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Horiguchi A, Shinchi M, Ojima K, Iijima K, Inoue K, Inoue T, Kaneko N, Kanematsu A, Saito D, Sakae T, Sugihara T, Sekine K, Takao T, Tabei T, Tamura Y, Funabiki T, Yagihashi Y, Yanagi M, Takahashi S, Nakajima Y. The Japanese Urological Association's clinical practice guidelines for urotrauma 2023. Int J Urol 2024; 31:98-110. [PMID: 37929795 DOI: 10.1111/iju.15331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/10/2023] [Indexed: 11/07/2023]
Abstract
The Japanese Urological Association's guidelines for the treatment of renal trauma were published in 2016. In conjunction with its revision, herein, we present the new guidelines for overall urotrauma. Its purpose is to provide standard diagnostic and treatment recommendations for urotrauma, including iatrogenic trauma, to preserve organ function and minimize complications and fatality. The guidelines committee comprised urologists with experience in urotrauma care, selected by the Trauma and Emergency Medicine Subcommittee of the Specialty Area Committee of the Japanese Urological Association, and specialists recommended by the Japanese Association for the Surgery of Trauma and the Japanese Society of Interventional Radiology. The guidelines committee established the domains of renal and ureteral, bladder, urethral, and genital trauma, and determined the lead person for each domain. A total of 30 clinical questions (CQs) were established for all domains; 15 for renal and ureteral trauma and five each for the other domains. An extensive literature search was conducted for studies published between January 1, 1983 and July 16, 2020, based on the preset keywords for each CQ. Since only few randomized controlled trials or meta-analyses were found on urotrauma clinical practice, conducting a systematic review and summarizing the evidence proved challenging; hence, the grade of recommendation was determined according to the 2007 "Minds Handbook for Clinical Practice Guidelines" based on a consensus reached by the guidelines committee. We hope that these guidelines will be useful for clinicians in their daily practice, especially those involved in urotrauma care.
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Affiliation(s)
- Akio Horiguchi
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
- Division of Trauma Reconstruction, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masayuki Shinchi
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kenichiro Ojima
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kazuyoshi Iijima
- Department of Urology, Nagano Municipal Hospital, Nagano, Nagano, Japan
| | - Koji Inoue
- Department of Urology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Takamitsu Inoue
- Department of Nephrology and Urological Surgery, International University of Health and Welfare, Otawara, Tochigi, Japan
| | - Naoyuki Kaneko
- Trauma and Emergency Center, Fukaya Red Cross Hospital, Fukaya, Saitama, Japan
| | - Akihiro Kanematsu
- Department of Urology, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Daizo Saito
- Graduate School of Emergency Medical System, Kokushikan University, Setagaya, Tokyo, Japan
| | - Tatefumi Sakae
- IVR Center, Miyazaki University Hospital, Miyazaki, Japan
| | - Toru Sugihara
- Department of Urology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kazuhiko Sekine
- Department of Emergency and Critical Care Medicine, Tokyo Saiseikai Central Hospital, Minato, Tokyo, Japan
| | - Tetsuya Takao
- Department of Urology, Osaka General Medical Center, Osaka, Japan
| | - Tadashi Tabei
- Department of Urology, Fujisawa Shonandai Hospital, Fujisawa, Kanagawa, Japan
| | - Yoshimi Tamura
- Department of Urology, Shibukawa Medical Center, Shibukawa, Gunma, Japan
| | - Tomohiro Funabiki
- Advanced Emergency and Critical Care Center, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Yusuke Yagihashi
- Department of Urology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Masato Yanagi
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
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Choudhury S, Ray P, Pal DK. Changing paradigms of management of isolated blunt renal trauma. