Presentation Authors: Jacob Lucas*, Philadelphia, PA, Jeremy Myers, Sorena Keihani, Rachel Moses, Yizhe Xu, Salt Lake City, UT, Bradley Morris, Sarah Majercik, Murray, UT, Timothy Hewitt, Frank Burks, Royal Oak, MI, Ian Schwartz, Sean Elliott, Minneapolis, MN, Cullen Black, Kaushik Mukherjee, Loma Linda, CA, Brenton Sherwood, Bradley Erickson, Iowa City, IA, Brandi Miller, Richard Santucci, Detroit, MI, Jurek Kocik, Tyler, TX, Brian Smith, Philadelphia, PA, Joshua Piotrowski, Christopher Dodgion, Milaukee, WI, Erik Desoucy, Scott Zakaluzny, Sacramento, CA, Nima Baradaran, Benjamin Breyer, San Francisco, CA, Angela Presson, James Hotaling, Raminder Nirula, Salt Lake City, UT, Amir Patel, Jay Simhan, Philadelphia, PA
Introduction: There are no clear treatment algorithms with strong evidence base for the management of extraperitoneal bladder injuries (EBI). Accordingly, patients can be managed either surgically or conservatively with Foley catheter drainage and healing by secondary intention. We analyzed treatment failures and complications associated with EBI management using a large, multi-institutional cohort of traumatic bladder injuries.
Methods: A prospective study of bladder injury was performed from 2014-2017 at 16 Level-1 trauma centers. Patients with EBI were included in the study. All intraperitoneal and combined intraperitoneal/extraperitoneal injuries were excluded. Patient characteristics and complications were compared between those receiving initial conservative management (CM) and surgery (S). Treatment failure for CM was considered on the basis of need for definitive surgical repair of EBI for any reason following an initial period of catheter drainage.
Results: Of 205 traumatic bladder injuries, 90 EBI were identified (mean age 43.5 yrs, 62.3% male). Of the EBI patients, 53 were managed in the initial period with Foley catheter drainage (CM) while 37 underwent surgery (S) (Table 1). In the CM group, 15.1% (8/53) failed an initial period of catheter drainage and required definitive surgery at a mean of 10.4 days from time of injury. Although the rate of complications between CM and S cohorts were similar (22.6% vs. 24.3%, p=1.0), initial S recipients who developed complications had significantly higher AAST bladder injury scores than CM counterparts (3.9 vs. 2.6, p=0.02). On multivariate analysis, AAST bladder trauma score was the only predictor of a urologic complication (OR 19.7, CI 3.0-129.4, p=0.002).
Conclusions: This analysis of a large multi-institutional database reveals a greater than 1 in 5 complication rate in patients presenting with low severity EBI who are managed with initial Foley catheterization. Conversely, patients who undergo initial surgery have a similar complication rate that seems to occur in patients with significantly higher risk bladder injuries as determined by AAST bladder score. While further investigation is necessary, initial surgery performance in lower risk EBI patients may offer improved patient morbidity.