) minor urethral distraction, and (3) partial urethral injury. Major distraction vs minor distraction was determined by the ability to pass a cystoscope retrograde into the bladder. Simple statistics summarized differences between groups. Multi-variable analyses determined odds ratios for obstruction and urethroplasty controlling for urethral injury type, age, and Injury Severity Score. ResultsThere were 99 patients included, 72(72%) patients had major, 13(13%) had minor, and 14(14%) had partial urethral injuries. The rate of urethral obstruction differed in patients with major (95.8%), minor (84.6%), and partial injuries (50%) (P < 0.001). Urethroplasty was performed in 90% of major, 66.7% of minor, and 35.7% of partial injuries (P < 0.001). ConclusionIn PFUI, a spectrum of severity exists that influences outcomes. While major and minor distraction injuries are associated with a higher risk of developing urethral obstruction and need for urethroplasty, up to 50% of partial PFUI will result in obstruction, and as such need to be closely followed.

Fracture Penis: Diagnosis, Treatment and Outcome of 9 Patients

Background: First reported case of penile fracture was made an Arab physician, more than 1000 years ago. Fracture penis not an uncommon genitourinary trauma, once it was thought. Sexual intercourse, masturbation, rolling over or falling onto the erect penis, abrupt blunt trauma by forceful bending of the erect penis etc. are the main causes of penile fracture. Treatment option of fracture penis now a days is operative. Materials and methods: It was a retrospective study. Patients with fracture penis admitted in the Department of Urology and Surgery Rangamati Medical College hospital and Chattogram National Hospital (Pvt.) Ltd. since May 2008 to December 2019 were included in this study. Total 9 patients were treated with fracture penis in this period of time. Patients were diagnosed by proper history, physical examination and investigations. Patients with genitourinary trauma due to other reasons were excluded from the study. Patient’s data were collected from hospital records and were analyzed later on. Results: Nine patients with fracture penis were included in this study. Six patients developed fracture during sexual intercourse, two during penile manipulation and one gave ambiguous history. After proper preoperative preparation and counselling, they underwent operation. The defect of tunica albuginea was identified and repaired. One patient had urethral injury which was also repaired at the time of repair of tunica albuginea. All the patients were evaluated post operatively. One patient had mild erectile dysfunction, others were normal. Conclusion: Immediate repair of the tunica albuginea was the corner stone of success. Bangladesh J. Urol. 2021; 24(1): 20-24

The Pattern, Management and Outcome of Genitourinary Trauma in Ghana

Objectives: This is to review the pattern of causes, management and outcome of genitourinary(GU) injuries managed at the Korle Bu and the 37 Military Teaching Hospitals from 1978 to 2010.&#x0D; Patients and Methods: Prospectively cases of genitourinary trauma from 1978 to 2010 were studied at the Korle Bu and 37 Military Teaching Hospitals. Patient history and clinical examination was taken and classified into haemodynamically stable or unstable condition. Stable patients were admitted and investigated whilst unstable patients were stabilised and operated. Investigations were based on the injuries sustained and included a full blood count , plain and contrast radiological investigations and computerised tomography .&#x0D; Results: A total of 523 cases (460 cases from Korle Bu teaching hospital from 1978 to 2001 and 63 cases from 37 Military Hospital from 2001 to 2010) were managed made up of 412 males (78.8%) and 111 females (21.2%) with a male to female ratio of 4 to 1. The youngest was 4 years and the oldest was 64 years. Sites affected included 38 renal (7.3%), 63 ureteral (12.1%), 109 bladder (20.8%), 233 urethral (44.6%) and 54 external genital (10.3%). Causes included road traffic accidents (49.5%), industrial accidents (0.77%), falls (16.8%), high (1.15%) and low (2.7%) velocity injuries, bites (0.57%), iatrogenic (23.71%) and idiopathic (0.2%). Presentation included haematuria (80%), urinary retention (8%), anuria plus abdominal pain /peritonitis (10%) and 2% with peritonitis. Management was 57 (10.8%) conservative and 466 (89.2%) operative. Outcome was 462 (88.3%) recovery, 47 (8.9%) with complications and 14 (2.64%) deaths. &#x0D; Conclusion: Commonest causes of Genitourinary injuries in Ghana include Road traffic accidents 259(49.5%), Iatrogenic causes 124 (23.7%) and Falls 88 (16.8%). Early intervention in unstable patients prevents mortality .

