High Riding Prostate: Epidemiology of Genitourinary Injury in Motorcyclists from a UK Register of over 12,000 Victims

Background: The mechanism of motorcycle accidents (high speeds, pelvis behind fuel tank) may predispose to genitourinary injury (GUI) but the epidemiology is poorly understood. Previous studies have assessed GUI patterns in cyclists, and road traffic accident victims in general, but no study has analyzed GUI patterns in a large cohort of motorcyclists. Objectives: We aimed to better understand patterns of urological injuries among motorcyclists admitted to hospital. We aimed to determine any relationship between pelvic fracture and GUI patterns or severity. Methods: The Trauma Audit Research Network was reviewed to identify motorcyclists admitted between January 2012 and December 2016 (n = 12,374). Cases were divided into riders (n = 11,926) and pillion passengers (n = 448), and the data analyzed to identify urological injuries and their associations. The associations between pelvic fracture and other injury types were tested for significance by one- and two-way χ2. Results: GUI was identified in 6%. Renal trauma was the most common GUI among riders (4%) and pillions (2%). There was no statistically significant relationship between grade of renal trauma and presence of pelvic fracture. Urethral injury occurred in 0.2% of riders and passengers, and bladder injury in 0.4% of riders and 0.7% of pillions. Urethral and bladder injuries were positively associated with pelvic fracture, which was present in 81 and 92%, respectively. Testicular trauma occurred in 0.4% of riders and 0.7% of pillions. Body armor was recorded in 3% of casualties with urological trauma, and 3% overall. Conclusions: A significant proportion of motorcyclists brought to accident and emergency department have GUI, most commonly renal trauma. Pelvic fracture is more common in pillion passengers than riders, and associated with urethral and bladder injuries, but it does not predict severity of renal trauma. External genital injuries are rare, but we recommend examination in the tertiary survey, as consequences of missed injury are severe. Further research is needed to explore protective effects of motorcyclist clothing.

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Urinary Tract Injury at Gynecological Surgery: Results from a Tertiary-Care Institution

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2016.679 ◽

2017 ◽

Vol 23 (3) ◽

pp. 143

Author(s):

Tayfun Toptaş ◽

Aysel Uysal ◽

Selim Karataş ◽

Işın Üreyen ◽

Onur Erol

Keyword(s):

Urinary Tract ◽

Tertiary Care ◽

High Volume ◽

Urethral Injury ◽

Annual Number ◽

Bladder Injury ◽

Ureteric Injury ◽

Urinary Tract Injury ◽

Bladder Injuries ◽

Ureteric Injuries

Objective: To identify clinical features of urinary tract injuries detected during or after gynecologic surgeries, with a specific focus on incidence and role of surgeon and surgical route on urinary injury.Study design: The institutional database from January 2009 to January 2017 was reviewed with respect to gynecologic (non-obstetric) surgeries and urinary injuries.Results: A total of 8719 gynecologic surgeries were identified. Of these, 46 (0.52%) were found to be complicated with a bladder (N=34, 0.38%), ureteral (N=11, 0.12%) and/or urethral injury (N=1, 0.01%). Bladder injuries occurred mostly at the superior part of the bladder, while ureteric injuries at the most distal part of the ureter. Ureteric injuries were mostly delayed (81.8% vs. 5.9%, P<0.001) and were more related to thermal injury than bladder injuries (45.5% vs. 8.8%, P=0.029). Among all surgical procedures, radical hysterectomy had the highest incidence for the ureteric injury (8.53%), while Burch colposuspension via minimally invasive route had the highest incidence for the bladder injury (16.6%). Cumulative incidence of urinary injury significantly differed according to the surgical route preferred (P=0.032), with the vaginal surgeries were associated with the highest incidence (0.96%). However, there was no such a difference in injury rates between the low-volume (0.55%) and high-volume (0.52%) surgeons (P=0.328)Conclusion: Overall incidence of lower urinary tract injury at gynecologic surgeries is low, does not differ according to annual number of surgeries performed, but increases with the vaginal surgeries.

