<< Emergency Management of Renal and Genitourinary Trauma: Best Practices Update (Trauma CME)


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Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study is included in bold type following the reference, where available. In addition, the most informative references cited in this paper, as determined by the authors, are noted by an asterisk (*) next to the number of the reference.

  1. Yeung LL, Brandes SB. Contemporary management of renal trauma: differences between urologists and trauma surgeons. J Trauma Acute Care Surg. 2012;72(1):68-75. (Survey study; 156 participants)
  2. Kuy S, Codner PA, Guralnick M, et al. Combined rectovesicular injuries from low velocity penetrating trauma in an adult. WMJ. 2013;112(1):32-34. (Case report and review article)
  3. * McGeady JB, Breyer BN. Current epidemiology of genitourinary trauma. Urol Clin North Am. 2013;40(3):323-334. (Review article)
  4. Lynch TH, Martínez-Piñeiro L, Plas E, et al. EAU guidelines on urological trauma. Eur Urol. 2005;47(1):1-15. (Review article)
  5. Cinman NM, McAninch JW, Porten SP, et al. Gunshot wounds to the lower urinary tract: a single-institution experience. J Trauma Acute Care Surg. 2013;74(3):725-730. (Prospective analysis; 50 patients)
  6. Nnamani NS, Janak JC, Hudak SJ, et al. Genitourinary injuries and extremity amputation in Operations Enduring and Iraqi Freedom: early findings from the Trauma Outcomes and Urogenital Health (TOUGH) project. J Trauma Acute Care Surg. 2016;81(5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium):S95-S99. (Retrospective; 1367 patients)
  7. Srinivasa RN, Akbar SA, Jafri SZ, et al. Genitourinary trauma: a pictorial essay. Emerg Radiol. 2009;16(1):21-33. (Review article)
  8. Baverstock R, Simons R, McLoughlin M. Severe blunt renal trauma: a 7-year retrospective review from a provincial trauma centre. Can J Urol. 2001;8(5):1372-1376. (Retrospective; 227 patients)
  9. Kansas BT, Eddy MJ, Mydlo JH, et al. Incidence and management of penetrating renal trauma in patients with multiorgan injury: extended experience at an inner city trauma center. J Urol. 2004;172(4 I):1355-1360. (Retrospective; 123 patients)
  10. Hsieh CH, Chen RJ, Fang JF, et al. Diagnosis and management of bladder injury by trauma surgeons. Am J Surg. 2002;184(2):143-147. (Retrospective; 51 patients)
  11. Lückhoff C, Mitra B, Cameron PA, et al. The diagnosis of acute urethral trauma. Injury. 2011;42(9):913-916. (Retrospective; 223 patients)
  12. Ziran BH, Chamberlin E, Shuler FD, et al. Delays and difficulties in the diagnosis of lower urologic injuries in the context of pelvic fractures. J Trauma. 2005;58(3):533-537. (Retrospective; 43 patients)
  13. Bjurlin MA, Fantus RJ, Mellett MM, et al. Genitourinary injuries in pelvic fracture morbidity and mortality using the national trauma data bank. J Trauma. 2009;67(5):1033-1039. (Retrospective; 1444 patients)
  14. Matlock KA, Tyroch AH, Kronfol ZN, et al. Blunt traumatic bladder rupture: a 10-year perspective. Am Surg. 2013;79(6):589-593. (Retrospective; 54 patients)
  15. Harpole BG, Wibbenmeyer LA, Erickson BA. Genital burns in the national burn repository: incidence, etiology, and impact on morbidity and mortality. Urology. 2014;83(2):298-302. (Retrospective; 1245 patients)
  16. Ter-Grigorian AA, Kasyan GR, Pushkar DY. Urogenital disorders after pelvic ring injuries. Cent European J Urol. 2013;66(3):352-356. (Review article)
