Wilson Danielle J, Melin Isaac, Shah Nayan, O'Connor R Corey, Carver Thomas
Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Trauma Surg Acute Care Open. 2025 Feb 19;10(1):e001693. doi: 10.1136/tsaco-2024-001693. eCollection 2025.
Traumatic bladder injuries, although rare, may result in significant patient morbidity. Operative management is recommended for intraperitoneal (IP), mixed, and select extraperitoneal (EP) injuries. Current guidelines lack recommendations on catheter duration following operative repair and suggest follow-up cystography may be unnecessary for simple, repaired injuries. This has led to practice variation in postoperative management at our institution. We hypothesized that the trauma surgery service would have a shorter catheter duration and obtain fewer follow-up cystograms compared with the urology service, without increased complications.
A retrospective review was conducted at a single level 1 trauma center between January 2010 and December 2022. All patients with traumatic bladder injuries during this period were included from the trauma registry. Those who were <18 years of age, lacked a full-thickness injury, died within 7 days of presentation, had a concomitant urethral injury or complex injury, did not undergo surgical repair, were lost to follow-up, underwent surgical management elsewhere, or had an iatrogenic injury were excluded. Data on patient demographics, management, and complications were recorded. Injuries were classified as complex when involving the trigone, ureters, or bladder neck, or were described as complex in the operative report.
Of the 178 patients identified, 86 met the inclusion criteria. IP injuries were most common (43%), followed by EP (31%), and mixed (26%). Patient outcomes following the repair of simple injuries were similar regardless of the team performing the repair, although differences in catheter duration (11 days vs 17 days, p=0.006) and use of postoperative cystography (77% vs 100%, p<0.001) were observed (trauma vs urology, respectively).
Variations in postoperative management regarding catheter drainage and follow-up imaging for simple bladder repairs resulted in similar leak and complication rates. Our findings present an opportunity to reduce the duration of postoperative catheter drainage and cystography use in simple repairs.
IV.
创伤性膀胱损伤虽罕见，但可能导致患者出现严重并发症。对于腹膜内（IP）、混合型以及部分腹膜外（EP）损伤，建议进行手术治疗。目前的指南缺乏关于手术修复后导尿管留置时间的建议，并指出对于简单的修复损伤，后续膀胱造影可能不必要。这导致了我们机构术后管理的实践差异。我们推测，与泌尿外科相比，创伤外科服务的导尿管留置时间更短，后续膀胱造影更少，且并发症不会增加。
在2010年1月至2022年12月期间，于一家一级创伤中心进行回顾性研究。在此期间，创伤登记处纳入了所有创伤性膀胱损伤患者。排除年龄<18岁、无全层损伤、就诊7天内死亡、伴有尿道损伤或复杂损伤、未接受手术修复、失访、在其他地方接受手术治疗或医源性损伤的患者。记录患者人口统计学、管理和并发症的数据。当损伤累及三角区、输尿管或膀胱颈，或手术报告中描述为复杂损伤时，将其分类为复杂损伤。
在确定的178例患者中，86例符合纳入标准。IP损伤最为常见（43%），其次是EP损伤（31%）和混合型损伤（26%）。简单损伤修复后的患者结局相似，无论进行修复的团队如何，尽管观察到导尿管留置时间存在差异（11天对17天，p = 0.006）以及术后膀胱造影的使用情况存在差异（分别为77%对100%，p<0.001）（分别为创伤外科对泌尿外科）。
对于简单膀胱修复，术后导尿管引流和后续影像学检查管理的差异导致渗漏和并发症发生率相似。我们的研究结果为减少简单修复中术后导尿管引流时间和膀胱造影的使用提供了机会。
四级