Nephrogenic Adenoma of Bladder—An Unusual Mimicker of Malignancy

AbstractNephrogenic adenoma also referred to as nephrogenic metaplasia is a rare benign condition occurring most frequently in the urinary bladder. It is most commonly associated with chronic inflammation and genitourinary trauma and can present with a broad spectrum of histological features. It must be differentiated from malignant lesions, which can mimic both at cystoscopy and microscopically. Here, we report a case of nephrogenic adenoma in a middle-aged male with predisposing factors.

Impact of the COVID-19 pandemic on emergency department visits for genitourinary trauma

IntroductionThe mean number of emergency department visits for all-cause traumas has declined significantly during the COVID-19 pandemic. We aim to identify how a global pandemic and social distancing could affect the trends and pattern of genitourinary traumas.MethodsWe queried the National Electronic Injury Surveillance System to obtain consumer product-related genitourinary injuries leading to emergency department visits. Using three key events in 2020, we divided the study period to three intervals: January 20, when the first COVID-19 case was confirmed in the United States; March 13, when a national state of emergency was declared; April 20, when Texas became the first state to start a phased reopening of economy. We compared the injury characteristics in 2020 to their identical intervals in 2019.ResultsDaily emergency department visits dropped significantly during the national lockdown (mean 131.5 vs. 78; Δ-40.7%; p < 0.01). The genitourinary injuries decreased significantly in children ≤ 17 years (p < 0.01), males (p < 0.001), and White population (p < 0.01). However, it did not change significantly in adults 18–64 years (p = 0.92), old adults ≥ 65 years (p = 0.37), females (p = 0.60), Black population (p = 0.90), other/unknown races (p = 0.93), and for injuries sustained at home (p = 0.75) and public (p = 0.11) locations. During the lockdown period, injuries associated with toilets/toilet seats (− 320, − 74.6%), day wear (− 266, − 77.7%), beds/bedframes (− 209, − 64.2%) decreased while injuries associated with knickknacks/statues/vases (+ 154, n/a), sofas/couches/divans (+ 130, 2,684%), and razors/shavers (+ 99, n/a) increased.ConclusionsThe COVID-19 lockdown had a significant impact on genitourinary traumas. The contributing factors could be investigated further to prevent such injuries during deconfinement periods.

DoD-VA Trauma Infection Research Collaboration.

In the aftermath of wars, there is a surge in the number of wounded service members who leave active duty and become eligible for healthcare through the Department of Veterans Affairs (VA). Collaborations between the Department of Defense (DoD) and VA are crucial to capture comprehensive data and further understand the long-term impact of battlefield trauma. We provide a summary of the development, methodology, and status of an effective collaboration between the Infectious Disease Clinical Research Program and the St. Louis VA Health Care System with the multicenter, observational Trauma Infectious Disease Outcomes Study (TIDOS), which examines the short- and long-term outcomes of deployment-related trauma. As part of TIDOS, wounded service members who transitioned to participating military hospitals in the United States (2009-2014) were given the opportunity to enroll in a prospective follow-up cohort study to continue to capture infection-related data after their hospital discharge. Enrollees in the TIDOS cohort who left military service and received health care through the VA also had the option of consenting to have relevant VA medical records abstracted and included with the study data. Infections considered to be complications resulting from the initial trauma were examined. Among 1,336 TIDOS enrollees, 1,221 (91%) registered and received health care through the VA with 633 (47%) consenting to follow-up using VA records and comprising the TIDOS-VA cohort. Of the first 337 TIDOS-VA cohort enrollees, 38% were diagnosed with a new trauma-related infection following hospital discharge (median: 88 days; interquartile range: 18-351 days). Approximately 71% of the infections were identified through DoD sources (medical records and follow-up) and 29% were identified through VA electronic medical records, demonstrating the utility of DoD-VA collaborations. The TIDOS DoD-VA collaboration has also been utilized to assess intermediate and long-term consequences of specific injury patterns. Among 89 TIDOS-VA cohort enrollees with genitourinary trauma, 36% reported sexual dysfunction, 21% developed at least one urinary tract infection, 14% had urinary retention/incontinence, and 8% had urethral stricture. The rate of urinary tract infections was 0.05/patient-year during DoD follow-up time and 0.07/patient-year during VA follow-up time. Wider capture of infection-related outcome data through the DoD-VA collaboration provided a clearer picture of the long-term infection burden resulting from deployment-related trauma. Planned analyses include assessment of osteomyelitis among combat casualties with amputations and/or open fractures, evaluation of mental health and social factors related to injury patterns, and examination of health care utilization and cost in relation to infectious disease burdens.