  17. Vanni AJ, Hotaling J, Hamlat C, et al. Do inclusive trauma systems improve outcomes after renal trauma? J Trauma Acute Care Surg. 2012;72(2):385-389. (Retrospective; 14,590 patients)
  18. Dunfee BL, Lucey BC, Soto JA. Development of renal scars on CT after abdominal trauma: does grade of injury matter? AJR Am J Roentgenol. 2008;190(5):1174-1179. (Retrospective; 54 patients)
  19. Tasian GE, Aaronson DS, McAninch JW. Evaluation of renal function after major renal injury: correlation with the American Association for the Surgery of Trauma Injury Scale. J Urol. 2010;183(1):196-200. (Retrospective; 67 patients)
  20. Shoobridge JJ, Corcoran NM, Martin KA, et al. Contemporary management of renal trauma. Rev Urol. 2011;13(2):65-72. (Review article)
  21. Gomez RG, Mundy T, Dubey D, et al. SIU/ICUD consultation on urethral strictures: pelvic fracture urethral injuries. Urology. 2014;83(3 Suppl):S48-S58. (Consensus statement)
  22. Mundy AR, Andrich DE. Urethral trauma. Part II: types of injury and their management. BJU Int. 2011;108(5):630-650. (Review article)
  23. Brandes SB, McAninch JW. Renal trauma: a practical guide to evaluation and management. ScientificWorldJournal. 2004;4 Suppl 1:31-40. (Review article)
  24. Shewakramani S, Reed KC. Genitourinary trauma. Emerg Med Clin North Am. 2011;29(3):501-518. (Review article)
  25. Pontes JE, Pierce JM Jr. Anterior urethral injuries: four years of experience at the Detroit General Hospital. J Urol. 1978;120(5):563-564. (Retrospective; 19 patients)
  26. Black PC, Miller EA, Porter JR, et al. Urethral and bladder neck injury associated with pelvic fracture in 25 female patients. J Urol. 2006;175(6):2140-2144. (Retrospective; 25 patients)
  27. Bryk DJ, Zhao LC. Guideline of guidelines: a review of urological trauma guidelines. BJU Int. 2016;117(2):226-234. (Review article)
  28. Santucci RA, Wessells H, Bartsch G, et al. Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee. BJU Int. 2004;93(7):937-954. (Consensus statement)
  29. Mundy AR, Andrich DE. Urethral trauma. Part I: introduction, history, anatomy, pathology, assessment and emergency management. BJU Int. 2011;108(3):310-327. (Review article)
  30. * Sheth S, Casalino D, Remer E, et al. American College of Radiology Appropriateness Criteria®: renal trauma. [Consensus Guideline]. 2012. Available at: https://acsearch.acr.org/docs/69373/Narrative/. Accessed July 10, 2017. (Consensus guideline)
  31. Lockhart M, Remer E, Leyendecker J, et al. American College of Radiology Appropriateness Criteria®: suspected lower urinary tract trauma. [Consensus Guideline]. 2013. Available at: https://acsearch.acr.org/docs/69376/Narrative/. Accessed July 10, 2017. (Consensus guideline)
  32. * Morey AF, Brandes S, Dugi DD 3rd, et al. Urotrauma: AUA guideline. J Urol. 2014;192(2):327-335. (Practice guideline)
  33. * Holevar M, DiGiacomo C, Ebert J, et al. Practice management guidelines for the evaluation of genitourinary trauma. [Literature review and consensus guideline]. 2003. Available at: https://www.east.org/education/practice-management-guidelines/genitourinary-trauma-diagnostic-evaluation-of. Accessed July 10, 2017. (Consensus guideline)
  34. * Kitrey N, Djakovic N, European Association of Urology (EAU) Guidelines Group for Urological Trauma, et al. Guidelines on urological trauma: 2016 update. [European Association of Urology Guidelines]. 2016. Available at: http://uroweb.org/guideline/urological-trauma/. Accessed July 10, 2017. (Practice guideline)
