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Chong EY, Goh DWX, Lim AHS, Goh SSN, Balasubramaniam S. A systematic review of penetrating perineal trauma in a civilian setting. Eur J Trauma Emerg Surg 2022; 48:4365-4383. [PMID: 35262749 DOI: 10.1007/s00068-022-01908-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/29/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Penetrating injuries to the perineum and associated pelvic organs have largely been reported in the military. Given the rarity of presentation and unique clinical characteristics of these injuries, we set out to address the gap in the literature in civilian settings. METHODS A systematic review of studies addressing penetrating perineal trauma from January 2000 to April 2021 was performed. Outcomes of interest were the epidemiology, associated injuries, management, follow-up, and patient outcomes. RESULTS 26 studies were included in this review, reporting on a total of 2316 patients. Most injuries occurred in males (88.1%), with gunshot wounds (88.2%) representing the most common aetiology, followed by knife wounds (5.0%), impalement (3.1%), coital injuries/sexual assault (1.5%), and others (2.4%). Regarding associated injuries, anorectal (n = 1419, 69.4%), bladder (n = 351, 32.4%), penile (n = 282, 20.8%), scrotal (n = 375, 27.7%), and testicular (n = 229, 16.9%) occurred frequently. Bony injuries involved the pelvis (n = 88, 8.1%) and femoral fractures (n = 5, 0.5%), while soft-tissue injuries involved the inguinal region (n = 19, 1.6%) and buttocks (n = 14, 1.3%). Vascular injuries occurred in 79 (7.8%) patients. Regarding patient outcomes, 65 (4.8%) deaths were reported, and significant morbidity was detected with a mean injury severity score of 18.4 detected in the cohort. In terms of complications of injury, wound/infective complications (n = 135, 61.3%) and fistula formation/leakage (n = 16, 0.7%) featured prominently. CONCLUSION Penetrating perineal trauma in the civilian population poses a considerable challenge to clinicians, compounded by the potential for multisystem injury requiring involvement of different medical and surgical specialties.
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Affiliation(s)
- Elliot Yeung Chong
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore city, Singapore
| | - Daniel Wen Xiang Goh
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore city, Singapore
| | - Angela Hui-Shan Lim
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore city, Singapore
| | - Serene Si Ning Goh
- Department of General Surgery, Tan Tock Seng Hospital, Singapore city, Singapore
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2
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Ukpong AE, Akaiso OE, Udo EA, Essiet IU, Peter OBO, Etim IP. Scrotal self-inflicted gunshot injuries: report of two consecutive cases and literature review. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00234-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Isolated scrotal gunshot injuries are uncommon. Even more so when they are self-inflicted. The extent of the injury is determined by the caliber of the weapon. Established management protocols when followed yields excellent results.
Case presentations
We present two male patients, aged 41 and 51 years old, who sustained gunshot injuries to the scrotum following accidental discharges from hand guns stored in their trouser pockets. The first (41 years) sustained grade 5 American Association for Surgery of Trauma (AAST) left testicular injury and was managed by unilateral orchidectomy. The second (51 years old) sustained bilateral grade 4 AAST testicular injuries and had both testes salvaged by primary repair after meticulous debridement.
Conclusion
Isolated scrotal gunshot injuries can occur when low velocity guns are placed adjacent to the genitalia and accidentally discharged. The testes are endangered and can be devitalized requiring orchidectomy or salvaged by meticulous debridement and primary repair when viability is not compromised.
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3
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Goldman C, Shaw N, du Plessis D, Myers JB, van der Merwe A, Venkatesan K. Gunshot wounds to the penis and scrotum: a narrative review of management in civilian and military settings. Transl Androl Urol 2021; 10:2596-2608. [PMID: 34295746 PMCID: PMC8261456 DOI: 10.21037/tau-20-1175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022] Open
Abstract
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).
