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MP18-12 BLUNT SCROTAL TRAUMA - IS SURGICAL EXPLORATION NECESSARY?
THE JOURNAL OF UROLOGYâ
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patients who underwent hysterectomy between 2009e2011. Multi-level clinical classification software expanded procedure categories were used to classify patients as having undergone hysterectomy (124), caesarean section (134), or cystoscopy (100e101). ICD9 codes identified patients with a ureteral injury diagnosis (867.2, 867.3), bladder injury diagnosis (867.1, 867.0), or as having undergone ureteral repair (56.39, 56.79, 56.82, 56.86, 56.89, 56.99, 56.74, 56.75, 56.83) or bladder repair (86.71, 86.70, 57.89, 75.61, 57.85, 57.12, 57.19). Pearson’s Chi square test was used to compare treatment and outcome variables. RESULTS: Between 2009 e 2011, 70,373 patients underwent hysterectomy in the state of Florida. Cystoscopy was performed concurrently for 9,820 patients (14%). Urinary tract injury was diagnosed over the course of follow-up in 996 patients (1.4%). Bladder Injury diagnosis was made in 730 patients, during either the initial admission in 687 (94%), or over follow-up in 43 (5.9%). The diagnosis of ureteral injury was made in 281 patients, during the initial admission or over follow-up in 176 (63%) and 105 (37%) patients, respectively. In patients who developed a urinary tract injury, there was a decreased rate of delayed ureteral injury when cystoscopy was performed at the time of hysterectomy (17% with cystoscopy, 58% without cystoscopy; c2¼48, p<0.001). There was no difference in the rate of delayed bladder injuries. A limitation of this analysis is the decision-making to perform a cystoscopy. Given the low rate of concurrent cystoscopy, routine screening following hysterectomy was not performed. As such, for patients who underwent cystoscopy there was likely a high clinical suspicion of urinary tract injury. CONCLUSIONS: Urinary tract injury is an uncommon complication of hysterectomy. Routine cystoscopic screening following hysterectomy is a quick, minimally invasive, diagnostic procedure that can decrease the rate of delayed diagnosis of ureteral injury. Source of Funding: none
MP18-12 BLUNT SCROTAL TRAUMA - IS SURGICAL EXPLORATION NECESSARY? Elaine Redmond*, Fergal MacNamara, Hugh Flood, Limerick, Ireland INTRODUCTION AND OBJECTIVES: EAU and AUA guidelines recommend urgent surgical exploration in cases of suspected testicular rupture. However, the first line treatment for rupture of most other encapsulated organs (e.g. kidney, liver) is non-operative. The aim of this study was to evaluate the conservative management of blunt scrotal trauma in our institution. METHODS: The standard practice in our Level 1 trauma centre is to manage all blunt scrotal injuries conservatively with analgesia, antibiotics and scrotal support. Scrotal ultrasonography is performed where testicular injury or haematocoele is suspected clinically. All patients are offered a 3 month follow-up appointment. A retrospective chart analysis was performed on all patients who underwent ultrasonography for blunt scrotal trauma between 1998 and 2014. In addition, each patient was contacted by telephone to assess for testicular atrophy. RESULTS: Thirty-eight patients underwent ultrasound evaluation for blunt scrotal trauma. The median age was 20 years (8e84) and follow up period 3.2 years (0.2-14). Twenty-four patients were diagnosed with significant testicular injury. One patient with testicular rupture underwent immediate exploration with partial orchidectomy and repair of the tunica. In this single case, the decision to operate was based on the individual preference of the surgeon on call. When contacted as part of the study, this patient reported testicular atrophy. The remaining 37 patients were managed conservatively regardless of ultrasound findings. Of these, three patients reported testicular atrophy. None reported chronic pain or required delayed orchidectomy. Four patients underwent repair of an asymptomatic post-traumatic hydrocoele. CONCLUSIONS: Our experience suggests that emergency exploration of suspected testicular injury is not essential in the management of blunt scrotal trauma. Source of Funding: none
Vol. 193, No. 4S, Supplement, Saturday, May 16, 2015
MP18-13 READMISSION AFTER TREATMENT OF GRADE 3 AND 4 RENAL INJURIES AT A LEVEL 1 TRAUMA CENTER: STATEWIDE ASSESSMENT USING THE COMPREHENSIVE HOSPITAL ABSTRACT REPORTING SYSTEM Brian Winters*, Hunter Wessells, Brian Winters, Seattle, WA INTRODUCTION AND OBJECTIVES: A criticism of renal trauma research is the limited outpatient follow-up after index hospitalization with modern literature estimating this to be w30%. As patients are often transferred to tertiary care centers for acute trauma care, this lack of follow up may be geographical in nature and may not reflect the true outcome of these injuries. We determined statewide readmission rates following admission for AAST grade 3 and 4 renal injury at Harborview Medical Center (HMC) using the Comprehensive Hospital Abstract Reporting System (CHARS). METHODS: We evaluated all