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Wirjopranoto S, Alkaff FF, Yogiswara N, Azmi YA, Purba AKR, Soetanto KM. Pediatric genitourinary injuries: 7-year experience at the largest tertiary referral hospital in Eastern part of Indonesia. J Pediatr Urol 2024; 20:117.e1-117.e5. [PMID: 37863703 DOI: 10.1016/j.jpurol.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/28/2023] [Accepted: 09/25/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION The anatomical variations between children and adults render pediatric patients more prone to urogenital trauma. However, it is not known for certain whether children are more prone to genitourinary trauma than adults. The aim of the study is to scrutinize the characteristic of pediatric genitourinary trauma at, the largest tertiary hospital in Eastern part of Indonesia. STUDY DESIGN The design of the study was analytic retrospective gathering medical records of all pediatric patients with urogenital trauma with total sampling. The number of patients, ages, genders, etiology, locations, and management were collected. Data was statistically analyzed using SPSS®, and p < 0.05 was considered statistically significant. RESULTS We found 13.5 (10-15.5) years as the median age in our 60 samples. Boy (75.00%), renal trauma (56.67%), abdominal and pelvic trauma (96.67%), traffic accident (91.67%), suprapubic catheterization (52.17%), and hemodynamically stable (91.67) was among the majority. We also found that non-operative management was in majority. Statistical analysis demonstrated significant differences for management and grade of injury (p < 0.05). DISCUSSIONS This is, to the best of our knowledge, the first study of genitourinary injuries in children who were treated at a tertiary hospital in Indonesia during the course of the 7-year research period. The limitations of this study are retrospective character and conducted in single institution. CONCLUSION The highest incidence of pediatric urogenital trauma is renal trauma due to traffic accident, which often multitrauma. Future prospective multi-center studies should be done to corroborate the results.
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Affiliation(s)
- Soetojo Wirjopranoto
- Department of Urology, Faculty of Medicine, Universitas Airlangga, the Netherlands.
| | - Firas Farisi Alkaff
- Division of Pharmacology and Therapy, Department of Anatomy, Histology, And Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands.
| | - Niwanda Yogiswara
- Department of Urology, Faculty of Medicine, Universitas Airlangga, the Netherlands.
| | - Yufi Aulia Azmi
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Groningen, the Netherlands; Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Abdul Khairul Rizki Purba
- Division of Pharmacology and Therapy, Department of Anatomy, Histology, And Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
| | - Kevin Muliawan Soetanto
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.
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Cassell III AK, Manobah B. Management of genitourinary trauma – current evaluation from the Sub-Saharan region: A systematic review. World J Crit Care Med 2021; 10:377-389. [PMID: 34888163 PMCID: PMC8613721 DOI: 10.5492/wjccm.v10.i6.377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/19/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Trauma 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.
AIM To provide insight on the epidemiology and management of genitourinary trauma in Sub-Saharan Africa with recommendations based on international guidelines.
METHODS A thorough literature search of genitourinary trauma was conducted using PubMed, Google Scholar and African Journal Online.
RESULTS A 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%).
CONCLUSION Genitourinary 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.
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Affiliation(s)
- Ayun K Cassell III
- Department of Surgery, John F. Kennedy Medical Center, Monrovia 100010, Liberia
| | - Burgess Manobah
- Department of Surgery, John F. Kennedy Medical Center, Monrovia 100010, Liberia
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Mehta C, Loecher M, Sih A, Reese AC. A report of a retained bullet in the bladder which migrated from an extraperitoneal injury. Urol Case Rep 2020; 34:101463. [PMID: 33224728 PMCID: PMC7666374 DOI: 10.1016/j.eucr.2020.101463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/21/2020] [Indexed: 11/29/2022] Open
Abstract
Genitourinary 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 pelvis. The bullet was originally extraluminal to the bladder; however, upon repeat CT scan eight days later, the bullet had migrated intra-luminally. We hope to show through this case that uncomplicated extraperitoneal injuries with an adjacent missile might benefit from early surgical exploration.
