EAU Guidelines on Urological Trauma
Introduction
Genitourinary injuries (GUI) can lead to significant morbidity and mortality, but the incidence, severity and optimal treatment of these injuries has not been established in population-based cross-sectional studies. To codify the appropriate evaluation and management of GUI, a committee was convened by the Health Care Office (HCO) of European Association of Urology (EAU). The committee was charged with reviewing the available literature on the subject of GUI and creating a consensus document on the appropriate diagnosis and treatment of renal, ureteral, bladder, urethral and genital injuries. This is a brief summarized report (<5000 words) of the full Urological Trauma report (35,000 words) which appears in full online at http://www.europeanurology.com.
Section snippets
Subcommittee composition
The HCO of the EAU selected trauma subcommittee members from 6 European countries and the US. Each member was a Urologist with special expertise in GUI based on training, experience, and research publications.
Search criteria
A Medline search using PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) included articles from 1966 to November 2003. Retrievable articles numbered in the thousands. 350 pertinent peer reviewed articles were retrieved, and additional papers referenced in bibliographies but not initially
Renal trauma
Renal injury (RI) occurs in approximately 1–5% of all traumas [1], as the kidney is the most commonly injured genitourinary and abdominal organ [2]. Blunt trauma accounts for the largest percentage of RIs (90–95%) [3], while gunshot and stab wounds represent the most common causes of penetrating injuries. Penetrating injuries tend to be more severe, have a higher number of associated organ injuries, and usually result in a higher nephrectomy rate (25–33%) [4]. The Committee on Organ Injury
Ureteral trauma
Because of its protected location, small size, and mobility, trauma to the ureter is relatively rare and accounts for only 1% of all GUI. In large studies of ureteral injuries (UIs), 75% are iatrogenic, 18% are from blunt trauma, and 7% were from penetrating trauma. Among iatrogenic injuries, 73% are gynaecological in origin, 14% are from general surgical cases and 14% are urological. The injury in the upper third is reported 13%, in the middle third 13%, and in the lower third 74% [45]. The
Bladder trauma
Among abdominal injuries that require surgical repair, 2% involve the bladder [48]. Blunt trauma accounts for 67–86% of bladder ruptures (BR), while penetrating trauma for 14–33% [49]. The most common cause (90%) of BR by blunt trauma is motor vehicle accidents [50]. BR in the setting of blunt trauma may be classified as extraperitoneal or intraperitoneal. About 70–97% of patients with BR from blunt trauma have associated pelvic fractures [51]. The AAST organ injury severity scale for the
Urethral trauma
Unstable diametric pelvic fractures [59] and bilateral ischiopubic rami fractures have the highest likelihood of injuring the posterior urethra. In particular, the combination of straddle fractures with diastasis of the sacroiliac joint has the highest overall risk; the odds ratio is about 7 times higher for these types of fractures [60].
Multiple classifications for urethral injuries have been proposed, however the Committee on Organ Injury Scaling of the American Association for the Surgery of
Genital trauma
One-third to two-thirds of GUI are associated with the external genitalia [88]. Proper management of genital trauma requires gathering of information about the persons, animals or weapons involved in the accident. In males, a direct blow to the erect penis may cause penile fracture, frequently occurring during consensual intercourse, which accounts for approximately 60% of penile fractures [89] (Fig. 6). Penile fracture is caused by rupturing of the cavernosal tunica albuginea and may be
References (104)
- et al.
Radiographic evaluation of adult patients with blunt renal trauma
J Urol.
(1992) - et al.
Radiographic assessment of renal trauma: a 10-year prospective study of patient selection
J Urol.
(1989) - et al.
Routine preoperative “one-shot” intravenous pyelography is not indicated in all patients with penetrating abdominal trauma
J Am Coll Surg.
(1997) - et al.
Single shot intraoperative excretory urography for the immediate evaluation of renal trauma
J Urol.
(1999) - et al.
Limitations of routine spiral computerized tomography in the evaluation of blunt renal trauma
J Urol.
(1998) - et al.
Renal reconstruction after injury
J Urol.