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Renal injury management in an urban trauma centre and implications for urological training

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x14055925061117 ◽

2015 ◽

Vol 97 (3) ◽

pp. 194-197 ◽

Cited By ~ 12

Author(s):

M McPhee ◽

N Arumainayagam ◽

M Clark ◽

N Burfitt ◽

R DasGupta

Keyword(s):

Renal Injury ◽

Road Traffic ◽

Demographic Data ◽

Rare Event ◽

Research Network ◽

Renal Trauma ◽

Trauma Patients ◽

Electronic Patient Records ◽

Severity Of Injury ◽

Grade Iii

Introduction The aim of this study was to analyse the treatment and management of renal injury patients presenting to our major trauma unit to determine the likelihood of patients needing immediate nephrectomy. Methods The Trauma Audit and Research Network (TARN) database was used to review trauma cases presenting to our department between February 2009 and September 2013. Demographic data, mechanism and severity of injury, grade of renal trauma, management and 30-day outcome were determined from TARN data, electronic patient records and imaging. Results There were a total of 1,856 trauma cases, of which 36 patients (1.9%) had a renal injury. In this group, the median age was 28 years (range: 16–92 years), with 28 patients (78%) having blunt renal trauma and 8 (22%) penetrating renal trauma. The most common cause for blunt renal trauma was road traffic accidents. Renal trauma cases were stratified into American Association for the Surgery of Trauma (AAST) grades (grade I: 19%, grade II: 22%, grade III: 28%, grade IV: 28%, grade V: 0%). All patients with grade I and II injuries were treated conservatively. There were three patients (1 with grade III and 2 with grade IV renal injuries) who underwent radiological embolisation. One of these patients went on to have a delayed nephrectomy owing to unsuccessful embolisation. Conclusions Trauma patients rarely require emergency nephrectomy. Radiological selective embolisation provides a good interventional option in cases of active bleeding from renal injury in haemodynamically stable patients. This has implications for trauma care and how surgical cover is provided for the rare event of nephrectomy.

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A retrospective study of urological injuries during obstetrics and gynecological procedures

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20202563 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2746

Author(s):

Sunil Kumar Samal ◽

Setu Rathod ◽

Kalaivani Thangavel

Keyword(s):

Clinical Presentation ◽

Tertiary Care ◽

Bladder Injury ◽

Obstetrics And Gynecology ◽

Management Option ◽

Ureteric Injury ◽

Obstetrics And Gynaecology ◽

Bladder Injuries ◽

High Degree ◽

Urological Injuries

Background: Urological injury in obstetrics and gynaecology are not uncommon because there is a close anatomical association between reproductive and urological system. The objective of this study was to find out the incidence and types of urological injuries in obstetric and gynaecological procedures, clinical presentation and various management option in a tertiary care hospital.Methods: The study was a retrospective analysis of all obstetric and gynecological surgeries over a period of 6 years from January 2014 to December 2019. Cases with the documented urological injuries during these procedures were analyzed further.Results: Total 8595 patients had undergone different obstetrics and gynecology procedures, out of which 5429 were obstetrics and 3166 were gynecology surgeries. Out of 3166 of gynecology procedures, there were 16 cases (0.5%) of bladder injuries and one case (0.03%) of ureteric injury. Out of 5429 cases of obstetric procedures there were 11 (0.2%) cases of bladder injury and one case (0.01%) of ureteric injury.Conclusions: The incidence urological injuries during obstetrics and gynecological procedures are rare but the morbidity associated these are significant. Therefor surgeons should be more cautious and high degree of suspicion can help in early diagnosis and avoid the sequel.

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The Incidence, Management, and Outcome of Penetrating Bladder Injuries in Civilians Resultant from Armed Conflict in Baghdad 2005-2006

Advances in Urology ◽

10.1155/2009/275634 ◽

2009 ◽

Vol 2009 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Firas G. Petros ◽

Richard A. Santucci ◽

Naimet K. Al-Saigh

Keyword(s):