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Affiliation(s)
- Chintan Mehta
- The Lewis Katz School of Medicine at Temple University, 3401 N. Broad StreetPhiladelphia, PA, 19140, USA
| | - Matthew Loecher
- The Lewis Katz School of Medicine at Temple University, 3401 N. Broad StreetPhiladelphia, PA, 19140, USA
| | - Allison Sih
- The Lewis Katz School of Medicine at Temple University, 3401 N. Broad StreetPhiladelphia, PA, 19140, USA
| | - Adam C Reese
- The Lewis Katz School of Medicine at Temple University, 3401 N. Broad StreetPhiladelphia, PA, 19140, USA
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Abstract
A pelvic fracture with entrapment of the urinary bladder in the fracture site is a rare pattern of injury. As the “team captains” in the trauma bay and in the care of polytraumatized patients, trauma surgeons must be aware of this entity and its implications. We report a case of acute bladder entrapment in the fracture site of a lateral compression pelvic fracture. A review of the English literature yielded four previous reports, including two patients with delayed diagnosis (Ghuman et al., 2014; Kumar et al., 1980; Wright and Taitsman, 1996; Min et al., 2010 [1–4]). Kumar and colleagues first documented bladder entrapment by a pelvic fracture in 1980 (Kumar et al., 1980 [2]). Ghuman et al. described a similar case treated with fixation of the pelvic fracture (Ghuman et al., 2014 [1]). Wright and colleagues treated a patient with bladder perforation due to entrapment diagnosed two weeks after a pelvic ring fracture (Wright and Taitsman, 1996 [3]). In this case the bladder injury was repaired, but internal fixation of the pelvis fracture was avoided due to fear of contamination. Finally, Min et al. documented a case of bladder entrapment and perforation presenting six months after non-operative management of a pelvic ring fracture. The female patient developed recurrent UTIs and dyspareunia, and imaging revealed fracture malunion with the bladder entrapped in the fracture site (Min et al., 2010 [4]). This collection of case reports demonstrates the potential for acute or delayed bladder injury even in seemingly benign pelvic fractures. A high index of suspicion is required to intervene and prevent morbidity from bladder injuries in pelvic trauma. Entrapment of the bladder may require surgical intervention even when the injury pattern would not normally dictate surgery for the pelvis or bladder alone (Bryk and Zhao, 2016 [5]). We describe the diagnosis and surgical management of bladder entrapment and present a brief review of bladder injuries associated with pelvic fractures.
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Affiliation(s)
- Derek S Stenquist
- Harvard Combined Orthopedic Residency Program, Brigham and Women's Hospital, United States of America
| | - Tyler J Chavez
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States of America
| | - Michael J Weaver
- Harvard Medical School, Brigham and Women's Hospital, United States of America.,Orthopaedic Trauma, Brigham and Women's Hospital, United States of America
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Shapiro R, Fuller K, Wiseman B, Bell C, Wu G, Mannanl R, Garcia OD. Factors in delay of diagnosis of gynecologic ureteral injuries at a rural academic hospital. Int Urogynecol J 2019; 31:359-363. [PMID: 30993387 DOI: 10.1007/s00192-019-03949-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/01/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Ureteral injuries are a source of morbidity, and delays in diagnosis can increase the risk for long-term sequelae. Our aim was to quantify and describe iatrogenic ureteral injuries in a rural tertiary care center. Our secondary goal was to evaluate the impact of delayed diagnosis of ureteral injury on patient outcomes and whether cystoscopy had any influence on these outcomes. METHODS A retrospective chart review was undertaken for ureteral injuries, identified by the ICD-9 code from 1997 to 2017 at West Virginia University (WVU) Hospital. Injuries were categorized by procedure, surgeon specialty, location (WVU versus community hospital), and intraoperative cystoscopy. A delay in diagnosis was defined as a ureteral injury sustained during surgery not diagnosed intraoperatively. RESULTS Forty-six patients were identified with iatrogenic ureteral injury at WVU. Twenty-seven occurred during gynecologic procedures (59%). Fourteen ureteral injuries were sustained at community hospitals and transferred to WVU for evaluation and treatment. Fifty percent of those had a known delay in diagnosis. The average delay in diagnosis for transferred patients was 6.5 days vs. 3.6 days for patients with ureteral injury sustained at WVU. Cystoscopy was only utilized in 37% (10/27) of gynecologic cases involving a ureteral injury. When cystoscopy was utilized, it was 80% (8/10) effective in helping to identify ureteral injury. CONCLUSIONS Within a rural population, approximately half of patients with ureteral injuries were transferred to a tertiary care center for evaluation and treatment. Transferred patients were more likely to have a delay to diagnosis than patients who had injuries sustained at WVU. The delayed diagnosis patients had comparatively worse outcomes. Gynecologic surgeons working in rural hospitals should be adequately trained to perform diagnostic cystoscopy.
