British Association of Urological Surgeons (BAUS) consensus document: management of bladder and ureteric injury

Abstract

Injuries to the bladder and ureter are uncommon but usually require prompt urological management. Due to their infrequent nature, Urologists maybe unfamiliar with managing these acute problems and may not work in specialist centres with readily available expertise in open and abdominal surgery. We aim to provide advice in the form of a consensus statement led by the Female, Neurological and Urodynamic Urology (FNUU) Section of the British Association of Urological Surgeons (BAUS), in consultation with BAUS members and consultants working in units throughout the UK, to create a comprehensive management pathway and a series of statements to aid clinicians.

Guidance for diagnosis and management of bladder injuries – is practice up to date?

“…For iatrogenic injuries, the consensus statement provides an update to the previous advice that intraoperative injury 'should be repaired by open surgery' by adding 'unless expertise and pre-existing approach allows a laparoscopic or robot-assisted laparoscopic repair' [1]. In our present series, 16/38 cases of iatrogenic BI that underwent primary repair were performed with a minimally invasive approach, i.e.…”

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The BAUS consensus statement [1] provides the latest update to guidance on management of bladder injury (BI). Clinical guidelines are a particularly helpful tool for such cases, which are uncommon, but require timely diagnosis and management to optimise outcome.Before 2021, the European Association of Urology (EAU) Guidelines on Urological Trauma [2] and British Orthopaedic Association Standard for Trauma (BOAST)14 [3] provided guidance on the best practice for management of traumatic BI, which are commonly secondary to blunt trauma (e.g.

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“…The BAUS consensus statement [1] provides the latest update to guidance on management of bladder injury (BI). Clinical guidelines are a particularly helpful tool for such cases, which are uncommon, but require timely diagnosis and management to optimise outcome.…”

“…However, owing to the variability in presentation and need for multidisciplinary input, diagnosis can be difficult and delayed. Furthermore, management decisions can be challenging; although intraperitoneal injury has been traditionally managed with open repair, these are increasingly being managed conservatively with a catheter alone, which is reflected in the 2021 consensus statement [1].…”

“…Lastly, the EAU guidance recommends a follow-up cystogram for any case managed conservatively, in order to ensure injury resolution, prior to catheter removal [2]. The BAUS 2021 update extends this recommendation to all cases and advises catheterisation should last 2-3 weeks after injury [1].…”