PD29-02 RISK OF HYPERTENSION AFTER RENAL TRAUMA

You have accessJournal of UrologyCME1 May 2022PD29-02 RISK OF HYPERTENSION AFTER RENAL TRAUMA Matthew S. Swallow, Odinachi I. Moghalu, Joshua J. Horns, Benjamin J. McCormick, and Jeremy B. Myers Matthew S. SwallowMatthew S. Swallow More articles by this author , Odinachi I. MoghaluOdinachi I. Moghalu More articles by this author , Joshua J. HornsJoshua J. Horns More articles by this author , Benjamin J. McCormickBenjamin J. McCormick More articles by this author , and Jeremy B. MyersJeremy B. Myers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002577.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The risk of hypertension after renal trauma (RT) is not well-defined. Previous studies are limited by small cohorts and/or difficulty in long-term follow up after trauma. We aimed to utilize the Truven Health MarketScan (MS) database to evaluate the risk of hypertension after RT. METHODS: We conducted a retrospective analysis of inpatient records in MS from 2008-2017 for patients with renal and bladder/urethral trauma. Patients with a diagnosis of RT or non-renal lower genitourinary trauma (GUnRT) (bladder/urethral trauma) were identified through ICD-9/10 codes. The development of HTN (also defined by ICD-9/10 codes) was compared between those who experienced RT and a control group of those who experienced GUnRT. Patients were excluded if they experienced both trauma types, had pre-existing HTN, had less than one year of enrollment data prior to trauma, or if they were under 18 years of age. An adjusted analysis included multiple covariates. RESULTS: There were a total of 6,542 RT patients and 5,144 GUnRT patients. The median age was 52 years (IQR 31-65) for RT patients and 49 years (IQR 38-64) for GUnRT patients. Median follow up data was 18 months (IQR 6-38) for RT patients and 21 months (IQR 7-42) for GUnRT patients. A total of 2,232 (34.1%) RT patients developed post-trauma HTN compared to 1,194 (23.2%) GUnRT patients. On multivariate analysis, risk of post-trauma HTN was higher in individuals with RT compared to GUnRT (hazard ratio 1.75, 95% CI 1.63-1.88, p<0.001). Other covariates associated with increased risk of post-trauma HTN included increasing age, female gender, increased Charlson Comorbidity Index, increased inpatient length of stay, and presence of one or more of the following comorbidities: smoking, diabetes, obesity, hyperlipidemia, and alcohol use. Undergoing either an open or minimally invasive kidney procedure was not associated with a higher rate of HTN (hazard ratio 1.095, 95% CI 0.94-1.27, p=0.239). CONCLUSIONS: Patients experiencing renal trauma have an associated higher rate of developing hypertension compared to a control population. Patient age, female gender, and medical history of diabetes, obesity, and hyperlipidemia was also associated with increased risk of post-trauma HTN. Source of Funding: University of Utah Division of Urology © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e504 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew S. Swallow More articles by this author Odinachi I. Moghalu More articles by this author Joshua J. Horns More articles by this author Benjamin J. McCormick More articles by this author Jeremy B. Myers More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Role of Magnetic Resonance in Evaluating Abdominopelvic Trauma - Part 2: Trauma in Pregnancy, Vascular, and Genitourinary Injuries.

Trauma is an important cause of mortality, particularly in the young. While computed tomography (CT) is the mainstay of body imaging in the setting of trauma, magnetic resonance (MR) imaging can be useful in stable patients. Although more commonly used in spinal and musculoskeletal trauma, MR also has a role in abdominopelvic trauma. Broadly, its uses include clarification of equivocal cases, monitoring complications of trauma, particularly with solid organ injury, or as a primary imaging modality for patients with low suspicion for injury for whom avoiding ionizing radiation is a priority-namely, in pediatric and pregnant patients. In this two-part review article, we will review clinical scenarios where this may be encountered, utilizing case examples. Our second installment will focus on the use of MR in pregnant patients and in the characterization of vascular and genitourinary trauma. Body MR can be useful in pregnant patients in characterizing injuries both specific for and not specific for pregnancy. Placental injuries and hematomas in particular may be better seen on MR relative to CT, owing to its superior contrast resolution. MR angiography can be performed either without or with contrast and can be useful to monitor low-grade traumatic aortic injuries. Renal and ureteral injuries can be followed with MR to help identify urine leaks, either in a delayed presentation or in patients who have an iodinated contrast allergy. Lastly, penile injuries are often imaged with ultrasound, but may benefit from additional imaging with MR when the tunica albuginea cannot be completely seen due to overlying hematoma.