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408620965446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The last thirty years has seen a change in management of renal trauma with progression more towards nonoperative management; however there is lack of guidelines of many practical aspects for conservative management of renal trauma. Here we are sharing our experience of managing isolated renal trauma over a period of five years. Materials and methods The study was conducted in a tertiary care centre of eastern part of India from April 2015–March 2020. It was a retro-prospective study and included cases of isolated blunt renal trauma managed in our hospital. Results A total of 61 cases of isolated blunt renal trauma were treated in the mentioned time period. Seventeen (28%) cases were of AAST Grade IV and five (8%) Grade V injury. Blood transfusion was required in eighteen (29%) cases during management. In eight (47%) cases of Grade IV injury and two (40%) cases of Grade V injury angioembolization was done. In two (11.7%) cases of Grade IV injury ureteral stenting was performed. Delayed surgical exploration and nephrectomy was required in one case of Grade V injury because of failed angioembolization and one Grade IV injury due to sepsis. One death was encountered in Grade V injury who had delayed presentation with haemorrhagic shock and underwent immediate surgical exploration. On follow up four patients (23%) of Grade IV injury and one patient of Grade III injury and two patients (40%) of Grade IV injury developed hypertension. The remaining patients were found to be normal. Conclusion Conservative management of renal trauma is the norm nowadays. Angioembolisation was found to be one of the strongest armamentarium when patient needs intervention. Surgery is rarely contemplated, mostly in hemodynamically unstable high grade trauma patients.
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Affiliation(s)
- Sunirmal Choudhury
- Department of Urology, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Pinaki Ray
- Department of Urology, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Dilip Kumar Pal
- Department of Urology, Institute of Post Graduate Medical Education & Research, Kolkata, India
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Abstract
The purpose of this study was to determine the need of repeat follow-up computed tomography imaging in patients with renal trauma.All patients who were admitted in the trauma center of the Military Institute of Medicine with a diagnosis of kidney injury from January 2008 to December 2017 were identified. A retrospective review of all patients' medical records and radiologic imaging was conducted.Data on the following factors were collected - patients' demographics, mechanism of trauma, American Association for the Surgery of Trauma renal injury scale, injury severity score, laboratory examinations, multiorgan injuries, transfusion of fresh frozen plasma and packed red blood cells, time of surgical procedure in multiorgan injuries, length of hospital stay, and acute kidney injury.This group consisted of 37 patients with left renal injuries, 32 with right renal injuries, and 5 with bilateral renal injuries. Renal trauma due to blunt injury secondary to a motor vehicle accident was noted in 45 patients, falling from a height in 14 patients, injury from battery in 4 patients, sports-related activities in 1 patient, and other factors in 10 patients.Of the 63 patients treated conservatively due to multiorgan trauma or isolated trauma, values of morphology, serum creatinine and blood urea nitrogen, and ultrasonography in all patients did not reveal any pathological changes within earlier kidney damage.The conservative treatment of grade I-IV renal injury in the American Association for the Surgery of Trauma scale provided good outcome and only involved noninvasive ultrasonography.This study confirms that routine follow-up computed tomography imaging can be safely omitted in renal injuries graded I-IV providing that the patient remains in good clinical state.
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Affiliation(s)
| | | | | | - Saracyn Marek
- Department of Endocrinology and Radioisotope Therapy, Military Institute of Medicine, Warsaw, Poland
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Chong ST, Cherry-Bukowiec JR, Willatt JM, Kielar AZ. Renal trauma: imaging evaluation and implications for clinical management. Abdom Radiol (NY) 2016; 41:1565-79. [PMID: 27108132 DOI: 10.1007/s00261-016-0731-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Severe renal injuries are usually associated with multisystem injuries, may require interventional radiology to control hemorrhage and improve the chances for renal salvage, and are more likely to fail nonoperative management. However, most renal injuries are mild in severity and successfully managed conservatively. The AAST classification is the most widely used system to describe renal injuries and carries management and prognostic implications. CT with intravenous contrast is the imaging test of choice to assess for renal injuries. Contrast extravasation indicating active bleeding should be mentioned as its presence is predictive for failure of nonoperative management. Radiologists play a critical role in identifying renal injuries and should make every effort to describe renal injuries according to the AAST grading scheme to better inform the surgeon's management decisions.