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Affiliation(s)
- Charlotte Goldman
- Georgetown University School of Medicine, Department of Urology, Washington, DC, USA
| | - Nathan Shaw
- Georgetown University School of Medicine, Department of Urology, Washington, DC, USA
| | - Danelo du Plessis
- Division of Urology, Department of Surgical Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Andre van der Merwe
- Division of Urology, Department of Surgical Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Krishnan Venkatesan
- Georgetown University School of Medicine, Department of Urology, Washington, DC, USA.,MedStar Washington Hospital Center, Department of Urology, Washington, DC, USA
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4
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Robledo XG, Gualdron YG, Vallecilla KV, Díaz-Hung A, García-Perdomo HA. Testicular Doppler ultrasound in scrotal trauma: A diagnostic tool with potentially relevant therapeutic implications. Can Urol Assoc J 2020; 15:E366-E369. [PMID: 33382369 DOI: 10.5489/cuaj.6840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Scrotal trauma is one of the rare causes of genital trauma. Although not usually fatal, it has many social and psychological implications, impacting the male reproductive and endocrine functions. Blunt trauma is the most frequent scrotal trauma; however, a non-negligible proportion is due to penetrating injuries. The diagnosis of blunt trauma has historically been clinical and its management relegated to exploratory surgical interventions, accompanied by a high testicular loss rate; timely diagnosis and proper treatment are critical to avoid testicular loss. Although multiple tools have been described to characterize scrotal lesions objectively, testicular Doppler ultrasound can cost-effectively provide relevant information so as to avoid unnecessary surgical interventions.
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Affiliation(s)
- Ximena Guzmán Robledo
- Department of Surgery/Urology, School of Medicine, Universidad del Valle, Cali, Colombia.,UROGIV Research Group, School of Medicine, Universidad del Valle, Cali, Colombia
| | | | | | - Andrés Díaz-Hung
- Department of Surgery/Urology, School of Medicine, Universidad del Valle, Cali, Colombia.,UROGIV Research Group, School of Medicine, Universidad del Valle, Cali, Colombia
| | - Herney Andrés García-Perdomo
- Department of Surgery/Urology, School of Medicine, Universidad del Valle, Cali, Colombia.,UROGIV Research Group, School of Medicine, Universidad del Valle, Cali, Colombia
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5
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Male genital trauma at a level 1 trauma center. World J Urol 2020; 38:3283-3289. [DOI: 10.1007/s00345-020-03115-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/02/2020] [Indexed: 11/25/2022] Open
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6
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Chiancone F, Fabiano M, Langella N, Sannino S, Fedelini P. Direct gunshot wound to the testicular artery: A rare case report. IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2020. [DOI: 10.4103/ijmbs.ijmbs_90_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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7
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Battaloglu E, Figuero M, Moran C, Lecky F, Porter K. Urethral injury in major trauma. Injury 2019; 50:1053-1057. [PMID: 30857738 DOI: 10.1016/j.injury.2019.02.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 02/06/2019] [Accepted: 02/21/2019] [Indexed: 02/02/2023]
Abstract
Urethral injury in major trauma is infrequent, with complex problems of diagnosis and treatment. The aims of this study are to determine the incidence and epidemiological factors relating to urethral injury in major trauma, as well as determine if any additional prognostic factors are evident within this cohort of patients. A retrospective review of patients sustaining urethral injury following major trauma was made over a 6-year period, from 2010 to 2015. Quantitative analysis was made using the national trauma registry for England and Wales, the Trauma Audit and Research Network (TARN) database, identifying all patients with injury codes for urethral injury. 165 patients with urethral injuries were identified, over 90% were male, most commonly injured during road traffic accidents and with an associated overall mortality of 12%. Urethral injury in association with pelvic fracture occurred in 136 patients (82%), representing 0.6% of all pelvic fractures, and was associated with double the rate of mortality. Urethral injury was associated with unstable pelvic fractures (LC2, LC3, APC3, VS, CM) but not with a specific pelvic fracture type. This study confirms the rare incidence of this injury in major trauma at 1 per 2 million population per year.
