Dear Editor,We appreciated the letter to editor [1] regarding ourrecent article in the WJU and would like to elucidate someimportant points:1. The fact that our study shows an unusually highpercentage of patients with intraperitoneal lesions orperforating trauma mostly due to gunshot wounds [2]is related to its design as stated in the methods anddiscussion sections, respectively: ‘‘The inclusion cri-teria were patients experiencing laparotomy for traumaand bladder injury AAST-OIS grade C II’’/‘‘It shouldbe emphasized that the bladder injuries were deter-mined by findings at exploratory laparotomy fortrauma, being these data an exceptional cross-sectionalview of bladder trauma….’’ So we intentionally missedextra-peritoneal blunt bladder traumas and certainlyunderestimate it to be 4.3 %.2. From a urological standpoint, no predictors of bladder-related complications such as infection, voiding dys-function, urinary fistula, pain, leakage of urine orlength of catheter drainage could be identified in ourseries. Even though a supra-pubic cystostomy catheterwas inserted to protect the repair in eight patients(7.2 %) with complex injuries (three had associatedurethral tears), there was no mortality due to urinarycomplications that were mild and self-resolving with-out sequelae: non-complicated urinary infections werediagnosed in seven patients—6.3 % and transienturinary fistula in two—1.8 %.We agree that our findings are most likely generalizableto all of the 2,575 initially screened trauma patients in thisstudy. And this is in fact the main take-home message ofour hypothesis generating study. In other words, ‘‘associ-ated bladder trauma adds no clinically significant negativeimpact on trauma patients’’.Neither the severity (AAST-OIS grade) of the bladderinjury nor the trauma mechanism (blunt or penetrating) northe kind of rupture (intraperitoneal, extraperitoneal, orassociated) was related to the presence of complications, tothe length of hospital stay or to death. In clinical practice,from the perspective of our study design, the trauma scoresare more important than the mechanism, grade, or kind ofbladder injury. Urological complications in trauma patientsare minor and transient, mainly in the bladder traumacontext.On the other hand, trauma literature has a lot to improvein terms of quality of data available, and evidence-basedtrauma support is desirable. The bulk of literature ontrauma is composed of retrospective studies includingmainly Level III data, suffering from several importantbiases such as selection, measurement, and analytical andalso from known and unknown confounding factors, as isour article [2].To challenge this grim reality that commits the studiesvalidity, we have recently proposed the network ‘‘Evi-dence-based Telemedicine-Trauma and Acute Care Sur-gery’’ (EBT-TACS) Journal Club [3] with the key task ofconnecting strategic trauma centers around the world in‘‘brain storms’’, critically discussing the current literature,
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