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Thony F, Rodière M, Frandon J, Vendrell A, Jankowski A, Ghelfi J, Sengel C, Arvieux C, Bouzat P, Ferretti G. Polytraumatism and solid organ bleeding syndrome: The role of imaging. Diagn Interv Imaging 2015. [PMID: 26206744 DOI: 10.1016/j.diii.2015.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In multiple injuries, features of bleeding from solid organs mostly involve the liver, spleen and kidneys and may be treated by embolization. The indications and techniques for embolization vary between organs and depend on the pathophysiology of the injuries, type of vascularization (anastomotic or terminal) and type of embolization (curative or preventative). Interventional radiologists should have a full understanding of these indications and techniques and management algorithms should be produced within each facility in order to define the respective place of the different treatment options.
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Affiliation(s)
- F Thony
- Radiology and Medical Imaging University Clinic, Grenoble University Hospitals, Grenoble, France.
| | - M Rodière
- Radiology and Medical Imaging University Clinic, Grenoble University Hospitals, Grenoble, France
| | - J Frandon
- Radiology and Medical Imaging University Clinic, Grenoble University Hospitals, Grenoble, France
| | - A Vendrell
- Radiology and Medical Imaging University Clinic, Grenoble University Hospitals, Grenoble, France
| | - A Jankowski
- Radiology and Medical Imaging University Clinic, Grenoble University Hospitals, Grenoble, France
| | - J Ghelfi
- Radiology and Medical Imaging University Clinic, Grenoble University Hospitals, Grenoble, France
| | - C Sengel
- Radiology and Medical Imaging University Clinic, Grenoble University Hospitals, Grenoble, France
| | - C Arvieux
- Gastrointestinal and Emergency Surgery University Clinic, Grenoble University Hospitals, Grenoble, France
| | - P Bouzat
- Anesthesia Intensive Care Unit, Grenoble University Hospitals, Grenoble, France
| | - G Ferretti
- Radiology and Medical Imaging University Clinic, Grenoble University Hospitals, Grenoble, France
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McCombie SP, Thyer I, Corcoran NM, Rowling C, Dyer J, Le Roux A, Kuan M, Wallace DMA, Hayne D. The conservative management of renal trauma: a literature review and practical clinical guideline from Australia and New Zealand. BJU Int 2014; 114 Suppl 1:13-21. [DOI: 10.1111/bju.12902] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Steve P. McCombie
- School of Surgery; University of Western Australia; Crawley WA Australia
- Department of Urology; Fremantle Hospital; Fremantle WA Australia
| | - Isaac Thyer
- Department of Urology; Fremantle Hospital; Fremantle WA Australia
| | - Niall M. Corcoran
- Departments of Urology and Surgery; Royal Melbourne Hospital and University of Melbourne; Parkville VIC Australia
| | | | - John Dyer
- Department of Infectious Diseases; Fremantle Hospital; Fremantle WA Australia
| | - Anton Le Roux
- Department of Radiology; Fremantle Hospital; Fremantle WA Australia
| | - Melvyn Kuan
- Department of Urology; Fremantle Hospital; Fremantle WA Australia
| | | | - Dickon Hayne
- School of Surgery; University of Western Australia; Crawley WA Australia
- Department of Urology; Fremantle Hospital; Fremantle WA Australia
