Genitourinary Trauma, Management of
Published 2004
Published 2004
1. Level I
There is insufficient Class I and Class II data to support any standards regarding management of bladder trauma.
2. Level II
There is insufficient Class II data to support any recommendations regarding management of bladder trauma.
3. Level III
1) Conservative, nonoperative management of blunt extraperitoneal bladder rupture has a similar outcome to that of patients treated with primary suturing.
2) Transurethral catheters result in fewer complications and fewer days of catheterization than suprapubic catheters, regardless of the degree of bladder injury, and are therefore preferable to suprapubic catheters whether the patient is being treated nonoperatively or operatively.
1. Level I
There is insufficient Class I and Class II data to support any standards regarding management of renal trauma.
2. Level II
1) Preliminary vascular control does not decrease blood loss or increase renal salvage.
2) Conservative management of shattered but perfused kidneys in hemodynamically stable patients with minimal transfusion requirements will result in a low incidence of complications, which can usually be treated with endourological or percutaneous methods.
3. Level III
1) Preliminary vascular control may prolong operative time
2) The success of nonoperative management may be enhanced by the use of angiographic embolization.
3) Nonoperative treatment of renal lacerations from blunt trauma associated with extravasation is associated with few complications, which can usually be treated with endourological or percutaneous methods.
4) Conservative management of major renal lacerations associated with devascularized segments is associated with a high rate of urologic morbidity (38 - 82%). In patients who present with a major renal laceration associated with devascularized segments, conservative management is feasible in those who are clinically stable with blunt trauma. The physician must be especially aware of the probable complications within this subset of patients.
5) Operative exploration of the kidney should be considered in patients with major blunt renal injuries with a devascularized segment in association with fecal spillage or pancreatic injury.
6) Nonoperative treatment of penetrating renal lacerations is appropriate in hemodynamically stable patients without associated injuries hwo have been staged completely with CT scan and/or IVP. A high index of suspicion is needed to avoid ureteral injuries if a course of nonexploration is chosen.
7) Penetrating Grade III or IV injuries are associated with a significant risk of delayed bleeding if treated expectantly. Exploration should be considered if laparotomy is indicated for other injuries or if the injury is not completely staged prior to exploratory laparotomy for other injuries.
1. Level I
There is insufficient Class I and Class II data to support any standards regarding management of renovascular trauma.
2. Level II
There is insufficient Class II data to support any recommendations regarding management of renovascular trauma.
3. Level III
There is insufficient Class III data to support any recommendations regarding management of renovascular trauma.
1. Level I
There is insufficient Class I and Class II data to support any standards regarding management of ureteral trauma.
2. Level II
There is insufficient Class II data to support any recommendations regarding management of ureteral trauma.
3. Level III
There is insufficient Class III data to support any recommendations regarding management of ureteral trauma.
1. Level I
There is insufficient Class I and Class II data to support any standards regarding management of urethral trauma.
2. Level II
There is insufficient Class II data to support any recommendations regarding management of urethral trauma.
3. Level III
1) Posterior urethral injuries secondary to blunt trauma may be treated either with delayed perineal reconstruction or primary endoscopic realignment, resulting in equivalent outcomes.