Do concomitant urological injuries in severely injured patients lead to poorer outcomes? : Amultivariate risk analysis

Severely injured patients with associated genitourinary (GU) injuries have only rarely been investigated in the current literature. If at all, analyses are commonly focussed on renal injuries, marginalising other GU traumas such as ureteral injuries. In this study, we would like to characterise patients with GU injuries and analyse the impact of such injuries on mortality and length of stay. The inclusion criteria for this retrospective analysis of TraumaRegister DGU® data were: Injury Severity Score ≥ 16 within the period between 2009 and 2016 with available data on age and length of stay. Adescriptive analysis was used to compare patients with and without GU injuries. The impact of GU injuries on mortality and length of hospital stay was evaluated by means of multivariate regression analyses. In all, 90,962patients met the inclusion criteria; 5.9% of them had suffered GU injuries (n = 5345). The prevalence in patients with pelvic fractures was up to 19%. On average, patients with GU trauma were 10years younger (42.9 vs. 52.2years) and more severely injured (ISS: 31.8 vs. 26.4). The multivariate analyses demonstrated that GU injuries in severely injured patients are no independent risk factor for mortality. However, particularly bladder and genital injuries result in longer hospitalisation. GU injuries do not represent an additional risk factor for mortality. However, after adjusting for established prognosis factors, they can cause prolonged periods of hospitalisation of severely injured patients.

Management of genitourinary trauma - current evaluation from the Sub-Saharan region: A systematic review.

BACKGROUNDTrauma is a major cause of morbidity globally and the sixth leading cause of death, accounting for 10% of all mortalities. The genitourinary trauma is estimated for approximately 10% of all patients presenting with trauma, and the kidney is the most injured genitourinary organ globally. However, there is a paucity of data on genitourinary injury from the Sub-Saharan, and there may be variations from common genitourinary organs injured in developed nations. AIMTo provide insight on the epidemiology and management of genitourinary trauma in Sub-Saharan Africa with recommendations based on international guidelines.METHODSA thorough literature search of genitourinary trauma was conducted using PubMed, Google Scholar and African Journal Online. RESULTSA total of 30 studies from the Sub-Saharan region were eligible for the study and reviewed for epidemiology, biodata, types of injury, mechanisms of injury, treatment and follow-up. After evaluating 21904 patients presenting with urological emergencies, approximately 6.6% of cases were due to genitourinary trauma. The commonest injury was urethral 42.9% (22.2-62.2%) followed by injury to the external genitalia (penis, scrotum, testes) 25.1% (8.8-67.7%).CONCLUSIONGenitourinary injury in Sub-Saharan Africa is underreported, and the presence of more trauma registries, trained urologists and trauma facilities could improve the overall standard of care as well as providing data for research and development in the field.

EDITORIAL COMMENT

The authors present a detailed review of data from the Multi-institutional Genito-Urinary Trauma Study (MiGUTS), specifically looking at high grade renal trauma (HGRT) and looked for associations with nephrectomy. There were 1181 patients with HGRT and 129 (11%) underwent nephrectomy and 96 (8%) died. The authors analyzed variables of these patients with HGRT and performed descriptive statistics. They found that those who underwent nephrectomy had triple the death rate compared with those who did not.