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[Role of transcatheter arterial embolization (TAE) for deep renal injury]. Nihon Hinyokika Gakkai Zasshi 2014; 104:688-96. [PMID: 24564075 DOI: 10.5980/jpnjurol.104.688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE We evaluated usefulness of transcatheter arterial embolization (TAE) for deep renal injury, and investigated whether there is any difference in outcomes for transcatheter arterial embolization (TAE) performed for deep renal injury in a large-sized hospital (university hospital) in comparison with a middle-sized hospital (local hospital). METHODS We retrospectively reviewed the outcomes of 42 patients with renal injury who were transported to the critical care center of Nippon Medical School (NMS) Hospital in Tokyo from April 2001 to April 2011 and 33 patients of renal injury transported to the critical care center of Ohtawara Red Cross (ORC) Hospital in Tochigi prefecture from April 2001 to April 2009. Therefore, a total of 75 patients, which is the sum of the patients presenting to both the hospitals for renal injury were reevaluated according to the guidelines developed by the Japanese Association for the Surgery of Trauma (JAST) and published in 2008. RESULTS Forty-two patients in NMS hospital included 6 women and 36 men who were 16 to 88 years old (mean 41.6), and they were divided into Type I (16), Type II (11), and Type III (15) and were treated with bedrest (30), TAE (7), or laparotomy (5). Five patients died, but no one succumbed solely due to the renal injury. On the other hand, 33 Patients in ORC Hospital included 8 women and 25 men who were 16 to 87 years old (mean 46.6). They were divided into Type I (9). Type II (12), and Type III (12) and were treated with bedrest (24) or TAE (9). Eight patients died, but no one succumbed solely due to the renal injury. Sixteen patients were treated successfully with TAE in the 2 hospitals, and 15 of these 16 patients were divided into type III renal injury. Therefore, we believe that nephrectomy should be avoided in such patients because of the benefits offered by TAE. CONCLUSION TAE was found to be useful for the treatment of type III renal injury in both institutions, irrespective of the size of a hospital.
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Abstract
BACKGROUND Our aim is to assess state variation in renal trauma outcomes. We hypothesize that states with more hospitals participating in a trauma system will have lower nephrectomy and mortality rates. METHODS The Healthcare Cost and Utilization Project State Inpatient Database was used to conduct a retrospective cohort study of all patients hospitalized with renal injury from partnering states during 2001, 2004, and 2007. State trauma systems were categorized based on the proportion of all acute care hospitals designated as a trauma center (Levels I-V) with higher proportions correlating to a more inclusive system. Poisson regression for relative risks (RRs) of inpatient nephrectomy and case fatality were performed adjusting for patient and state level factors. RESULTS Patients in states with the "most inclusive" trauma systems had a 30% lower risk of nephrectomy (RR, 0.70; 95% confidence interval [CI], 0.56-0.88) and a 2.06% lower unadjusted inpatient case fatality rate compared with states with "exclusive" trauma systems. Inpatient case fatality risk varied significantly by trauma system inclusiveness. Patients treated in states with either a "more inclusive" (RR, 0.85; 95% CI, 0.74-0.97) or "most inclusive" (RR, 0.74; 95% CI, 0.64-0.85) trauma system were independently associated with a lower inpatient case fatality risk compared with states with "exclusive" systems. CONCLUSIONS A reduced risk of nephrectomy and inpatient case fatality are more common among states that have a higher proportion of acute care hospitals participating as a trauma center (Levels I-V). Standardization of care may correlate with improved patient outcomes after renal trauma. LEVEL OF EVIDENCE II, exploratory cohort analysis.