  35. Wessells H, Suh D, Porter JR, et al. Renal injury and operative management in the United States: results of a population-based study. J Trauma. 2003;54(3):423-430. (Retrospective; 6231 patients)
  36. Bagga HS, Fisher PB, Tasian GE, et al. Sports-related genitourinary injuries presenting to United States emergency departments. Urology. 2015;85(1):239-244. (Retrospective review; 13,851 observations)
  37. Shnorhavorian M, Hidalgo-Tamola J, Koyle MA, et al. Unintentional and sexual abuse-related pediatric female genital trauma: a multiinstitutional study of free-standing pediatric hospitals in the United States. Urology. 2012;80(2):417-422. (Retrospective; 5664 patients)
  38. Cutinha P, Venugopal S, Salim F. Genitourinary trauma. Surgery (Oxford). 2013;31(7):362-370. (Review article)
  39. Siram SM, Gerald SZ, Greene WR, et al. Ureteral trauma: patterns and mechanisms of injury of an uncommon condition. Am J Surg. 2010;199(4):566-570. (Retrospective; 582 patients)
  40. Lehnert BE, Sadro C, Monroe E, et al. Lower male genitourinary trauma: a pictorial review. Emerg Radiol. 2014;21(1):67-74. (Review article)
  41. Figler BD, Hoffler CE, Reisman W, et al. Multi-disciplinary update on pelvic fracture associated bladder and urethral injuries. Injury. 2012;43(8):1242-1249. (Review article)
  42. Swanson DE, Polackwich AS, Helfand BT, et al. Penile fracture: outcomes of early surgical intervention. Urology. 2014;84(5):1117-1121. (Retrospective analysis; 30 cases)
  43. Moore EE, Shackford SR, Pachter HL, et al. Organ injury scaling: spleen, liver, and kidney. J Trauma. 1989;29(12):1664-1666. (Practice guideline)
  44. Moore EE, Cogbill TH, Jurkovich GJ, et al. Organ injury scaling. III: chest wall, abdominal vascular, ureter, bladder, and urethra. J Trauma. 1992;33(3):337-339. (Practice guideline)
  45. Tinkoff G, Esposito TJ, Reed J, et al. American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg. 2008;207(5):646-655. (Retrospective; 54,148 patients)
  46. Scott I, Porter K, Laird C, et al. The prehospital management of pelvic fractures: initial consensus statement. Emerg Med J. 2013;30(12):1070-1072. (Consensus statement)
  47. Bjurlin MA, Fantus RJ, Fantus RJ, et al. The impact of seat belts and airbags on high grade renal injuries and nephrectomy rate in motor vehicle collisions. J Urol. 2014;192(4):1131-1136. (Retrospective; 3846 patients)
  48. Fanning DM, Forde JC, Mohan P. A simple football injury leading to a grade 4 renal trauma. BMJ Case Rep. 2012 Mar 8;2012. (Case report)
  49. Schmidlin FR, Iselin CE, Naimi A, et al. The higher injury risk of abnormal kidneys in blunt renal trauma. Scand J Urol Nephrol. 1998;32(6):388-392. (Retrospective; 120 patients)
  50. Morey AF, Iverson AJ, Swan A, et al. Bladder rupture after blunt trauma: guidelines for diagnostic imaging. J Trauma. 2001;51(4):683-686. (Practice guideline)
  51. Gomez RG, Ceballos L, Coburn M, et al. Consensus statement on bladder injuries. BJU Int. 2004;94(1):27-32. (Consensus statement)
  52. Yamacake KG, Lucon M, Lucon AM, et al. Renal artery pseudoaneurysm after blunt renal trauma: report on three cases and review of the literature. Sao Paulo Med J. 2013;131(5):356-362. (Case report)
  53. Goldman HB, Idom CB, Dmochowski RR. Traumatic injuries of the female external genitalia and their association with urological injuries. J Urol. 1998;159(3):956-959. (Retrospective; 20 patients)
