Incidence of urinary extravasation and rate of ureteral stenting after high-grade renal trauma in adults: a meta-analysis

Keihani, Sorena; Anderson, Ross; Fiander, Michelle; McFarland, Mary; Stoddard, Gregory J.; Hotaling, James M.; Myers, Jeremy B.

doi:10.21037/tau.2018.04.13

Cited by 18 publications

(15 citation statements)

References 40 publications

(68 reference statements)

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“…Arterial repair should be attempted in cases of patients with only one kidney or in those with bilateral renal injuries. Urine extravasation is not by itself an indication for OM in the acute setting [18, 169, 180].…”

Section: Methodsmentioning

confidence: 99%

Kidney and uro-trauma: WSES-AAST guidelines

et al. 2019

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Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians.

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Section: Methodsmentioning

confidence: 99%

Kidney and uro-trauma: WSES-AAST guidelines

et al. 2019

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“…In the current AAST grading system, the presence of any renal collecting system injury (positive urinary extravasation), will upgrade renal injuries to at least grade IV. 1,5 Since most cases of urinary extravasation heal spontaneously or with the help of ureteral stenting, 35 this information adds no benefit in predicting bleeding interventions for grade IV injuries. We believe that if a grade IV injury is to represent a severe injury with high probability for requiring bleeding control interventions, urinary extravasation should not be included as a grade IV criterion and may be more useful if provided as separate information.…”

Section: Discussionmentioning

confidence: 99%

The American Association for the Surgery of Trauma renal injury grading scale: Implications of the 2018 revisions for injury reclassification and predicting bleeding interventions

Keihani

Rogers

Putbrese

et al. 2019

J Trauma Acute Care Surg

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BACKGROUND:In 2018, the American Association for the Surgery of Trauma (AAST) published revisions to the renal injury grading system to reflect the increased reliance on computed tomography scans and non-operative management of high-grade renal trauma (HGRT). We aimed to evaluate how these revisions will change the grading of HGRT and if it outperforms the original 1989 grading in predicting bleeding control interventions. METHODS:Data on HGRTwere collected from 14 Level-1 trauma centers from 2014 to 2017. Patients with initial computed tomography scans were included. Two radiologists reviewed the scans to regrade the injuries according to the 1989 and 2018 AAST grading systems. Descriptive statistics were used to assess grade reclassifications. Mixed-effect multivariable logistic regression was used to measure the predictive ability of each grading system. The areas under the curves were compared. RESULTS:Of the 322 injuries included, 27.0% were upgraded, 3.4% were downgraded, and 69.5% remained unchanged. Of the injuries graded as III or lower using the 1989 AAST, 33.5% were upgraded to grade IV using the 2018 AAST. Of the grade V injuries, 58.8% were downgraded using the 2018 AAST. There was no statistically significant difference in the overall areas under the curves between the 2018 and 1989 AAST grading system for predicting bleeding interventions (0.72 vs. 0.68, p = 0.34). CONCLUSION:About one third of the injuries previously classified as grade III will be upgraded to grade IV using the 2018 AAST, which adds to the heterogeneity of grade IV injuries. Although the 2018 AAST grading provides more anatomic details on injury patterns and includes important radiologic findings, it did not outperform the 1989 AAST grading in predicting bleeding interventions.

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“…Most cases of urinary extravasation are believed to heal spontaneously, although ureteral stenting is used in about 30% of patients to facilitate the healing process or to treat subsequent complications. 26 It may be argued that the immediate assessment of urinary extravasation is not as important as evaluation of parenchymal and vascular injuries that are associated with the risk of hemorrhage. However, knowledge of urinary extravasation is important for accurate grading of the injuries and remains critical for development of an appropriate management plan, particularly for determining if early intervention is justified.…”

Section: Discussionmentioning

confidence: 99%

Optimal timing of delayed excretory phase computed tomography scan for diagnosis of urinary extravasation after high-grade renal trauma

Keihani

Putbrese

Rogers

et al. 2019

J Trauma Acute Care Surg

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BACKGROUND:Excretory phase computed tomography (CT) scan is used for diagnosis of renal collecting system injuries and accurate grading of high-grade renal trauma. However, optimal timing of the excretory phase is not well established. We hypothesized that there is an association between excretory phase timing and diagnosis of urinary extravasation and aimed to identify the optimal excretory phase timing for diagnosis of urinary extravasation. METHODS:The Genito-Urinary Trauma Study collected data on high-grade renal trauma (grades III-V) from 14 Level I trauma centers between 2014 and 2017. The time between portal venous and excretory phases at initial CT scans was recorded. Poisson regression was used to measure the association between excretory phase timing and diagnosis of urinary extravasation. Predictive receiver operating characteristic analysis was used to identify a cutoff point optimizing detection of urinary extravasation. RESULTS:Overall, 326 patients were included; 245 (75%) had excretory phase CT scans for review either initially (n = 212) or only at their follow-up (n = 33). At initial CTwith excretory phase, 46 (22%) of 212 patients were diagnosed with urinary extravasation. Median time between portal venous and excretory phases was 4 minutes (interquartile range, 4-7 minutes). Time of initial excretory phase was significantly greater in those diagnosed with urinary extravasation. Increased time to excretory phase was positively associated with finding urinary extravasation at the initial CT scan after controlling for multiple factors (risk ratio per minute, 1.15; 95% confidence interval, 1.09-1.22; p < 0.001). The optimal delay for detection of urinary extravasation was 9 minutes. CONCLUSION:Timing of the excretory phase is a significant factor in accurate diagnosis of renal collecting system injury. A 9-minute delay between the early and excretory phases optimized detection of urinary extravasation.

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Incidence of urinary extravasation and rate of ureteral stenting after high-grade renal trauma in adults: a meta-analysis

Cited by 18 publications

References 40 publications

Kidney and uro-trauma: WSES-AAST guidelines

Kidney and uro-trauma: WSES-AAST guidelines

The American Association for the Surgery of Trauma renal injury grading scale: Implications of the 2018 revisions for injury reclassification and predicting bleeding interventions

Optimal timing of delayed excretory phase computed tomography scan for diagnosis of urinary extravasation after high-grade renal trauma

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