Primary Repair ◽

Bladder Injury ◽

Associated Injuries ◽

Bladder Drainage ◽

Young Males ◽

Iraqi War ◽

Missed Injury ◽

War Zone ◽

Civilian Trauma ◽

Bladder Injuries

The purpose of this paper is to review the diagnosis, treatment, and outcomes of penetrating bladder injuries suffered by civilians in the Iraqi war zone.Materials and Methods.All civilian trauma cases received alive at Al-Yarmouk Teaching Hospital from January 2005 to August 2006 were reviewed for the presence of bladder injury.Results.533 cases of penetrating abdominal trauma were identified, of which 177 (33%) involved the genitourinary (GU) system and 64 (12%) involved the bladder. Most (70%) were young males, and most (55%) had grade IV injuries. Associated injuries occurred in 63/64 (98%) of patients. 3 patients had missed bladder injuries, and all of these had complications related to their missed injury. Bladder-related complications occurred in 11% of cases, and mortality in 13%, all due to extravesical injuries.Conclusions.Penetrating bladder injury among civilians in Baghdad war zone resulted in 64 cases in 18 months. The initial detection rate is very high (98%), and after primary repair, lasting complications are rare. Morbidities from missed injuries were severe hematuria and vesicorectal fistula. However, (3%) of vesicorectal fistulae healed spontaneously with prolonged bladder drainage. Associated injuries are the rule in penetrating bladder injury patients, and must be diligently investigated and treated.

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The value of digital rectal examination in assessing for pelvic fracture–associated urethral injury

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e3182a68668 ◽

2013 ◽

Vol 75 (5) ◽

pp. 913-915 ◽

Cited By ~ 3

Author(s):

Michael H. Johnson ◽

Andrew Chang ◽

Steven B. Brandes

Keyword(s):

Pelvic Fracture ◽

Digital Rectal Examination ◽

Urethral Injury ◽

Rectal Examination

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Redo pelvic fracture urethral injury repair: The case for tadalafil

10.5152/tud.2021.21065 ◽

2021 ◽

Vol 47 (4) ◽

pp. 319-324

Author(s):

Pankaj M. Joshi ◽

◽

Devang Desai ◽

Seichi Fuziwara ◽

Sheliyan Raveenthiran ◽

...

Keyword(s):

Pelvic Fracture ◽

Urethral Injury ◽

Injury Repair

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Traumatic Urethral Injury without Pelvic Fracture in an Adult Female

The Scientific World JOURNAL ◽

10.1100/tsw.2010.29 ◽

2010 ◽

Vol 10 ◽

pp. 308-310 ◽

Cited By ~ 4

Author(s):

Nathan A. Bockholt ◽

Kenneth G. Nepple ◽

Charles R. Powell ◽

Karl J. Kreder

Keyword(s):

Adult Female ◽

Pelvic Fracture ◽

Acetabular Fracture ◽

Bladder Neck ◽

Motor Vehicle ◽

Urethral Catheter ◽

Urethral Injury ◽

Rare Occurrence ◽

Urethral Meatus ◽

Vehicle Collision

A 23-year-old female was involved in a motor vehicle collision with multiple injuries, including a right acetabular fracture, but no pelvic fracture. Urology consultation was obtained due to difficulty placing a urethral catheter. Examination revealed a longitudinal urethral tear with vaginal laceration extending 2 cm from the urethral meatus proximally toward the bladder neck. The longitudinal urethral tear was repaired primarily. Traumatic female urethral injury in the absence of a pelvic fracture is an exceedingly rare occurrence.

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Outcomes Following Primary Realignment Versus Suprapubic Cystostomy with Delayed Urethroplasty for Pelvic Fracture-Associated Posterior Urethral Injury: A Systematic Review with Meta-Analysis

Current Urology ◽

10.1159/000499282 ◽

2019 ◽

Vol 13 (3) ◽

pp. 113-124 ◽

Cited By ~ 1

Author(s):

Alexander Light ◽

Tanya Gupta ◽

Maria Dadabhoy ◽

Allen Daniel ◽

Madura Nandakumar ◽

...

