Medico

European Association of Urology

GUIDELINES ON UROLOGICAL TRAUMA

D. Lynch, L. Martinez-Piñeiro, E. Plas, E. Serafetinidis, L. Turkeri, M. Hohenfellner
FEBRUARY 2003

TABLE OF CONTENTS
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RENAL TRAUMA 1.1 Background 1.2 Mode of injury 1.2.1Injury classification 1.3 Diagnosis: initial emergency assessment 1.3.1 History and physical examination 1.3.1.1 Guidelines on history and physical examination 1.3.2 Laboratory evaluation 1.3.2.1 Guidelines on laboratory evaluation 1.3.3 Imaging: criteria for radiographic assessment 1.3.3.1 Ultrasonography 1.3.3.2 Intravenous pyelography (IVP) 1.3.3.3 Computed tomography (CT) 1.3.3.4 Magneticresonance imaging (MRI) 1.3.3.5 Angiography 1.3.3.6 Guidelines on radiographic assessment 1.4 Treatment 1.4.1 Indications for renal exploration 1.4.2 Operative findings and reconstruction 1.4.3 Non-operative management of renal injuries 1.4.4 Guidelines on management of renal trauma 1.4.5 Post-operative care and follow-up 1.4.5.1 Guidelines on post-operative management and follow-up 1.4.6Complications 1.4.6.1 Guidelines on management of complications 1.4.7 Paediatric renal trauma 1.4.7.1 Guidelines on management of paediatric trauma 1.4.8 Renal trauma in the polytrauma patient 1.4.8.1 Guidelines on management of polytrauma with associated renal injury 1.5 Suggestions for future research studies 1.6 Algorithms 1.7 References URETERAL TRAUMA 2.1 Introduction 2.2 Aetiology 2.3 Diagnosis 2.3.1Clinical diagnosis 2.3.2 Radiological diagnosis 2.4 Classification 2.5 Management 2.5.1 Partial injuries 2.5.2 Complete injuries 2.5.3 Sterile surgery 2.5.3.1 Uretero-ureterostomy 2.5.3.2 Ureterocalycostomy 2.5.3.3 Transuretero-ureterostomy 2.5.3.4 Ureteroneocystostomy with Boari flap 2.5.3.5 Ureterocystostomy and psoas hitch 2.5.3.6 Ileal interposition graft 2.5.3.7 Autotransplantation 2.5.3.8Nephrectomy 2.6 References

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BLADDER TRAUMA 3.1 Background 3.2 Classification 3.3 Risk factors 3.4 Diagnosis 3.4.1 Macroscopic (gross) haematuria 3.4.2 Microscopic haematuria 3.4.3 Cystography 3.4.4 Excretory urography (intravenous pyelogram) 3.4.5 Ultrasound 3.4.6 Computed tomography (CT) 3.4.7 Angiography 3.4.8 Magnetic resonance imaging (MRI) 3.5 Treatment 3.5.1Blunt trauma: extraperitoneal rupture 3.5.2 Blunt trauma: intraperitoneal rupture 3.5.3 Penetrating injuries 3.6 Recommendations 3.6.1 General 3.6.2 Diagnosis 3.6.3 Treatment 3.7 References URETHRAL TRAUMA 4.1 Anatomical and aetiological considerations 4.1.1 Posterior urethral injuries 4.1.1.1 Stable pelvic fracture 4.1.1.2 Unstable pelvic fractures 4.1.1.3 Urethral injuries in children 4.1.1.4Urethral injuries in women 4.1.1.5 Penetrating injuries to the perineum 4.1.2 Anterior urethral injuries 4.1.2.1 Blunt trauma 4.1.2.2 Intercourse-related trauma 4.1.2.3 Penetrating trauma 4.1.2.4 Constriction band-related trauma 4.1.2.5 Iatrogenic trauma 4.2. Diagnosis: initial emergency assessment 4.2.1 Clinical assessment 4.2.1.1 Blood at the meatus 4.2.1.2 Blood at the vaginal introitus `4.2.1.3 Haematuria 4.2.1.4 Pain on urination or inability to void 4.2.1.5 Haematoma or swelling 4.2.1.6 High-riding prostate 4.2.2 Radiographic Examination 4.2.3 Endoscopic examination

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4.4 4.5 4.6 5.

Management 4.3.1Anterior urethral injuries 4.3.1.1 Blunt injuries 4.3.1.2 Open injuries 4.3.1.2.1 Male urethral injuries 4.3.1.2.2 Female urethral injuries 4.3.2 Posterior urethral injuries 4.3.2.1 Partial urethral rupture 4.3.2.2 Complete urethral rupture 4.3.2.3 Primary realignment 4.3.2.4 Immediate open urethroplasty 4.3.2.5 Delayed primary urethroplasty 4.3.2.6 Delayed urethroplasty Distraction defects longer...