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Bukur M, Inaba K, Barmparas G, Paquet C, Best C, Lam L, Plurad D, Demetriades D. Routine follow-up imaging of kidney injuries may not be justified. ACTA ACUST UNITED AC 2011; 70:1229-33. [PMID: 21610437 DOI: 10.1097/ta.0b013e3181e5bb8e] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this investigation was to determine the yield of repeat follow-up imaging in patients sustaining renal trauma. METHODS The Los Angeles County+University of Southern California Medical Center trauma registry was reviewed to identify all patients with a diagnosis of kidney injury from 2005 to 2008. All final attending radiologist interpretations and the dates of the initial and follow-up computerized tomography (CT) scans were also reviewed. Grades I, II, and III were grouped as low-grade injuries and grades IV and V as high-grade injuries. RESULTS During the 4-year study period, 120 (1.2% of all trauma admissions) patients had a total of 121 kidney injuries: 85.8% were male, and the mean age±SD was 31.1 years±14.5 years. Overall, 22.6% of blunt and 35.6% of penetrating kidney injuries were high grade (IV-V; p=0.148). These high-grade injuries were managed operatively in 35.7% and 76.2% of blunt and penetrating injuries, respectively, (p=0.022). Overall, 31.7% underwent at least one follow-up CT; 24.2% of patients with blunt and 39.7% of patients with penetrating kidney injury, respectively. None of the patients with a low-grade injury managed nonoperatively developed a complication, independent of the injury mechanism. High-grade blunt and penetrating kidney injuries managed nonoperatively were associated with 11.1% and 20.0% complication rate identified on follow-up CT, respectively. For patients who underwent surgical interventions for penetrating kidney injuries, the diagnosis of the complication was made at 9.8 days±7.0 days (range, 1-24 days), with 83.3% of them diagnosed within 8 days postoperatively. The most frequent complication identified was an abscess in the renal fossa (50.0% of all complications). Other complications included urinoma, ureteral stricture, and pseudoaneurysm. All patients who developed complications were symptomatic, prompting the imaging that led to the diagnosis. All patients who developed a complication after a penetrating injury required intervention for the management of the complication. CONCLUSION Selective reimaging of renal injuries based on clinical and laboratory criteria seems to be safe regardless of injury mechanism or management. High-grade penetrating injuries undergoing operative intervention should carry the highest degree of vigilance and lowest threshold for repeat imaging.
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Affiliation(s)
- Marko Bukur
- Division of Trauma Surgery and Surgical Critical Care, Los Angeles County Medical Center+University of Southern California, Los Angeles, California 90033, USA
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Huber J, Pahernik S, Hallscheidt P, Sommer CM, Wagener N, Hatiboglu G, Haferkamp A, Hohenfellner M. Selective Transarterial Embolization for Posttraumatic Renal Hemorrhage: A Second Try is Worthwhile. J Urol 2011; 185:1751-5. [DOI: 10.1016/j.juro.2010.12.045] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Indexed: 11/15/2022]
Affiliation(s)
- Johannes Huber
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Sascha Pahernik
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Peter Hallscheidt
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Christof M. Sommer
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Nina Wagener
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Gencay Hatiboglu
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Axel Haferkamp
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Markus Hohenfellner
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
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Combat urologic trauma in US military overseas contingency operations. ACTA ACUST UNITED AC 2010; 69 Suppl 1:S175-8. [PMID: 20622614 DOI: 10.1097/ta.0b013e3181e45cd1] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This article reports on the occurrences and patterns of genitourinary (GU) trauma in the contemporary high-intensity conflict of the overseas contingency operations (OCOs). METHODS The Joint Theater Trauma Registry was queried for all US military members who received treatment for GU wounds and concomitant injuries sustained in OCOs for >75 months between October 2001 and January 2008. RESULTS Of the 16,323 trauma admissions annotated in the Joint Theater Trauma Registry, 819 (5%) had one or more GU injuries. Of the GU casualties, 90% were sustained in Iraq and 65% were because of explosions. The average casualty age was 26 years (range, 18-58 years) and 98.5% were men. There were 887 unique GU injuries distributed as follows: scrotum, 257 (29.0%); kidney, 203 (22.9%); bladder, 189 (21.3%); penis, 126 (14.2%); testicle, 81 (9.1%); ureter, 24 (2.7%); and urethra, 7 (0.8%). Of the 203 patients with kidney injuries, 22% went to the operating room with 31 patients having nephrectomies. There were 189 bladder injuries with 26 patients (14%) having concomitant pelvic fractures. CONCLUSIONS This is the largest report of GU injuries during any military conflict. The distribution and percentage of casualties with GU injuries in the OCO are similar to those of previous conflicts. Consideration should be given to personnel protective equipment for the areas associated with GU injuries and predeployment training directed at the care of these injuries.
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