patients with radiologically diagnosed AAST grade 3 and 4 renal injuries admitted to HMC between 1998e2010. Grade 4 renal injuries were stratified by collecting system laceration (CSL) or segmental vascular injury (SVI). Data was abstracted from the CHARS database for readmissions to any WA state hospital within six months of renal injury. Variables of interest included age, sex, length of stay (index, readmission), time to readmission, urologic related procedures, and death. Diagnoses, imaging, and procedures were queried based on ICD-9 codes. RESULTS: Of 477 grade 3 and 159 grade 4 renal injuries initially treated at HMC, blunt trauma constituted 85% and 91% of these injuries, respectively. At index admission,111 patients required intervention: 75/ 477 (16%) grade 3 and 36/159 (23%) grade 4. Within six months of index hospitalization, 86/477 (18%) grade 3 and 38/159 (24%) grade 4 patients (23 CSL & 15 SVI) were readmitted to any WA state hospital (124 total). 80% of grade 3 injuries and 66% of grade 4 injuries returned to HMC compared to other area hospitals (p¼0.083). At time of readmission, 19/ 86 grade 3 (22%) and 16/38 grade 4 (42%) injuries had a urologic diagnosis as part of their readmission (37% CSL vs. 5% SVI p¼0.004). There were 14 urologic procedures performed during readmission with no delayed nephrectomies or urology-related deaths. CONCLUSIONS: Readmission rates following grade 3 and 4 renal trauma treatment ranged from 18e24% and the majority of patients returned to HMC. Urologic diagnoses at readmission were more common in grade 4 patients and specifically in the CSL sub-group, however, the need for adjunctive renal-related procedures was low overall (14 of 124 readmitted patients, 11%) suggesting acceptable initial management. Renal Trauma Readmission Interventions* Grade 3
Grade 4 CSL
Grade 4 SVI
Totals
Endoscopic
3
2
0
5
Open
0
2
0
2
Interventional Radiology
3
3
1
7
Totals
6
7
1
14
Type of Urologic Intervention
* Includes any hospital readmission within 6 months, ALL interventions performed at HMC
Source of Funding: None
MP18-14 UROLOGY CONSULTATION CAN IMPROVE SURVIVAL RATES IN RENAL TRAUMA PATIENTS Rodrigo Donalisio da Silva*, Diedra Gustafson, Leticia Nogueira, Wilson R. Molina, Fernando J. Kim, Denver, CO INTRODUCTION AND OBJECTIVES: Renal trauma is diagnosed in 8e10% of patients with abdominal trauma. The management of renal trauma patients is usually performed by trauma surgeons upon admission, and some patients require urological consultation during the treatment. The objective of this study was to evaluate if urological consultation can improve outcomes in renal trauma patients.
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patients who underwent hysterectomy between 2009e2011. Multi-level clinical classification software expanded procedure categories were used to classify patients as having undergone hysterectomy (124), caesarean section (134), or cystoscopy (100e101). ICD9 codes identified patients with a ureteral injury diagnosis (867.2, 867.3), bladder injury diagnosis (867.1, 867.0), or as having undergone ureteral repair (56.39, 56.79, 56.82, 56.86, 56.89, 56.99, 56.74, 56.75, 56.83) or bladder repair (86.71, 86.70, 57.89, 75.61, 57.85, 57.12, 57.19). Pearson’s Chi square test was used to compare treatment and outcome variables. RESULTS: Between 2009 e 2011, 70,373 patients underwent hysterectomy in the state of Florida. Cystoscopy was performed concurrently for 9,820 patients (14%). Urinary tract injury was diagnosed over the course of follow-up in 996 patients (1.4%). Bladder Injury diagnosis was made in 730 patients, during either the initial admission in 687 (94%), or over follow-up in 43 (5.9%). The diagnosis of ureteral injury was made in 281 patients, during the initial admission or over follow-up in 176 (63%) and 105 (37%) patients, respectively. In patients who developed a urinary tract injury, there was a decreased rate of delayed ureteral injury when cystoscopy was performed at the time of hysterectomy (17% with cystoscopy, 58% without cystoscopy; c2¼48, p<0.001). There was no difference in the rate of delayed bladder injuries. A limitation of this analysis is the decision-making to perform a cystoscopy. Given the low rate of concurrent cystoscopy, routine screening following hysterectomy was not performed. As such, for patients who underwent cystoscopy there was likely a high clinical suspicion of urinary tract injury. CONCLUSIONS: Urinary tract injury is an uncommon complication of hysterectomy. Routine cystoscopic screening following hysterectomy is a quick, minimally invasive, diagnostic procedure that can decrease the rate of delayed diagnosis of ureteral injury. Source of Funding: none