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Affiliation(s)
- Robert Shapiro
- Departments of Obstetrics & Gynecology, School of Medicine, West Virginia University, PO Box 9186, Robert C. Byrd Health Sciences Center, Morgantown, WV, 26506, USA.
| | - Kylie Fuller
- Departments of Obstetrics & Gynecology, School of Medicine, West Virginia University, PO Box 9186, Robert C. Byrd Health Sciences Center, Morgantown, WV, 26506, USA
| | - Brian Wiseman
- Departments of Obstetrics & Gynecology, School of Medicine, West Virginia University, PO Box 9186, Robert C. Byrd Health Sciences Center, Morgantown, WV, 26506, USA
| | - Christopher Bell
- Departments of Obstetrics & Gynecology, School of Medicine, West Virginia University, PO Box 9186, Robert C. Byrd Health Sciences Center, Morgantown, WV, 26506, USA
| | - Gary Wu
- Departments of Obstetrics & Gynecology, School of Medicine, West Virginia University, PO Box 9186, Robert C. Byrd Health Sciences Center, Morgantown, WV, 26506, USA
| | - Rahul Mannanl
- Departments of Obstetrics & Gynecology, School of Medicine, West Virginia University, PO Box 9186, Robert C. Byrd Health Sciences Center, Morgantown, WV, 26506, USA
| | - Omar Duenas Garcia
- Departments of Obstetrics & Gynecology, School of Medicine, West Virginia University, PO Box 9186, Robert C. Byrd Health Sciences Center, Morgantown, WV, 26506, USA
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Moses RA, Selph JP, Voelzke BB, Piotrowski J, Eswara JR, Erickson BA, Gupta S, Dmochowski RR, Johnsen NV, Shridharani A, Blaschko SD, Elliott SP, Schwartz I, Harris CR, Borawski K, Figler BD, Osterberg EC, Burks FN, Bihrle W, Miller B, Santucci RA, Breyer BN, Flynn B, Higuchi T, Kim FJ, Broghammer JA, Presson AP, Myers JB. An American Association for the Surgery of Trauma (AAST) prospective multi-center research protocol: outcomes of urethral realignment versus suprapubic cystostomy after pelvic fracture urethral injury. Transl Androl Urol 2018; 7:512-520. [PMID: 30211041 PMCID: PMC6127553 DOI: 10.21037/tau.2017.11.07] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Pelvic fracture urethral injuries (PFUI) occur in up to 10% of pelvic fractures. It remains controversial whether initial primary urethral realignment (PR) after PFUI decreases the incidence of urethral obstruction and the need for subsequent urethral procedures. We present methodology for a prospective cohort study analyzing the outcomes of PR versus suprapubic cystostomy tube (SPT) after PFUI. Methods A prospective cohort trial was designed to compare outcomes between PR (group 1) and SPT placement (group 2). Centers are assigned to a group upon entry into the study. All patients will undergo retrograde attempted catheter placement; if this fails a cystoscopy exam is done to confirm a complete urethral disruption and attempt at gentle retrograde catheter placement. If catheter placement fails, group 1 will undergo urethral realignment and group 2 will undergo SPT. The primary outcome measure will be the rate of urethral obstruction preventing atraumatic passage of a flexible cystoscope. Secondary outcome measures include: subsequent urethral interventions, post-injury complications, urethroplasty complexity, erectile dysfunction (ED) and urinary incontinence rates. Results Prior studies demonstrate PR is associated with a 15% to 50% reduction in urethral obstruction. Ninety-six men (48 per treatment group) are required to detect a 15% treatment effect (80% power, 0.05 significance level, 20% loss to follow up/death rate). Busy trauma centers treat complete PFUI approximately 1–6 times per year, thus our goal is to recruit 25 trauma centers and enroll patients for 3 years with a goal of 100 or more total patients with complete urethral disruption. Conclusions The proposed prospective multi-institutional cohort study should determine the utility of acute urethral realignment after PFUI.
