Urotrauma Guideline 2020: AUA Guideline

Abstract

The authors of this guideline reviewed the urologic trauma literature to guide clinicians in the appropriate methods of evaluation and management of genitourinary injuries. Materials and Methods: The Panel amended the Guideline in 2020 to reflect additional literature published through February 2020. When sufficient evidence existed, the Panel assigned the body of evidence a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, the Panel provided additional information as Clinical Principles and Expert Opinions (See table 1). Results: The Panel updated a total of six existing statements on renal, ureteral, bladder, urethra, and genital trauma. Additionally, four new statements were added based on literature released since the 2017 amendment. Statement 5b was added based on new evidence for treatment of hemodynamically unstable patients with renal trauma. Statement 20b was added based on new literature for percutaneous or open suprapubic tube placement following pelvic fracture urethral injury. Statements 30a and 30b were also added to provide guidance on ultrasonography for blunt scrotal injuries suggestive of testicular rupture and for performing surgical exploration with repair or orchiectomy for penetrating scrotal injuries respectively. Conclusions: These evidence-based updates to the AUA Guidelines further inform the treatment of urotrauma.

A large renal bullet that resembles a large renal stone. A rare case scenario

“…Based on the ASST classification, renal gunshot injury results in a grade IV injury. Abdominal exploration was reserved only if there were hemodynamic instability, renal hilar involvement, and active haemorrhage (11) . Gunshot injuries to the kidney are commonly associated with thoracic and abdominal injuries.…”

Minimally invasive management versus open surgery in the treatment of penetrating bladder injuries: a retrospective cohort study

“…Hemodynamically unstable patients and patients with other hollow viscus injuries are not candidates for MIM [ 6 ]. For extraperitoneal injury, operative repair is recommended if the patient is already undergoing pelvic surgery for another injury such as exploratory laparotomy or orthopedic repair of the pelvis [ 2 , 3 ]. Complicated injuries involving the ureteral orifice or trigone may require surgery to prevent future incontinence [ 4 ].…”

“…In the 2004 Eastern Association trauma guidelines for genitourinary trauma for all mechanisms, Holevar reported that catheter drainage shows results equal to surgical repair [ 6 ]. The latest AUA guidelines recommend MIM with drainage for extraperitoneal bladder injury without mention of injury mechanism [ 3 ]. Bryk published a 2013 review of urologic trauma guidelines.…”

“…The latest American Association for the Surgery of Trauma (AAST) urologic trauma guidelines recommend selective MIM of extraperitoneal bladder injury for both blunt and penetrating trauma [ 1 ]. European Urologic Association (EUA) guidelines recommend operative treatment of all penetrating bladder injury [ 2 ], and American Urologic Association (AUA) guidelines do not distinguish treatment based on mechanism [ 3 ]. The individual studies that form the basis of the guidelines include very little penetrating trauma.…”

Vicarious excretion of intravenous contrast masquerading as a nephroenteric fistula in a patient with a grade IV renal injury

“…Follow-up CT imaging 48–72 hours after initial imaging is recommended in patients with high-grade renal injury (American Association for the Surgery of Trauma [AAST] grades IV-V), given the increased risk for complications such as hemorrhage, urinoma, and fistula formation. 1 We present the case of a patient with an AAST grade IV renal injury who demonstrated vicarious excretion of intravenous contrast into the bowel masquerading as a nephroenteric fistula.…”