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Affiliation(s)
| | | | | | - Fiona Lecky
- Trauma Audit & Research Network, United Kingdom
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8
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Grigorian A, Livingston JK, Schubl SD, Hasjim BJ, Mayers D, Kuncir E, Barrios C, Joe V, Nahmias J. National analysis of testicular and scrotal trauma in the USA. Res Rep Urol 2018; 10:51-56. [PMID: 30128306 PMCID: PMC6089605 DOI: 10.2147/rru.s172848] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background To provide a descriptive analysis of scrotal and testicular trauma in the USA. Additionally, we hypothesized that motorcycle collision would have a higher association with scrotal or testicular trauma and subsequent scrotal or testicular operation, compared to a bicycle collision. Methods The National Trauma Data Bank (2007–2015) was queried to identify adult male patients with scrotal or testicular trauma. A multivariable logistic regression analysis was performed. Results A total of 8,030 patients (0.23%) had scrotal/testicular injury, with 44.6% involved in blunt trauma. A penetrating mechanism occurred in 50.5% of cases, with assault by firearm (75.8%) being the most common. The median age of the patients was 31 years and the median injury severity score was 8. Most had isolated scrotal or testicular trauma (74.5%), with 48.3% requiring scrotal or testicular operation, most commonly repair of laceration (37.3%). Patients involved in a motorcycle collision had higher risk for scrotal/testicular trauma (OR=5.40, CI=4.40–6.61, p=0.0004) and subsequent scrotal/testicular surgery (OR=4.93, CI=3.82–6.36, p=0.0005), compared to bicycle collision. Conclusion Scrotal or testicular trauma is rare but occurs most commonly after assault by firearm. Most patients only have isolated scrotal or testicular trauma, but nearly half require subsequent scrotal or testicular operation. Trauma patients presenting after a motorcycle collision have a higher association of scrotal or testicular trauma and subsequent surgery when compared to those involved in a bicycle collision.
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Affiliation(s)
- Areg Grigorian
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange County, CA, USA,
| | - Joshua K Livingston
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange County, CA, USA,
| | - Sebastian D Schubl
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange County, CA, USA,
| | - Bima J Hasjim
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange County, CA, USA,
| | - Daniel Mayers
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange County, CA, USA,
| | - Eric Kuncir
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange County, CA, USA,
| | - Cristobal Barrios
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange County, CA, USA,
| | - Victor Joe
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange County, CA, USA,
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange County, CA, USA,
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9
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Usefulness of Preoperative Ultrasound for the Evaluation of Testicular Rupture in the Setting of Scrotal Gunshot Wounds. J Urol 2018; 199:1546-1551. [DOI: 10.1016/j.juro.2018.01.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2018] [Indexed: 11/18/2022]
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10
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Abstract
Scrotal surgery encompasses a wide-variety of surgical techniques for an even wider variety of indications. In this manuscript, we review our indications, techniques, and pit-falls for various reconstructive scrotal surgeries as-well-as surgical tips for placement of testicular prostheses. Penoscrotal webbing (PSW) is an abnormal, often-problematic distal insertion of scrotal skin onto the ventral penile shaft. There are several effective and straightforward techniques used to revise this condition, which include simple scrotoplasty, single- or double-Z-plasty, or the VY-flap scrotoplasty. Reconstruction is also commonly indicated following scrotal skin loss caused by infection, trauma, lymphedema, hidradenitis, and cancer. Although initial management of these conditions often involves scrotal skin removal, repair of expansive scrotal skin loss can be technically difficult and can be accomplished by using one of several skin flaps or skin grafting. Split-thickness skin grafting of scrotal defects can be accomplished easily, and provides durable results.