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Affiliation(s)
- Rachel A Moses
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - John Patrick Selph
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bryan B Voelzke
- Department of Urology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Joshua Piotrowski
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jairam R Eswara
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Shubham Gupta
- Department of Urology, University of Kentucky, Lexington, KY, USA
| | - Roger R Dmochowski
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Niels V Johnsen
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anand Shridharani
- Department of Urology, University of Tennessee College of Medicine, Chattanooga, TN, USA
| | | | - Sean P Elliott
- Division of Urology, Department of Surgery, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Ian Schwartz
- Division of Urology, Department of Surgery, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
| | | | - Kristy Borawski
- Department of Urology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Bradley D Figler
- Department of Urology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - E Charles Osterberg
- Department of Surgery, University of Texas, Dell Medical School, Austin, TX, USA
| | - Frank N Burks
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | | | - Brandi Miller
- Department of Urology, Detroit Medical Center, Detroit, MI, USA
| | | | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Brian Flynn
- Department of Surgery (Urology), University of Colorado School of Medicine, Aurora, CO, USA
| | - Ty Higuchi
- Department of Surgery (Urology), University of Colorado School of Medicine, Aurora, CO, USA
| | - Fernando J Kim
- Department of Surgery (Urology), University of Colorado School of Medicine, Aurora, CO, USA
| | - Joshua A Broghammer
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Angela P Presson
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
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Osterberg EC, Awad MA, Gaither TW, Sanford T, Alwaal A, Hampson LA, Yoo J, McAninch JW, Breyer BN. Major genitourinary-related bicycle trauma: Results from 20 years at a level-1 trauma center. Injury 2017; 48:153-7. [PMID: 27423305 DOI: 10.1016/j.injury.2016.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 06/21/2016] [Accepted: 07/04/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Epidemiological studies have shown that bicycle trauma is associated with genitourinary (GU) injuries. Our objective is to characterize GU-related bicycle trauma admitted to a level I trauma center. MATERIALS AND METHODS We queried a prospective trauma registry for bicycle injuries over a 20-year period. Patient demographics, triage data, operative interventions and hospital details were collected. RESULTS In total, 1659 patients were admitted with major bicycle trauma. Of these, 48 cases involved a GU organ, specifically the bladder (n=7), testis (n=6), urethra (n=3), adrenal (n=4) and/or kidneys (n=36). The median age of cyclists with GU injuries was 29 (range 5-70). More men were injured versus women (35 versus 13). GU-related bicycle trauma involved a motor vehicle in 52% (25/48) of injuries. The median injury severity score for GU-related bicycle trauma was 17 (range 1-50). The median number of concomitant organ injuries was 2 (range 0-6), the most common of which was the lungs (13/48, 27%) and ribs (13/48, 27%). The majority of GU injured cyclists were admitted to an ICU (15/48, 31%) or hospital floor (12/48, 25%). Operative intervention for a GU-related trauma was low (12/48, 25%). The most common GU organ injured was the kidney (36/48, 75%) however most were managed nonoperatively (33/36, 92%). Bladder injuries most often required operative intervention (6/7, 86%). Mortality following GU-related bicycle trauma was low (2/48, 4%). CONCLUSIONS In a large series of bicycle trauma, GU organs were injured in 3% of cases. The majority of cases were managed non-operatively and mortality was low.