(1991) - et al.
Attempted nonoperative management of blunt renal lacerations extending through the corticomedullary junction: the short-term and long-term sequelae
J Urol.
(1990) - et al.
Renal vascular injuries
Surg Clin North Am.
(2001) - et al.
Stab wounds of the kidney: conservative management in flank penetration
J Urol.
(1983) - et al.
Preservation of renal function after reconstruction for trauma: quantitative assessment with radionuclide scintigraphy
J Urol.
(1997)
Duodenal obstruction by retroperitoneal hematoma induced by severe blunt renal trauma
J Urol.
Genitourinary trauma in the pediatric patient
Urology
Traumatic hematuria in children can be evaluated as in adults
J Urol.
Nonoperative management of blunt pediatric major renal trauma
Urology.
Nonoperative management of major blunt renal trauma in children: in-hospital morbidity and long-term followup
J Urol.
Penetrating ureteral trauma at an urban trauma center: 10-year experience
Urology.
Efficacy of radiographic imaging in pediatric blunt renal trauma
J Urol.
Ureteral trauma: preoperative studies neither predict injury nor prevent missed injuries
J Am Coll Surg.
Unsuspected intraperitoneal rupture of bladder presenting with abdominal free air
Urology.
Genitourinary trauma
Emerg Med Clin North Am.
Major bladder trauma: mechanisms of injury and a unified method of diagnosis and repair
J Urol.
Indicators of genitourinary tract injury or anomaly in cases of pediatric blunt trauma
J Pediatr Surg.
Reconstructive surgery for trauma of the lower urinary tract
Urol Clin North Am.
Isolated intraperitoneal bladder rupture in patients with alcohol intoxication and minor abdominal trauma
Ann Emerg Med.
Computerized tomography cystography for the diagnosis of traumatic bladder rupture
J Urol.
Posterior urethral injuries associated with pelvic fractures
Urology.
Bladder and urethral injuries in patients with pelvic fractures
J Urol.
Urethral injuries in female subjects following pelvic fractures
J Urol.
Rupture of the corpus cavernosum: surgical management
J Urol.
Pelvic fracture urethral injuries: the unresolved controversy
J Urol.
Partial tears of prostatomembranous urethra in children
Urology
Urethral injury due to external trauma
Urology
Prevention of complications resulting from pelvic fracture urethral injuries—and from their surgical management
Urol Clin North Am.
Traumatic posterior urethral injury and early realignment using magnetic urethral catheters
J Urol.
A technique for immediate realignment and catheterization of the disrupted prostatomembranous urethra
J Urol.
Prostatomembranous urethral injuries: a review of the literature and a rational approach to their management
J Urol.
Posttraumatic complete and partial loss of urethra with pelvic fracture in girls: an appraisal of management
J Urol.
Experience with management of posterior urethral injury associated with pelvic fracture
J Urol.
Core-through optical internal urethrotomy in management of impassable traumatic posterior urethral strictures
J Urol.
Internal urethrotomy in the management of anterior urethral strictures: long-term followup
J Urol.
Endoscopic re-establishment of membranous urethral disruption
J Urol.
Penile fracture with urethral injury
J Urol.
Traumatic testicular dislocation: a case report and review of published reports
Urology
Traumatic dislocation of testis
Urology.
Testicular injuries
Urology.
Accuracy of ultrasound diagnosis after blunt testicular trauma
J Urol.
The value of ultrasound in the evaluation of patients with blunt scrotal trauma
Injury.
Severe blunt renal trauma: a 7-year retrospective review from a provincial trauma centre
Can J Urol.
Management of blunt renal trauma
Br J Urol.
Urological trauma in the Pacific Northwest: etiology, distribution, management and outcome
J Urol.
Cited by (206)
Management of testicular rupture following blunt scrotal trauma
2024, Asian Journal of SurgeryMan with Motorcycle Injury
2021, Annals of Emergency MedicineRenal Parenchyma Trauma and General Trauma Recommandations
2021, Progres en UrologieManagement of complications of upper urinary tract trauma (kidney and ureter)
2021, Progres en Urologie