PD31-06 MENTAL HEALTH ILLNESS AFTER EXTERNAL GENITOURINARY TRAUMA: A CASE-CONTROL STUDY IN A US POPULATION

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II (PD31)1 Sep 2021PD31-06 MENTAL HEALTH ILLNESS AFTER EXTERNAL GENITOURINARY TRAUMA: A CASE-CONTROL STUDY IN A US POPULATION Christopher J Loftus, Alexander Skokan, Sarah Holt, and Judith C Hagedorn Christopher J LoftusChristopher J Loftus More articles by this author , Alexander SkokanAlexander Skokan More articles by this author , Sarah HoltSarah Holt More articles by this author , and Judith C HagedornJudith C Hagedorn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002032.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients who sustain traumatic injuries are at risk for developing post-traumatic stress and mental health disease. Due to the nature of the injuries, trauma that affects the penis, testicles and scrotum may place men at an even greater risk for these psychological sequelae. The objective of this study was to characterize the development of mental health illness in men experiencing external genitourinary (GU) trauma in a national cohort. METHODS: We performed a case-control study using Truven MarketScan, a national employer-based insurance claims database, from 2007 to 2019. Male patients at least 18 years of age who sustained external GU injury involving the penis, scrotum and/or testicles were identified by ICD-9/10 codes. We excluded men with a history of depression, anxiety or erectile dysfunction (ED) in the year before injury, those with pelvic fractures at time of injury, and those with <24months of continuous follow-up after their injury. Control patients were defined as men with isolated traumatic injuries of the upper extremity (UE). The primary outcome of interest was a new claim with an ICD-9/10 diagnostic code for either depression or anxiety which acted as a surrogate marker for mental health illness. Logistic regression was used to adjust for age and calculate adjusted odds ratios. RESULTS: We identified 4,026 men who sustained external GU trauma and 102,045 men with UE trauma. Men with GU injuries had a median age of 40 years (IQR 26-51) and were younger than men with UE injuries (40 vs. 43 years, p<.001). Men with GU injuries had a higher rate of developing depression/anxiety (11.6% vs. 10.3%, OR 1.2 [1.04-1.27], p=.007). Of men with GU injuries, 7.1% developed new ED as compared to 3.6% with UE injuries (OR 2.4 [2.07-2.67], p<.0001). While ED was positively correlated with new depression/anxiety in all men (p<.0001), GU injury was associated with mental health illness independently of the additional diagnosis of ED (p<.0001). Of men with GU injuries, 2.2% developed Peyronie’s disease as compared to 0.1% with UE injuries (OR 20.8 [15.8-27.5], p<.0001). CONCLUSIONS: Even within intermediate-term follow-up, men who sustain external GU traumatic injury have high rates of developing new depression and anxiety and this rate is higher than in those sustaining an isolated orthopedic injury. These data support that counseling these patients about mental health should be considered at the time of injury and that subsequent signs of psychological distress and ED should be monitored closely in follow-up. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e540-e540 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher J Loftus More articles by this author Alexander Skokan More articles by this author Sarah Holt More articles by this author Judith C Hagedorn More articles by this author Expand All Advertisement Loading ...

MP04-09 POPULATION-BASED ANALYSIS OF OCCUPATION RELATED GENITOURINARY INJURIES: MALE EXTERNAL GENITALIA STILL AT RISK

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I (MP04)1 Sep 2021MP04-09 POPULATION-BASED ANALYSIS OF OCCUPATION RELATED GENITOURINARY INJURIES: MALE EXTERNAL GENITALIA STILL AT RISK Ruth Blum, Shawn Mendonca, Sun-Ming J. Pan, Jane Kurtzman, and Steven Brandes Ruth BlumRuth Blum More articles by this author , Shawn MendoncaShawn Mendonca More articles by this author , Sun-Ming J. PanSun-Ming J. Pan More articles by this author , Jane KurtzmanJane Kurtzman More articles by this author , and Steven BrandesSteven Brandes More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001971.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Occupational injuries are a significant problem in the United States, resulting in a large economic burden in medical care, lost wages and time from work. Little is known about genitourinary (GU) trauma in the workplace. This is the 1st population-based and largest cohort report in the literature. METHODS: The National Trauma Data Bank (NTDB) database was queried for all patients with a GU (adrenal, bladder, kidney, penis, scrotum, ureter, or urethra) and ″work-related″ injury from 2007 to 2016. Outcomes were sub-stratified by external GU injuries versus intra-abdominal injuries, as well as blue collar versus white collar jobs. Chi-squared analysis was utilized to compare characteristics between each GU injury. Polynomial logistic regression to assess if characteristics favored any GU injury. Multivariate regression analysis was used to determine variables predictive of GU injuries. RESULTS: 2893 traumatic GU injuries were identified. 2748 (95%) patients were male and 140 (5.0%) female. Mean age 41.3 years (range 15-85). Mean injury severity score (ISS) 20.7 (range 1-75). Mean length of stay 12.6 days (range 1-249 days). Charleson Comorbidity Index , 0 - 2 in 1947 (67%). GU injuries: kidney (1149, 39.7%), adrenal (574, 19.8%), urethra (310, 10.7%), bladder (300, 10.4%), scrotum (270, 9.3%), penis (135, 4.7%), testes (119, 4.1%), and ureter (36, 1.2%). Associated injuries: liver 8.1%, spleen 12.2%, thorax 35%, lower extremity 11%, vertebral 32%. 202 (7.0%) patients died. All genital injuries were lacerations, grade (G) 1-3 and intra-abdominal urotrauma G 1-3, except kidney (13.6% G 4 and 3.31% G 5). Construction was associated with the highest frequency of GU injuries (N=663, 22.0%) and agriculture, forestry, and fishing (AFF) second (N=179, 6.2%). On polynomial logistic regression, AFF was associated with a higher risk of penis (OR 4.1, p=0.0009), urethra (OR 2.5, p=0.0005) and scrotum (OR 2.4, 0=0.04) injuries vs. other blue-collar professions. In the multivariate model, AFF (p≤.0001) and construction (p≤.0001) were predictive of external GU injuries. CONCLUSIONS: Construction and AFF jobs are the most dangerous for GU injury and are particularly prone to external genital injuries. A safety issue clearly persists in these professions, and thus would benefit from additional safety regulations, protective undergarments, or equipment guards. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e70-e70 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ruth Blum More articles by this author Shawn Mendonca More articles by this author Sun-Ming J. Pan More articles by this author Jane Kurtzman More articles by this author Steven Brandes More articles by this author Expand All Advertisement Loading ...