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Abstract
Contrast-enhanced multidetector computed tomography (MDCT) has become a critical tool in the evaluation of the trauma patient. MDCT can quickly and accurately assess trauma patients for renal, ureteral, and bladder injuries. Moreover, CT guides clinical management triaging patients to those requiring discharge, observation, angioembolization, and surgery. Recognition of urinary tract trauma on initial scan acquisition should prompt delayed excretory phase imaging to identify urine leaks. Urethral and testicular trauma are imaged with retrograde urethrography and sonography, respectively.
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Affiliation(s)
- Bari Dane
- Division of Trauma and Emergency Imaging, Department of Radiology, Bellevue Hospital/NYU Langone Medical Center, 550 1st Avenue, New York, NY 10016, USA
| | - Alexander B Baxter
- Division of Trauma and Emergency Imaging, Department of Radiology, Bellevue Hospital/NYU Langone Medical Center, 550 1st Avenue, New York, NY 10016, USA
| | - Mark P Bernstein
- Division of Trauma and Emergency Imaging, Department of Radiology, Bellevue Hospital/NYU Langone Medical Center, 550 1st Avenue, New York, NY 10016, USA.
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Chalmers DJ, Vemulakonda VM. Pediatric Urology for the General Surgeon. Surg Clin North Am 2016; 96:545-65. [PMID: 27261794 DOI: 10.1016/j.suc.2016.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pediatric urology spans the neonatal period through the transition into early adulthood. There are a variety of common pediatric urologic conditions that overlap significantly with pediatric surgery. This article reviews the pertinent pathophysiology of a few key disease processes, including the pediatric inguinal hernia and/or hydrocele, cryptorchidism, and circumcision. General surgeons may find themselves in the position of managing these problems primarily, particularly in rural areas that may lack pediatric subspecialization. An understanding of the fundamentals can guide appropriate initial management. Additional focus is devoted to the management of genitourinary trauma to guide the general surgeon in more acute, emergent settings.
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Abstract
The standard of care after a pelvic fracture urethral injury is a repair via a one-stage anastomotic posterior urethroplasty using a step-wise perineal approach. The initial injury, immediate postoperative management, and surgical repair can all affect urinary continence in these patients. Proximal continence mechanisms, particularly the bladder neck, are particularly important in maintaining urinary continence in these patients. Patients with bladder neck dysfunction should be counselled about the greater risk of urinary incontinence.
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Affiliation(s)
- Herman S. Bagga
- Corresponding author at: Cleveland Clinic, 9500 Euclid Avenue, Q10, Cleveland, OH 44195, USA.
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Abstract
Computed tomography (CT) imaging of the kidney, ureter, and bladder permit accurate and prompt diagnosis or exclusion of traumatic injuries, without the need to move the patient to the fluoroscopy suite. Real-time review of imaging permits selective delayed imaging, reducing time on the scanner and radiation dose for patients who do not require delays. Modifying imaging parameters to obtain thicker slices and noisier images permits detection of contrast extravasation from the kidneys, ureters, and bladder, while reducing radiation dose on the delayed or cystographic imaging. The American Association for the Surgery of Trauma grading system is discussed, along with challenges and limitations.