Keyword(s):

Systematic Review ◽

Urinary Incontinence ◽

Case Studies ◽

Pelvic Fracture ◽

Meta Analysis ◽

Urethral Injury ◽

Retrospective Case ◽

Eligibility Criteria ◽

High Quality Research ◽

Suprapubic Cystostomy

Objective: Pelvic fracture can be complicated by posterior urethral injury (PUI) in up to 25% of cases. PUI can produce considerable morbidity, including urethral stricture, erectile dysfunction (ED), and urinary incontinence. Optimal management of PUI is unclear, however, the current gold standard is placement of a suprapubic cystostomy with delayed urethroplasty (SCDU) performed several months later. Another option is early primary realignment (PR) with urethral catheter, performed either open or endoscopically. Through a systematic review and meta-analysis, we aimed to compare PR and SCDU regarding stricture, ED, and urinary incontinence rates. In light of advancing endoscopic techniques, we also aimed to compare early endoscopic realignment (EER) alone with SCDU. Methods: PubMed, Medline, and Embase were searched for eligible studies comparing PR, including EER, and suprapubic cystostomy plus delayed urethroplasty from database inception until July 17th, 2018. We also reviewed reference lists from relevant articles. Study quality assessment was conducted using a modified Newcastle-Ottawa (mNOS) scale (maximum score 9). Results: From 461 identified articles, 13 studies encompassing 414 PR and 308 SCDU patients met our eligibility criteria. Twelve studies were retrospective non-randomized case studies, with 1 prospective randomized case study. Included studies were of moderately low quality (mNOS mean score: 6.0 ± 0.6). Meta-analysis demonstrated that PR and SCDU had similar stricture rates [odds ratio (OR): 2.14; 95% confidence interval (CI): 0.67-6.85; p = 0.20], similar rates of ED (OR: 1.06; 95% CI: 0.62-1.81; p = 0.84), and similar rates of urinary incontinence (OR: 0.94; 95% CI: 0.49-1.79; p = 0.86). Six studies compared EER alone (229 patients) versus SCDU (195 patients). Meta-analysis demonstrated that these modalities also had similar stricture rates (OR: 4.14; 95% CI: 0.76-22.45; p = 0.10), similar rates of ED (OR: 0.79; 95% CI: 0.41-1.54; p = 0.49), and similar rates of urinary incontinence (OR: 1.10; 95% CI: 0.48-2.53; p = 0.82). Conclusion: For PUI patients, neither PR nor EER produces superior outcomes compared to SCDU regarding stricture, ED, and urinary incontinence rates. The quality of studies in the literature, however, is very poor, with the majority of studies being non-randomized retrospective case studies with potentially high bias. Additional high-quality research, particularly prospective studies and randomized controlled trials, are needed to strengthen the evidence base.

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Bladder injuries in emergency/expedited laparoscopic surgery in the absence of previous surgery: a case series

Annals of The Royal College of Surgeons of England ◽

10.1308/003588412x13171221502149 ◽

2012 ◽

Vol 94 (3) ◽

pp. e118-e120 ◽

Cited By ~ 10

Author(s):

BF Levy ◽

J De Guara ◽

PD Willson ◽

Y Soon ◽

A Kent ◽

...

Keyword(s):

Case Series ◽

Lower Abdominal Pain ◽

Bladder Injury ◽

Emergency Setting ◽

Surgical Trainees ◽

Bladder Injuries ◽

Site Planning ◽

Supervision And Training ◽

Alternative Sites ◽

And Training

INTRODUCTION The use of laparoscopy as a diagnostic and therapeutic tool is being used increasingly in the emergency setting with many of these procedures being performed by trainees. While the incidence of iatrogenic injuries is reported to be low, we present six emergency or expedited cases in which the bladder was perforated by the suprapubic trocar. CASES Three cases were related to the management of appendicitis, two to negative diagnostic laparoscopies for lower abdominal pain and one to an ectopic pregnancy. Management of the bladder injuries varied from a urinary catheter alone to laparotomy with debridement of the abdominal wall due to sepsis and later reconstruction. Four of the six cases were performed by registrars. CONCLUSIONS Although the incidence of bladder injury is low, its importance is highlighted by the large number of laparoscopies being performed. In addition to catheterisation of the patient, care must be taken with the insertion of low suprapubic ports and consideration should be made regarding alternative sites. Adequate laparoscopic supervision and training in port site planning is required for surgical trainees.

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