HF02-14 JOHN KELSO ORMOND: MORE THAN A SYNDROME

You have accessJournal of UrologyHistory of Urology Forum II (HF02)1 Sep 2021HF02-14 JOHN KELSO ORMOND: MORE THAN A SYNDROME Naveen Kachroo, Craig Rogers, and James Peabody Naveen KachrooNaveen Kachroo More articles by this author , Craig RogersCraig Rogers More articles by this author , and James PeabodyJames Peabody More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001993.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: John Kelso Ormond is remembered for his seminal paper providing the first description in English medical literature of Idiopathic Retroperitoneal Fibrosis (IRF) or Ormond’s Syndrome. We examine the many contributions this progressive Urologist provided in advancing the field of urology. METHODS: A comprehensive literature review concerning the life and works of Dr John Kelso Ormond was performed via online search, review of published historical texts and published material on PubMed. Contemporary records held by The Conrad R. Lam medical archives at Henry Ford Hospital were also reviewed. RESULTS: John Kelso Ormond (1886-1978) received his MD degree from Johns Hopkins University in 1914 and was the first surgical resident at the newly established Henry Ford Hospital in Detroit in 1916. During his training, he also provided medical services in Europe during World War I. On his return, he founded the Division of Urology as the inaugural Chief of Urology from 1920-1952. During his accomplished tenure, in addition to training a future generation of urologists, he published on eclectic areas such as intra-abdominal testis torsion, female stress incontinence treatment, genito-urinary trauma management and even recognition of deep vein thrombosis and targeted prevention of pulmonary embolism in urologic patients in 1952 where “early ambulation was pioneered at Henry Ford Hospital”. His surgical outcome observations following radical perineal prostatectomy were exemplary for that era. His 1947 publication revealed “in as much as at least half of the patients were still sexually active”, testament to his surgical prowess being 35 years prior to Patrick Walsh’s nerve sparing radical prostatectomy and over 50 years prior to Viagra. Regarding urinary incontinence, “I no longer fear it greatly. Some patients have satisfactory control from the start…of 27 patients…none has had incontinence at night”. His indelible mark on medicine was made in 1948 with his seminal description of the clinical and pathologic features of IRF based upon 2 cases he had treated. Seventeen years later, he correctly postulated the systemic nature of the disease related to IgG4 diseases. Today, there are 3457 PubMed results related to Ormond’s syndrome alone. Urology was his life’s passion, practicing until 88 and still writing about his syndrome until his death aged 91. CONCLUSIONS: Dr Ormond’s contribution to urology stretches beyond his eponymous syndrome. His pioneering establishment of the Henry Ford Urology Department and the work he accomplished with his enduring academic passion even to his death, is something to be emulated. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e241-e241 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Naveen Kachroo More articles by this author Craig Rogers More articles by this author James Peabody More articles by this author Expand All Advertisement Loading ...