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Affiliation(s)
- Joel A Gross
- Department of Radiology, Harborview Medical Center, University of Washington School of Medicine, Box 359728, 325 Ninth Avenue, Seattle, WA 98104-2499, USA.
| | - Bruce E Lehnert
- Department of Radiology, Harborview Medical Center, University of Washington School of Medicine, Box 359728, 325 Ninth Avenue, Seattle, WA 98104-2499, USA
| | - Ken F Linnau
- Department of Radiology, Harborview Medical Center, University of Washington School of Medicine, Box 359728, 325 Ninth Avenue, Seattle, WA 98104-2499, USA
| | - Bryan B Voelzke
- Department of Urology, Harborview Medical Center, University of Washington School of Medicine, Box 359868, 325 Ninth Avenue, Seattle, WA 98104-2499, USA
| | - Claire K Sandstrom
- Department of Radiology, Harborview Medical Center, University of Washington School of Medicine, Box 359728, 325 Ninth Avenue, Seattle, WA 98104-2499, USA
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Al-Azzawi IS, Koraitim MM. Lower genitourinary trauma in modern warfare: the experience from civil violence in Iraq. Injury 2014; 45:885-9. [PMID: 24485550 DOI: 10.1016/j.injury.2014.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/30/2013] [Accepted: 01/06/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Reports on genitourinary (GU) trauma during the Iraqi conflict have been limited to battlefield injuries. We sought to characterise the incidence, mechanism of injury, wounding pattern, and management of lower GU injuries sustained in civil violence during the Iraqi war. PATIENTS AND METHODS A total of 2800 casualties with penetrating trauma to the abdomen and pelvis were treated at the Yarmouk Hospital, Baghdad from January 2004 to June 2008. Of the casualties 504 (18%) had GU trauma including 217 (43%) with one or more injuries to the lower GU organs. RESULTS Among the 217 patients there were 262 lower GU injuries involving the bladder in 128 (48.8%) patients, bulbo-prostatic urethra in 21 (8%), penis in 24 (9.2%), and scrotum in 89 (34%). Injuries to the anterior urethra and genitals were inflicted by Improvised Explosive Devices (IEDs) in 53-67% of cases and by individual firearms in 33-47%, while injuries to the posterior urethra and bladder were inflicted by IEDs in 17-22% of cases and by firearms in 78-83%. All penile wounds were repaired save 3 (12.5%) patients who underwent total penectomy. Of 63 injured testicles 54 (86%) could be salvaged and 9 (14%) required unilateral orchiectomy. The leading cause of death was an associated injury to major blood vessels in 26 (84%) of 31 patients who died. CONCLUSIONS Injuries to the anterior urethra and genitals were commonly caused by IEDs, while injuries to the posterior urethra and bladder were usually caused by individual firearms. Testis injury was almost always salvageable. Associated trauma to major blood vessels was the leading cause of death in these casualties.
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Zumrutbas AE, Baser A, Acar CI, Ozlulerden Y, Okutan A, Sahin UY, Aybek Z. Urogenital and Rectal Multisystem Organ Injury After Detonation of an Explosive Substance in the Rectum of a Schizophrenic Man. Urol Case Rep 2014; 2:97-9. [PMID: 26955556 PMCID: PMC4733013 DOI: 10.1016/j.eucr.2014.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 02/06/2014] [Indexed: 10/25/2022] Open
Abstract
Penetrating injuries are caused by the injury of perineal area with gun or stab wounds, which may cause complex injuries or multiple organ injuries. Infections, bleeding, necrotizing fasciitis, ureterocutaneous fistulas, diverticulum, abscesses, narrowing, and incontinence may arise after urethral injuries. Although there are several case reports of urogenital system traumas in the literature, this case reports a schizophrenic patient who had a multisystem genitourinary and rectal trauma after self-detonation of an explosive in the rectum and managed with reconstructive surgery without any postoperative complications. Lower urinary tract anatomy was preserved and full continence was achieved after the surgical procedure.
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Affiliation(s)
- Ali E Zumrutbas
- Department of Urology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Aykut Baser
- Department of Urology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Cenk I Acar
- Department of Urology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Yusuf Ozlulerden
- Department of Urology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Aysegul Okutan
- Department of General Surgery, Denizli State Hospital, Ministry of Health, Denizli, Turkey
| | - Umit Y Sahin
- Department of General Surgery, Denizli State Hospital, Ministry of Health, Denizli, Turkey
| | - Zafer Aybek
- Department of Urology, Pamukkale University School of Medicine, Denizli, Turkey
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