Pd31-01 Injury Grade and Contrast Leakage From the Bladder on Delayed-Phase Imaging Is Prognostic for Conservatively-Managed Extraperitoneal Bladder Injuries

You have accessJournal of UrologyReconstruction: External Genitalia and Urotrauma (Including Transgender Surgery and Traumatic Fistula) I (PD31)1 May 2024PD31-01 INJURY GRADE AND CONTRAST LEAKAGE FROM THE BLADDER ON DELAYED-PHASE IMAGING IS PROGNOSTIC FOR CONSERVATIVELY-MANAGED EXTRAPERITONEAL BLADDER INJURIES George E. Koch, Reno E. Maldonado, Lane Shish, Madeleine Jackson, Reza Firoozabadi, Judith C. Hagedorn, and Alexander J. Skokan George E. KochGeorge E. Koch , Reno E. MaldonadoReno E. Maldonado , Lane ShishLane Shish , Madeleine JacksonMadeleine Jackson , Reza FiroozabadiReza Firoozabadi , Judith C. HagedornJudith C. Hagedorn , and Alexander J. SkokanAlexander J. Skokan View All Author Informationhttps://doi.org/10.1097/01.JU.0001009432.48553.4f.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In most cases of uncomplicated extraperitoneal (EP) bladder injuries, AUA Urotrauma Guidelines recommend conservative management (CM) with continuous bladder drainage. Between 18 and 22% of CM patients will have a persistent leak on cystogram requiring prolonged catheterization to heal or delayed cystorrhaphy. No series to date has identified significant risk factors for persistent extravasation or failure of CM in this population. METHODS: The trauma registry at a single Level 1 trauma center was queried retrospectively for all patients presenting with a blunt EP bladder rupture between 2004 and 2022. Patients with CM and follow-up through at least one postoperative cystogram or catheter removal were included. Patient and injury demographics and outcomes were collected. Univariable analysis for associations with a composite outcome of either persistent leakage or delayed cystorrhaphy was run. RESULTS: Eighty-four patients with an EP rupture underwent CM. Fifty-three (63.1%) were men and the average age was 41.5 years. Seventy-eight (92.9%) patients had an associated pelvic fracture and 17 of 84 (20.2%) underwent embolization for pelvic hemorrhage. Thirty-four (40.5%) patients also had delayed phase imaging, 17 (20.2%) of whom had extravasation from their bladder on delays. Six (7.1%) patients failed initial CM, 2 of whom underwent a delayed cystorrhaphy with the remaining 4 requiring prolonged catheterization (29-75 days). There was no association between our composite outcome and the presence of a pelvic fracture (p=0.35), embolization (p=0.11), or duration of catheterization (p=0.60). AAST grade (p=0.04) and presence of extravasation on delayed-phase imaging (p=0.03) were associated with the primary outcome. CONCLUSIONS: Contrast extravasation on initial delayed-phase imaging and AAST injury grade were associated with failed CM or persistent extravasation after EP bladder injury. This may reflect injuries that mechanistically yield incomplete antegrade drainage with CM (such as large lacerations). While retrograde cystography remains mandatory for the diagnosis of traumatic bladder injuries, contrast leakage on delayed-phase imaging may signal an increased risk of failed CM or persistent extravasation for EP bladder injuries. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e630 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information George E. Koch More articles by this author Reno E. Maldonado More articles by this author Lane Shish More articles by this author Madeleine Jackson More articles by this author Reza Firoozabadi More articles by this author Judith C. Hagedorn More articles by this author Alexander J. Skokan More articles by this author Expand All Advertisement PDF downloadLoading ...