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Affiliation(s)
- Jacob W Lucas
- Department of Urology, Einstein Healthcare Network/Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Kyle M Lester
- Department of Urology, Einstein Healthcare Network/Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Andrew Chen
- Department of Urology, Einstein Healthcare Network/Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jay Simhan
- Department of Urology, Einstein Healthcare Network/Fox Chase Cancer Center, Philadelphia, PA, USA
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11
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O'Connell BJ, Toschlog EA. Colonic injury after gunshot wound to the scrotum with accompanying inguinal hernia. Injury 2015; 46:1865-6. [PMID: 25813731 DOI: 10.1016/j.injury.2015.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 02/27/2015] [Accepted: 02/28/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Brian J O'Connell
- Department of Surgery, Division of Trauma and Surgical Critical Care, East Carolina University, Brody School of Medicine, Greenville, NC, USA. brian.o'
| | - Eric A Toschlog
- Department of Surgery, Division of Trauma and Surgical Critical Care, East Carolina University, Brody School of Medicine, Greenville, NC, USA
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12
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Bryk DJ, Zhao LC. Guideline of guidelines: a review of urological trauma guidelines. BJU Int 2015; 117:226-34. [PMID: 25600513 DOI: 10.1111/bju.13040] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To review the guidelines released in the last decade by several organisations for the optimal evaluation and management of genitourinary injuries (renal, ureteric, bladder, urethral and genital). METHODS This is a review of the genitourinary trauma guidelines from the European Association of Urology (EAU) and the American Urological Association (AUA), and renal trauma guidelines from the Société Internationale d'Urologie (SIU). RESULTS Most recommendations are guided by the American Association for the Surgery of Trauma (AAST) organ injury severity system. Grade A evidence is rare in genitourinary trauma, and most recommendations are based on Grade B or C evidence. The findings of the most recent urological trauma guidelines are summarised. All guidelines recommend conservative management for low-grade injuries. The major difference is for haemodynamically stable patients who have high-grade renal trauma; the SIU guidelines recommend exploratory laparotomy, the EAU guidelines recommend renal exploration only if the injury is vascular, and the AUA guidelines recommend initial conservative management. CONCLUSION There is generally consensus among the three guidelines. Recommendations are based on observational or retrospective studies, as well as clinical principles and expert opinions. Multi-institutional collaborative research can improve the quality of evidence and direct more effective evaluation and management of urological trauma.
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Affiliation(s)
- Darren J Bryk
- Department of Urology, NYU School of Medicine, New York, NY, USA
| | - Lee C Zhao
- Department of Urology, NYU School of Medicine, New York, NY, USA
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13
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Use of "off the shelf" extracellular matrix graft materials for repair of testicular rupture: a novel technique. Urology 2014; 84:719-21. [PMID: 25168558 DOI: 10.1016/j.urology.2014.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/16/2014] [Accepted: 05/23/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe a new technique for repairing traumatic testicular ruptures using readily available graft material. MATERIALS AND METHODS Surgical management of testicular rupture is often associated with loss of testicular parenchyma because of tissue debridement and concerns of pressure-related ischemia. We present our experience with 3 cases using a novel technique using extracellular matrix graft materials for the reconstruction of tunica albuginea in patients with testicular rupture. We describe a case using bovine pericardium (Neovasc Inc, Richmond, British Columbia) and 2 cases using cadaveric dermis (Coloplast Inc, Minneapolis, MN) to repair complex testicular defects without debridement of extruded testicular parenchyma. RESULTS No postoperative complications occurred in any of the patients. Long-term follow-up at 18 months for one patient revealed good cosmetic results, with radiographic findings confirming testicular integrity and flow. CONCLUSION The use of graft material in the repair of testicular rupture helps prevent the loss of testicular parenchyma through a tension-free closure leading to excellent cosmetic and radiographic outcomes.
