Elsevier

European Urology

Volume 47, Issue 1, January 2005, Pages 1-15
European Urology

EAU Guidelines on Urological Trauma

https://doi.org/10.1016/j.eururo.2004.07.028Get rights and content

Abstract

Purpose:

To determine the optimal evaluation and management of genitourinary (renal, ureteral, bladder, urethral and genital) injuries by review of the world's literature on the subject.

Methods:

A consensus committee convened by the Health Care Office of the European Association of Urology (EAU) to summarize the literature concerning the diagnosis and treatment of genitourinary trauma.

Results:

Findings of 350 citations are reviewed.

Conclusions:

The genitourinary trauma literature still relies heavily on expert opinion and single-institution retrospective series. Future prospective trials of the most significant issues, when possible, might improve the quality of evidence that dictates practitioner behavior. This paper represents a 5000 word summary of the full 35,000 word report. Full text of this review is available online at http://www.europeanurology.com.

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)

  • J.K. Park et al.

    Duodenal obstruction by retroperitoneal hematoma induced by severe blunt renal trauma

    J Urol.

    (2001)
  • I.M. McAleer et al.

    Genitourinary trauma in the pediatric patient

    Urology

    (1993)
  • R.A. Santucci et al.

    Traumatic hematuria in children can be evaluated as in adults

    J Urol.

    (2004)
  • J.B. Levy et al.

    Nonoperative management of blunt pediatric major renal trauma

    Urology.

    (1993)
  • L. Baumann et al.

    Nonoperative management of major blunt renal trauma in children: in-hospital morbidity and long-term followup

    J Urol.

    (1992)
  • L.S. Palmer et al.

    Penetrating ureteral trauma at an urban trauma center: 10-year experience

    Urology.

    (1999)
  • A.F. Morey et al.

    Efficacy of radiographic imaging in pediatric blunt renal trauma

    J Urol.

    (1996)
  • D. Medina et al.

    Ureteral trauma: preoperative studies neither predict injury nor prevent missed injuries

    J Am Coll Surg.

    (1998)
  • W.N. Castle et al.

    Unsuspected intraperitoneal rupture of bladder presenting with abdominal free air

    Urology.

    (1986)
  • D.A. Dreitlein et al.

    Genitourinary trauma

    Emerg Med Clin North Am.

    (2001)
  • P.R. Carroll et al.

    Major bladder trauma: mechanisms of injury and a unified method of diagnosis and repair

    J Urol.

    (1984)
  • W.A. Abou-Jaoude et al.

    Indicators of genitourinary tract injury or anomaly in cases of pediatric blunt trauma

    J Pediatr Surg.

    (1996)
  • A.F. Morey et al.

    Reconstructive surgery for trauma of the lower urinary tract

    Urol Clin North Am.

    (1999)
  • G. Festini et al.

    Isolated intraperitoneal bladder rupture in patients with alcohol intoxication and minor abdominal trauma

    Ann Emerg Med.

    (1991)
  • A.J. Deck et al.

    Computerized tomography cystography for the diagnosis of traumatic bladder rupture

    J Urol.

    (2000)
  • P.C. Devine et al.

    Posterior urethral injuries associated with pelvic fractures

    Urology.

    (1982)
  • J.P. Antoci et al.

    Bladder and urethral injuries in patients with pelvic fractures

    J Urol.

    (1982)
  • M.O. Perry et al.

    Urethral injuries in female subjects following pelvic fractures

    J Urol.

    (1992)
  • G.S. Nicolaisen et al.

    Rupture of the corpus cavernosum: surgical management

    J Urol.

    (1983)
  • M.M. Koraitim

    Pelvic fracture urethral injuries: the unresolved controversy

    J Urol.

    (1999)
  • K.I. Glassberg et al.

    Partial tears of prostatomembranous urethra in children

    Urology

    (1979)
  • A.S. Cass et al.

    Urethral injury due to external trauma

    Urology

    (1978)
  • R. Turner-Warwick

    Prevention of complications resulting from pelvic fracture urethral injuries—and from their surgical management

    Urol Clin North Am.

    (1989)
  • J.R. Porter et al.

    Traumatic posterior urethral injury and early realignment using magnetic urethral catheters

    J Urol.

    (1997)
  • M.K. Gelbard et al.

    A technique for immediate realignment and catheterization of the disrupted prostatomembranous urethra

    J Urol.

    (1989)
  • G.D. Webster et al.

    Prostatomembranous urethral injuries: a review of the literature and a rational approach to their management

    J Urol.

    (1983)
  • A.K. Hemal et al.

    Posttraumatic complete and partial loss of urethra with pelvic fracture in girls: an appraisal of management

    J Urol.

    (2000)
  • K.S. Coffield et al.

    Experience with management of posterior urethral injury associated with pelvic fracture

    J Urol.

    (1977)
  • N.P. Gupta et al.

    Core-through optical internal urethrotomy in management of impassable traumatic posterior urethral strictures

    J Urol.

    (1986)
  • V. Pansadoro et al.

    Internal urethrotomy in the management of anterior urethral strictures: long-term followup

    J Urol.

    (1996)
  • K. Yasuda et al.

    Endoscopic re-establishment of membranous urethral disruption

    J Urol.

    (1991)
  • T. Tsang et al.

    Penile fracture with urethral injury

    J Urol.

    (1992)
  • S. Shefi et al.

    Traumatic testicular dislocation: a case report and review of published reports

    Urology

    (1999)
  • V.P. Nagarajan et al.

    Traumatic dislocation of testis

    Urology.

    (1983)
  • A.S. Cass et al.

    Testicular injuries

    Urology.

    (1991)
  • J.G. Corrales et al.

    Accuracy of ultrasound diagnosis after blunt testicular trauma

    J Urol.

    (1993)
  • M.G. Patil et al.

    The value of ultrasound in the evaluation of patients with blunt scrotal trauma

    Injury.

    (1994)
  • R. Baverstock et al.

    Severe blunt renal trauma: a 7-year retrospective review from a provincial trauma centre

    Can J Urol.

    (2001)
  • A. Kristjansson et al.

    Management of blunt renal trauma

    Br J Urol.

    (1993)
  • J.N. Krieger et al.

    Urological trauma in the Pacific Northwest: etiology, distribution, management and outcome

    J Urol.

    (1984)
  • Cited by (206)

    • Man with Motorcycle Injury

      2021, Annals of Emergency Medicine
    View all citing articles on Scopus
    View full text