  54. Pereira BM, de Campos CC, Calderan TR, et al. Bladder injuries after external trauma: 20 years experience report in a population-based cross-sectional view. World J Urol. 2013;31(4):913-917. (Retrospective; 111 patients)
  55. Pichler R, Fritsch H, Skradski V, et al. Diagnosis and management of pediatric urethral injuries. Urol Int. 2012;89(2):136-142. (Review article)
  56. Docimo S Jr , Diggs L, Crankshaw L, et al. No evidence supporting the routine use of digital rectal examinations in trauma patients. Indian J Surg. 2015;77(4):265-269. (Retrospective; 111 patients)
  57. Ball CG, Jafri SM, Kirkpatrick AW, et al. Traumatic urethral injuries: Does the digital rectal examination really help us? Injury. 2009;40(9):984-986. (Retrospective; 41 patients)
  58. Bocchi F, Benecchi L, Russo F, et al. Early exploratory intervention in scrotal trauma. Urologia. 2013;80(2):140-144. (Retrospective; 43 patients)
  59. Hartman RJ Jr. Penile fracture. N Engl J Med. 2015;372(11): 1055. (Case report)
  60. Iqbal CW, Jrebi NY, Zielinski MD, et al. Patterns of accidental genital trauma in young girls and indications for operative management. J Pediatr Surg. 2010;45(5):930-933. (Retrospective; 167 patients)
  61. Santucci RA, McAninch JW, Safir M, et al. Validation of the American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma. 2001;50(2):195-200. (Retrospective; 2467 patients)
  62. Daum GS, Krolikowski FJ, Reuter KL, et al. Dipstick evaluation of hematuria in abdominal trauma. Am J Clin Pathol. 1988;89(4):538-542. (Prospective; 178 patients)
  63. Mee SL, McAninch JW, Robinson AL, et al. Radiographic assessment of renal trauma: a 10-year prospective study of patient selection. J Urol. 1989;141(5):1095-1098. (Prospective; 1146 patients)
  64. Hardeman SW, Husmann DA, Chinn HK, et al. Blunt urinary tract trauma: identifying those patients who require radiological diagnostic studies. J Urol. 1987;138(1):99-101. (Prospective: 506 patients)
  65. Herschorn S, Radomski SB, Shoskes DA, et al. Evaluation and treatment of blunt renal trauma. J Urol. 1991;146(2):274-276. (Retrospective; 126 patients)
  66. Nicolaisen GS, McAninch JW, Marshall GA, et al. Renal trauma: re-evaluation of the indications for radiographic assessment. J Urol. 1985;133(2):183-187. (Prospective; 359 patients)
  67. Brandes SB, McAninch JW. Urban free falls and patterns of renal injury: a 20-year experience with 396 cases. J Trauma. 1999;47(4):643-649. (Retrospective; 423 patients)
  68. Knudson MM, Harrison PB, Hoyt DB, et al. Outcome after major renovascular injuries: a Western Trauma Association multicenter report. J Trauma. 2000;49(6):1116-1122. (Retrospective; 89 patients)
  69. Boone TB, Gilling PJ, Husmann DA. Ureteropelvic junction disruption following blunt abdominal trauma. J Urol. 1993;150(1):33-36. (Retrospective; 8 patients)
  70. Elliott SP, McAninch JW. Ureteral injuries from external violence: the 25-year experience at San Francisco General Hospital. J Urol. 2003;170(4 I):1213-1216. (Review article)
  71. Voelzke BB, McAninch JW. Renal gunshot wounds: clinical management and outcome. J Trauma. 2009;66(3):593-601. (Prospective; 201 patients)
  72. McAninch JW. Urotrauma guidelines. J Urol. 2014;192(2):336. (Commentary)