Transitional Care of Service Members With Genitourinary Injury.

To improve urotrauma care by describing veterans' current demographics and needs assessment during transitional care to the Veteran Health Administration (VHA) system. We utilized our previously identified cohorts obtained from the DoD Trauma Registry data for male service members injured in theater linked with VHA electronic health records. We included veterans who received care at VHA at least once from October 2001 through September 2011 for chart review. We investigate demographics, opportunities for care, combat-related trauma, disability, and associated mental health or urologic conditions specifically at the initial encounter with a VHA healthcare provider. We queried 580 veterans' records in VHA from the linked databases. We idenfied that 141 (24.4%) veterans received addional care outside VHA and 17.1% (n = 99) of charts had insufficient data for injury validation. Reference to the urotrauma was mentioned in 72% of VHA initial visits (n = 416/580). The most common urotrauma occurred to the lower/external genitourinary injury (298, 51%). Of all the veterans identified with genitourinary trauma, approximately 28% (n = 160) were referred for urologic consultation, but only 14% were related to the original urotrauma. Ninety percent (522/580) of service members with urotrauma also had a mental health diagnosis, largely post-traumatic stress disorder (PTSD, 70.8%). The majority of men with urotrauma did have contact with VHA, yet there is no systematic approach to baseline assessment or long-term care strategy. However, only a small proportion of DoD-documented urotrauma requires ongoing care. We identified that coordinating care with mental health pathways (PTSD/traumatic brain injury) may be an opportunity to evaluate the long-term effects of urotrauma.

Analysis of genitourinary trauma patients admitted to the emergency department

Background and objective: Genitourinary injuries are commonly encountered in the emergency department but may be over looked in case of multi-trauma. Determining the clinical features of genitourinary injuries will help physicians in the management of genitourinary trauma.&#x0D; Methods: The study was conducted in a tertiary hospital. Patients of all ages, admitted in the emergency department, with trauma between 2015 and 2020 were included and analyzed. The cause of genitourinary trauma, affected organs, any accompanying injury, treatments, mortality status, and laboratory tests related to mortality were obtained from the hospital records and analyzed.&#x0D; Results: During the study period, 87 patients admitted to the emergency department with genitourinary trauma were included in the study. The majority of these patients (n=79) were male. Of the patients, 9.2% died. All the patients in the mortality group had additional injuries. The most frequently injured organ was determined as the kidney (51.7%), followed by the scrotum (25.3%) and penis (8.1%). Additional injuries were observed in 81.6% of the patients. Intra-abdominal organ injuries (19.5%) were the most common accompanying injuries. White blood cell count (WBC), aspartate aminotransferase (AST), alanine aminotransferase ( ALT), blood glucose and creatinine values measured at the time of admission to the emergency department were found to be higher in the non-survivor group. The majority of the patients (81%) were discharged with conservative treatment and follow-up.&#x0D; Conclusion: It was determined that genitourinary injuries were frequently seen with additional injuries. Genitourinary injury should be evaluated carefully, especially in the presence of intra-abdominal organ injuries.&#x0D; Ibrahim Med. Coll. J. 2021; 15(2): 32-37

Nephrectomy After High-Grade Renal Trauma is Associated With Higher Mortality: Results From the Multi-Institutional Genitourinary Trauma Study (MiGUTS)

ObjectiveTo test the hypothesis that undergoing nephrectomy after high-grade renal trauma is associated with higher mortality rates. MethodsWe gathered data from 21 Level-1 trauma centers through the Multi-institutional Genito-Urinary Trauma Study. Patients with high-grade renal trauma were included. We assessed the association between nephrectomy and mortality in all patients and in subgroups of patients after excluding those who died within 24 hours of hospital arrival and those with GCS≤8. We controlled for age, injury severity score (ISS), shock (systolic blood pressure <90 mmHg), and Glasgow Coma Scale (GCS). ResultsA total of 1181 high-grade renal trauma patients were included. Median age was 31 and trauma mechanism was blunt in 78%. Injuries were graded as III, IV, and V in 55%, 34%, and 11%, respectively. There were 96 (8%) mortalities and 129 (11%) nephrectomies. Mortality was higher in the nephrectomy group (21.7% vs 6.5%, P <.001). Those who died were older, had higher ISS, lower GCS, and higher rates of shock. After adjusting for patient and injury characteristics nephrectomy was still associated with higher risk of death (RR: 2.12, 95% CI: 1.26-2.55). ConclusionNephrectomy was associated with higher mortality in the acute trauma setting even when controlling for shock, overall injury severity, and head injury. These results may have implications in decision making in acute trauma management for patients not in extremis from renal hemorrhage.