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14
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Morey AF, Brandes S, Dugi DD, Armstrong JH, Breyer BN, Broghammer JA, Erickson BA, Holzbeierlein J, Hudak SJ, Pruitt JH, Reston JT, Santucci RA, Smith TG, Wessells H. Urotrauma: AUA guideline. J Urol 2014; 192:327-35. [PMID: 24857651 DOI: 10.1016/j.juro.2014.05.004] [Citation(s) in RCA: 205] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2014] [Indexed: 01/08/2023]
Abstract
PURPOSE The authors of this guideline reviewed the urologic trauma literature to guide clinicians in the appropriate methods of evaluation and management of genitourinary injuries. MATERIALS AND METHODS A systematic review of the literature using the MEDLINE® and EMBASE databases (search dates 1/1/90-9/19/12) was conducted to identify peer-reviewed publications relevant to urotrauma. The review yielded an evidence base of 372 studies after application of inclusion/exclusion criteria. These publications were used to inform the statements presented in the guideline as Standards, Recommendations or Options. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate) or C (low). In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. RESULTS Guideline statements were created to inform clinicians on the initial observation, evaluation and subsequent management of renal, ureteral, bladder, urethral and genital traumatic injuries. CONCLUSIONS Genitourinary organ salvage has become increasingly possible as a result of advances in imaging, minimally invasive techniques, and reconstructive surgery. As the field of genitourinary reconstruction continues to evolve, clinicians must strive to approach clinical problems in a creative, multidisciplinary, evidence-based manner to ensure optimal outcomes.
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Affiliation(s)
- Allen F Morey
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Steve Brandes
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Daniel David Dugi
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - John H Armstrong
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Benjamin N Breyer
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Joshua A Broghammer
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Bradley A Erickson
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Jeff Holzbeierlein
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Steven J Hudak
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Jeffrey H Pruitt
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - James T Reston
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Richard A Santucci
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Thomas G Smith
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
| | - Hunter Wessells
- American Urological Assocation Education and Research, Inc., Linthicum, Maryland
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15
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Clinical characteristics and surgical outcomes of penetrating external genital injuries. J Trauma Acute Care Surg 2013; 74:839-44. [PMID: 23425745 DOI: 10.1097/ta.0b013e31827e1b8a] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Penetrating external genital injuries, although uncommon, may present complex problems for the urologic and trauma surgeon. A paucity of data exists on the incidence, clinical characteristics, and management outcomes of these injuries because few institutions have the volume to report their experience. METHODS Penetrating external genital trauma presenting from 2004 to 2011 was retrospectively reviewed. Patient characteristics, operative and nonoperative management, and outcomes were analyzed while validating current guidelines. Surgical management is described in detail, and overall incidence and trends were calculated. RESULTS A total of 28,459 trauma patients were reviewed, of which 8,076 sustained penetrating injuries and 162 sustained penetrating external genital trauma. Penetrating external genital trauma was 0.57% of all trauma and 2.0% among penetrating trauma. Gunshot wounds accounted for the most common mechanism of injury (93%). Injury to the scrotum occurred in 78% and of these injuries, 63% resulted in a testicular injury, with bilateral testicular injuries occurring in 8%. Testicular reconstruction was performed in 65%. Penile injuries occurred in 28%, and urethral injuries occurred in 13%. For penile injuries, 62% were explored immediately. Urethral injuries were managed by immediate primary urethral repair (43%) or urinary diversion with delayed reconstruction (57%). In total, nonoperative management was performed in 26% of scrotal and 38% of penile injuries. The incidence of penetrating external genital injuries has remained constant during our study period, averaging 20.2 cases per year (R(2) = 0.99). The testicular salvage rate varied from 55% to 75% per year (R(2) = 0.06). CONCLUSION Penetrating external genital injuries occur at an incidence of 0.57% where scrotal injury from gunshot wounds is the most common form. Testicular preservation is possible in the majority of testicular injuries. Penile injuries were less likely to require surgical exploration compared with scrotal injuries likely because physical examination is better at confirming only superficial injury. Select patients with superficial scrotal or penile injuries may undergo nonoperative management with minimal morbidity. LEVEL OF EVIDENCE Therapeutic study, level IV; epidemiologic study, level IV.
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Abstract
This article reviews recent publications evaluating the current epidemiology of urologic trauma. The authors briefly explain databases that have been recently used to study this patient population and then discuss each genitourinary organ individually, utilizing the most relevant and up-to-date information published for each one. The conclusion of the article briefly discusses possible future research and development areas pertaining to the topic.
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Affiliation(s)
- James B McGeady
- Department of Urology, University of California, San Francisco, CA 94143, USA
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17
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Current World Literature. Curr Opin Support Palliat Care 2013; 7:116-28. [DOI: 10.1097/spc.0b013e32835e749d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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