  73. Brown SL, Hoffman DM, Spirnak JP. Limitations of routine spiral computerized tomography in the evaluation of blunt renal trauma. J Urol. 1998;160(6 Pt 1):1979-1981. (Retrospective; 35 patients)
  74. Mulligan JM, Cagiannos I, Collins JP, et al. Ureteropelvic junction disruption secondary to blunt trauma: excretory phase imaging (delayed films) should help prevent a missed diagnosis. J Urol. 1998;159(1):67-70. (Retrospective; 5 patients)
  75. Hardee MJ, Lowrance W, Brant WO, et al. High grade renal injuries: application of Parkland Hospital predictors of intervention for renal hemorrhage. J Urol. 2013;189(5):1771-1776. (Retrospective; 147 patients)
  76. Ortega SJ, Netto FS, Hamilton P, et al. CT scanning for diagnosing blunt ureteral and ureteropelvic junction injuries. BMC Urology. 2008;8:3. (Retrospective; 8 patients)
  77. Mee SL, McAninch JW, Federle MP. Computerized tomography in bladder rupture: diagnostic limitations. J Urol. 1987;137(2):207-209. (Prospective; 4 patients)
  78. Avery LL, Scheinfeld MH. Imaging of male pelvic trauma. Radiol Clin North Am. 2012;50(6):1201-1217. (Review article)
  79. Ramchandani P, Buckler PM. Imaging of genitourinary trauma. AJR Am J Roentgenol. 2009;192(6):1514-1523. (Review article)
  80. Harper K, Shah KH. Renal trauma after blunt abdominal injury. J Emerg Med. 2013;45(3):400-404. (Case report)
  81. Hong LW, Chun YX, Hong HW, et al. Emergency transcatheter arterial embolization for acute renal hemorrhage. Medicine. 2015;94(42):1-7. (Retrospective; 83 patients)
  82. Lin WC, Lin CH, Chen JH, et al. Computed tomographic imaging in determining the need of embolization for high-grade blunt renal injury. J Trauma Acute Care Surg. 2013;74(1):230-235. (Retrospective; 137 patients)
  83. Bent C, Iyngkaran T, Power N, et al. Urological injuries following trauma. Clin Radiol. 2008;63(12):1361-1371. (Review article)
  84. Ingram MD, Watson SG, Skippage PL, et al. Urethral injuries after pelvic trauma: evaluation with urethrography 1. Radiographics. 2008;28(6):1631-1643. (Review article)
  85. Wu TS, Pearson TC, Meiners S, et al. Bedside ultrasound diagnosis of a traumatic bladder rupture. J Emerg Med. 2011;41(5):520-523. (Case report)
  86. Nicola R, Carson N, Dogra VS. Imaging of traumatic injuries to the scrotum and penis. AJR Am J Roentgenol. 2014;202(6):W512-W520. (Review article)
  87. Shlamovitz GZ, McCullough L. Blind urethral catheterization in trauma patients suffering from lower urinary tract injuries. J Trauma. 2007;62(2):330-335. (Retrospective; 46 patients)
  88. Parry NG, Rozycki GS, Feliciano DV, et al. Traumatic rupture of the urinary bladder: is the suprapubic tube necessary? J Trauma. 2003;54(3):431-436. (Retrospective; 51 patients)
  89. Martinez-Pineiro L, Djakovic N, Plas E, et al. EAU guidelines on urethral trauma. Eur Urol. 2010;57(5):791-803. (Consensus statement)
  90. Haidari M, Azargoon A, Mahmoudvand H, et al. Complications of primary realignment of posterior urethral disruption after pelvic trauma. Trauma Mon. 2014;19(2):e13523. (Retrospective; 24 patients)
  91. Smith TG 3rd, Coburn M. Damage control maneuvers for urologic trauma. Urol Clin North Am. 2013;40(3):343-350. (Review article)
  92. Dugi DD 3rd, Morey AF, Gupta A, et al. American Association for the Surgery of Trauma grade 4 renal injury substratification into grades 4a (low risk) and 4b (high risk). J Urol. 2010;183(2):592-597. (Retrospective; 102 patients)