A large renal bullet that resembles a large renal stone. A rare case scenario.

IntroductionGenitourinary trauma secondary to a gunshot wound is uncommon as it only occurs in about 10% of cases. We present a case of a gentleman who suffered a gunshot wound to the kidney.Presentation of caseA 28 year old man presented with irritative lower urinary tract symptoms (LUTs) since three months. The medical history was irrelevant. He is known case of neurogenic bladder maintained on regular clean intermittent catheterization (CIC). He has history of gunshot to the back since few years that resulted in spinal injury. CTUT showed retained bullet inside the right kidney that look alike hyperdense renal stone, Moreover, multiple vesical stones. The vesical stones were treated with cystolitholapaxy. Given that the patient is asymptomatic, conservative management for the retained right renal bullet is the feasible option.DiscussionBased on the ASST classification, renal gunshot injury results in a grade IV injury. Abdominal exploration was reserved only in selected scenarios. Gunshot injuries to the kidney are commonly associated with thoracic and abdominal injuries. Gunshot injuries may be caused by low-velocity or high-velocity bullets. Given the paucity of cases reported in the literature, it is not obvious what is the optimum management of such patients with a retained renal bullet? We present the radiological findings and a clinical case summary as well for those who have Grade IV kidney injury and retained bullet managed conservatively.ConclusionRetained renal bullet post gunshot injury to the back is unusual presentation. A characteristic star-like pattern produced by lead shots and not by “stone,” consisting of plastic detonating cap will aid the urologist to differentiate retained renal bullet from renal stone. In such scenario, asymptomatic renal bullet look alike renal stone doesn't necessitate treatment.

Gunshot wounds to the penis and scrotum: a narrative review of management in civilian and military settings.

Gunshot wounds (GSW) to the penis and scrotum are present in two thirds of all genitourinary (GU) trauma, with a growing proportion of blast injuries in the military setting. Depending on the energy of the projectile, the injury patterns present differently for military and civilian GSWs. In this review, we sought to provide a detailed overview of GSWs to the external genitalia, from mechanisms to management. We examine how ballistic injury impacts tissues, as well as the types of injuries that occur, and how to assess these injuries to the external genitalia. If there is concern for injury to the deep structures of the penis or scrotum, operative exploration and repair is warranted. Relevant history and physical examination, role of imaging, and choice of conservative or surgical treatment options in the civilian and military setting are discussed, as well as guidelines for management set forth by the American Urological Association (AUA) and European Association of Urology (EAU).

Effectiveness of EUA colour Coding system in Urological Procedures during COVID-19: Experience at Institute of Kidney Diseases Peshawar Pakistan

Objective: To study effectiveness of EUA colour coding system in performing  urological procedures during COVID-19 Methodology: It is descriptive Study during three waves of COVID 19,  conducted  in Department of Urology  at Institute of Kidney Diseases Hayatabad Peshawar, Pakistan from March 24, 2020 till March 30, 2021. Total numbers of 3066 operated patients were included in the study. We followed the EUA guidelines of color coding for prioritization of surgical procedures. All the data of the patients and doctors were recorded on structured proforma and was analyzed on SPSS version 20. Results" Total numbers of 3066 surgeries were performed during three waves of COVID 19, that included 937 (30.5 %)) emergency Procedures with code black , 1272 (59.74%) high Priority labeled as code red, 636 (29.8%) as code yellow in intermediate priority and 221 (10.3%) as code green in. Regarding emergency surgeries code black, Obstructive uropathy remained high with 566 patients (60.4 %) patients, Pyonephrosis in 187(19.9%), Genito-urinary trauma in 93 (9.9%), miscellaneous in 91 (9.7%). The 1272 patients with high priority were dominated by Complicated Urolithiasis and High grade Urooncology. The preoperative nasopharyngeal PCR of 206 patients (22 %) in emergency procedures came positive for COVID-19. The rate of positive  seroconvesrion was recorded in  82(6%) in high and 9 (1.5%)in  intermediate priority and no seroconvesrion was recorded in code green . Conclusion:The EUA guidelines is a useful tool in prioritization of urological procedure.