MP18-12 BLUNT SCROTAL TRAUMA - IS SURGICAL EXPLORATION NECESSARY? Elaine Redmond*, Fergal MacNamara, Hugh Flood, Limerick, Ireland INTRODUCTION AND OBJECTIVES: EAU and AUA guidelines recommend urgent surgical exploration in cases of suspected testicular rupture. However, the first line treatment for rupture of most other encapsulated organs (e.g. kidney, liver) is non-operative. The aim of this study was to evaluate the conservative management of blunt scrotal trauma in our institution. METHODS: The standard practice in our Level 1 trauma centre is to manage all blunt scrotal injuries conservatively with analgesia, antibiotics and scrotal support. Scrotal ultrasonography is performed where testicular injury or haematocoele is suspected clinically. All patients are offered a 3 month follow-up appointment. A retrospective chart analysis was performed on all patients who underwent ultrasonography for blunt scrotal trauma between 1998 and 2014. In addition, each patient was contacted by telephone to assess for testicular atrophy. RESULTS: Thirty-eight patients underwent ultrasound evaluation for blunt scrotal trauma. The median age was 20 years (8e84) and follow up period 3.2 years (0.2-14). Twenty-four patients were diagnosed with significant testicular injury. One patient with testicular rupture underwent immediate exploration with partial orchidectomy and repair of the tunica. In this single case, the decision to operate was based on the individual preference of the surgeon on call. When contacted as part of the study, this patient reported testicular atrophy. The remaining 37 patients were managed conservatively regardless of ultrasound findings. Of these, three patients reported testicular atrophy. None reported chronic pain or required delayed orchidectomy. Four patients underwent repair of an asymptomatic post-traumatic hydrocoele. CONCLUSIONS: Our experience suggests that emergency exploration of suspected testicular injury is not essential in the management of blunt scrotal trauma. Source of Funding: none
Vol. 193, No. 4S, Supplement, Saturday, May 16, 2015
MP18-13 READMISSION AFTER TREATMENT OF GRADE 3 AND 4 RENAL INJURIES AT A LEVEL 1 TRAUMA CENTER: STATEWIDE ASSESSMENT USING THE COMPREHENSIVE HOSPITAL ABSTRACT REPORTING SYSTEM Brian Winters*, Hunter Wessells, Brian Winters, Seattle, WA INTRODUCTION AND OBJECTIVES: A criticism of renal trauma research is the limited outpatient follow-up after index hospitalization with modern literature estimating this to be w30%. As patients are often transferred to tertiary care centers for acute trauma care, this lack of follow up may be geographical in nature and may not reflect the true outcome of these injuries. We determined statewide readmission rates following admission for AAST grade 3 and 4 renal injury at Harborview Medical Center (HMC) using the Comprehensive Hospital Abstract Reporting System (CHARS). METHODS: We evaluated all patients with radiologically diagnosed AAST grade 3 and 4 renal injuries admitted to HMC between 1998e2010. Grade 4 renal injuries were stratified by collecting system laceration (CSL) or segmental vascular injury (SVI). Data was abstracted from the CHARS database for readmissions to any WA state hospital within six months of renal injury. Variables of interest included age, sex, length of stay (index, readmission), time to readmission, urologic related procedures, and death. Diagnoses, imaging, and procedures were queried based on ICD-9 codes. RESULTS: Of 477 grade 3 and 159 grade 4 renal injuries initially treated at HMC, blunt trauma constituted 85% and 91% of these injuries, respectively. At index admission,111 patients required intervention: 75/ 477 (16%) grade 3 and 36/159 (23%) grade 4. Within six months of index hospitalization, 86/477 (18%) grade 3 and 38/159 (24%) grade 4 patients (23 CSL & 15 SVI) were readmitted to any WA state hospital (124 total). 80% of grade 3 injuries and 66% of grade 4 injuries returned to HMC compared to other area hospitals (p¼0.083). At time of readmission, 19/ 86 grade 3 (22%) and 16/38 grade 4 (42%) injuries had a urologic diagnosis as part of their readmission (37% CSL vs. 5% SVI p¼0.004). There were 14 urologic procedures performed during readmission with no delayed nephrectomies or urology-related deaths. CONCLUSIONS: Readmission rates following grade 3 and 4 renal trauma treatment ranged from 18e24% and the majority of patients returned to HMC. Urologic diagnoses at readmission were more common in grade 4 patients and specifically in the CSL sub-group, however, the need for adjunctive renal-related procedures was low overall (14 of 124 readmitted patients, 11%) suggesting acceptable initial management. Renal Trauma Readmission Interventions* Grade 3
Grade 4 CSL
Grade 4 SVI
Totals
Endoscopic
3
2
0
5
Open
0
2
0
2
Interventional Radiology
3
3
1
7
Totals
6
7
1
14
Type of Urologic Intervention
* Includes any hospital readmission within 6 months, ALL interventions performed at HMC
Source of Funding: None
MP18-14 UROLOGY CONSULTATION CAN IMPROVE SURVIVAL RATES IN RENAL TRAUMA PATIENTS Rodrigo Donalisio da Silva*, Diedra Gustafson, Leticia Nogueira, Wilson R. Molina, Fernando J. Kim, Denver, CO INTRODUCTION AND OBJECTIVES: Renal trauma is diagnosed in 8e10% of patients with abdominal trauma. The management of renal trauma patients is usually performed by trauma surgeons upon admission, and some patients require urological consultation during the treatment. The objective of this study was to evaluate if urological consultation can improve outcomes in renal trauma patients.