  93. * McClung CD, Hotaling JM, Wang J, et al. Contemporary trends in the immediate surgical management of renal trauma using a national database. J Trauma Acute Care Surg. 2013;75(4):602-606. (Retrospective; 9002 patients)
  94. Deibert CM, Spencer BA. The association between operative repair of bladder injury and improved survival: results from the National Trauma Data Bank. J Urol. 2011;186(1):151-155. (Retrospective; 8565 patients)
  95. Barrett K, Braga LH, Farrokhyar F, et al. Primary realignment vs suprapubic cystostomy for the management of pelvic fracture-associated urethral injuries: a systematic review and meta-analysis. Urology. 2014;83(4):924-929. (Meta-analysis; 161 articles)
  96. Swanson DE, Polackwich AS, Helfand BT, et al. Penile fracture: outcomes of early surgical intervention. Urology. 2014;84(5):1117-1121. (Retrospective; 30 patients)
  97. Cubillos J, Reda EF, Gitlin J, et al. A conservative approach to testicular rupture in adolescent boys. J Urol. 2010;184(4 Suppl):1733-1738. (Prospective; 7 patients)
  98. Gomez RG, Storme O, Catalan G, et al. Traumatic testicular dislocation. Int Urol Nephrol. 2014;46(10):1883-1887. (Retrospective; 7 patients)
  99. Mani N, Kim L. The role of interventional radiology in urologic tract trauma. Semin Intervent Radiol. 2011;28(4):415-423. (Review article)
  100. McCombie SP, Thyer I, Corcoran NM, et al. The conservative management of renal trauma: a literature review and practical clinical guideline from Australia and New Zealand. BJU Int. 2014;114 Suppl 1:13-21. (Practice guideline)
  101. Chang AJ, Brandes SB. Advances in diagnosis and management of genital injuries. Urol Clin North Am. 2013;40(3):427-438. (Review article)
  102. Al-Qudah HS, Santucci RA. Complications of renal trauma. Urol Clin North Am. 2006;33(1):41-53, vi. (Practice guideline)
  103. Tank ES, Eraklis AJ, Gross RE. Blunt abdominal trauma in infancy and childhood. J Trauma. 1968;8(3):439-448. (Review article)
  104. Fallat ME, Casale AJ. Practice patterns of pediatric surgeons caring for stable patients with traumatic solid organ injury. J Trauma. 1997;43(5):820-824. (Retrospective; 87 respondents)
  105. Bagga HS, Tasian GE, Fisher PB, et al. Product related adult genitourinary injuries treated at emergency departments in the United States from 2002 to 2010. J Urol. 2013;189(4):1362-1368. (Retrospective; 3545 patients)
  106. Quinlan D, Gearhart J. Blunt renal trauma in childhood. Features indicating severe injury. Br J Urol. 1990;66(5):526-531. (Retrospective; 50 patients)
  107. LeeVan E, Zmora O, Cazzulino F, et al. Management of pediatric blunt renal trauma: a systematic review. J Trauma Acute Care Surg. 2016;80(3):519-528. (Meta-analysis; 32 articles)
  108. Bjurlin MA, Goble SM, Fantus RJ, et al. Outcomes in geriatric genitourinary trauma. J Am Coll Surg. 2011;213(3):415-421. (Retrospective; 9470 patients, 852 elderly)
  109. Ku JH, Jeon YS, Kim ME, et al. Is there a role for magnetic resonance imaging in renal trauma? Int J Urol. 2001;8(6):261-267. (Prospective; 12 patients)
  110. Cagini L, Gravante S, Malaspina CM, et al. Contrast enhanced ultrasound (CEUS) in blunt abdominal trauma. Crit Ultrasound. 2013;5(1):1. (Review article)
Publication Information

Whitney K. Bryant, MD, MPH, MEd; Sanjay Shewakramani, MD, FACEP

Publication Date

August 1, 2017

CME Expiration Date

August 31, 2020

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CME Information

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