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Richard A. Santucci - One of the best experts on this subject based on the ideXlab platform.
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An update on uroTrauma.
Current opinion in urology, 2015Co-Authors: Daniel M. Stein, Richard A. SantucciAbstract:PURPOSE OF REVIEW The subject of Genitourinary Trauma was recently reviewed as an American Urologic Association guideline as well as recently updated as a European Association of Urology guideline. These guidelines, while complete and authoritative, deserve review, amplification and clarification. Also, notably absent from the guidelines is a section on the management of renovascular injuries, which will be reviewed here. RECENT FINDINGS In the 2014, the American Urologic Association and updated European Association of Urology guidelines were published with highlighted features or changes described here. SUMMARY We report the updated features of the guidelines as well as sections of update from our own experiences in which the guidelines remain vague or are absent.
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Pediatric Genitourinary Trauma: The new, the uncommon, and the controversial
2011Co-Authors: Carrie Fitzgerald, Richard A. SantucciAbstract:For practicing urologists, triaging Genitourinary care for children can be more difficult than it is for adults, but it doesn't have to be. Clear and concise GU diagnosis and treatment should help maximize overall care.
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Urologic Trauma guidelines: a 21^st century update
Nature Reviews Urology, 2010Co-Authors: Richard A. Santucci, Jamie M. BartleyAbstract:In 2009, the European Association of Urology published guidelines for the evaluation and management of Genitourinary Trauma. In this Review, the authors discuss these guideline and provide an overview for clinicians involved in the treatment of patients with renal, ureteral, bladder, urethral and genital Trauma. The Genitourinary system is involved in 10% of all Trauma cases The kidney is the most commonly injured abdominal organ in cases of Trauma, but most injuries are managed nonoperatively Ureteral injuries are often iatrogenic; diagnosis requires high clinical suspicion and site-specific repair Bladder injuries are associated with pelvic fractures, which may be life threatening; extraperitoneal injuries can be managed with catheter drainage, while intraperitoneal injuries require open repair Catheter realignment can be successful in patients with urethral injuries; posterior distraction defects require delayed primary urethroplasty, while open anterior injuries require immediate exploration and primary repair External genital injuries can be diagnosed by history and physical examination; emergent exploration and repair is indicated in cases with marked hematoma, penile fracture or testicular disruption Trauma is the leading cause of death between the ages of 1 and 44 years in the USA. While stabilization of life-threatening injuries is the primary goal in the evaluation of all Trauma patients, subsequent diagnosis and treatment of secondary injuries are requirements for good Trauma care. The Genitourinary system is involved in 10% of Trauma cases, and these injuries can be associated with considerable morbidity and mortality. Accordingly, physicians involved in the initial evaluation and subsequent management of Trauma patients should be aware of the diagnosis and treatment of injuries that can occur in the Genitourinary system. In 2009, the European Association of Urology provided specific recommendations for the evaluation, diagnosis and management of Genitourinary Trauma. Here, we review and discuss these recommendations in order to provide a concise summary for clinicians involved in the evaluation and management of Trauma patients and their associated Genitourinary injuries.
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Urologic Trauma guidelines: a 21st century update.
Nature reviews. Urology, 2010Co-Authors: Richard A. Santucci, Jamie M. BartleyAbstract:In 2009, the European Association of Urology published guidelines for the evaluation and management of Genitourinary Trauma. In this Review, the authors discuss these guideline and provide an overview for clinicians involved in the treatment of patients with renal, ureteral, bladder, urethral and genital Trauma.
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EAU guidelines on urological Trauma.
European urology, 2005Co-Authors: Thomas H. Lynch, Luis Martínez-piñeiro, Eugen Plas, Efraim Serafetinides, Levent Türkeri, Richard A. Santucci, Markus HohenfellnerAbstract:Abstract Purpose: To determine the optimal evaluation and management of Genitourinary (renal, ureteral, bladder, urethral and genital) injuries by review of the world's literature on the subject. Methods: A consensus committee convened by the Health Care Office of the European Association of Urology (EAU) to summarize the literature concerning the diagnosis and treatment of Genitourinary Trauma. Results: Findings of 350 citations are reviewed. Conclusions: The Genitourinary Trauma literature still relies heavily on expert opinion and single-institution retrospective series. Future prospective trials of the most significant issues, when possible, might improve the quality of evidence that dictates practitioner behavior. This paper represents a 5000 word summary of the full 35,000 word report. Full text of this review is available online at http://www.europeanurology.com.
Jack W Mcaninch - One of the best experts on this subject based on the ideXlab platform.
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consensus on Genitourinary Trauma external genitalia
BJUI, 2004Co-Authors: Allen F Morey, Michael Metro, Kenneth J Carney, Kennon S Miller, Jack W McaninchAbstract:The SIU Consensus Group on Genitourinary Trauma continue their report with the statement on Trauma to the external genitalia. This will be the last such report, completing the series. These have been extremely important, and an excellent reference point for people interested in this subject.
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Consensus statement on urethral Trauma
BJU international, 2004Co-Authors: Christopher R. Chapple, Guido Barbagli, Gerald H. Jordan, Anthony R. Mundy, N. Rodrigues‐netto, V. Pansadoro, Jack W McaninchAbstract:In this continuation of the section on Genitourinary Trauma, the authors describe the consensus on urethral injury. This is an in-depth statement, describing all aspects of the condition, from anatomy to general recommendations.
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Consensus statement on bladder injuries
BJU international, 2004Co-Authors: Reynaldo Gomez, Lily Ceballos, Michael Coburn, Joseph N. Corriere, Christopher M. Dixon, Bernard Lobel, Jack W McaninchAbstract:The consensus on Genitourinary Trauma continues this month with the statement on bladder Trauma from several internationally recognised experts on the subject. They describe blunt, penetrating and iatrogenic injuries and their management, considering paediatric injuries separately. They underline the importance of prompt diagnosis and treatment, stressing that problems raised when the diagnosis is delayed.
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Diagnosis and management of ureteric injury: an evidence‐based analysis
BJU international, 2004Co-Authors: Steven B. Brandes, Michael Coburn, Noel A. Armenakas, Jack W McaninchAbstract:The Consensus on Genitourinary Trauma continues this month with an evidence-based analysis, by a team of experts under the chairmanship of Dr Jack McAninch, of current reports on the diagnosis and management of ureteric Trauma. This is quite a unique document, and of interest to all urologists; not only as a consensus on how this condition should be managed, but also as a model of how to review current publications.
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Diagnosis and management of Trauma to the kidney.
Current opinion in urology, 1999Co-Authors: Michael H. Safir, Jack W McaninchAbstract:Because Trauma is an unplanned event, guidelines for managing patients sustaining upper urinary tract injury must already exist in the surgeon's mind before laying eyes on the injured patient. In order to simplify and standardize the evaluation and treatment of such patients, urologists have applied a system of staging paradigms and treatment algorithms, analogous to systems successfully used in the less chaotic arena of, for example, urologic oncology. Advancements in imaging modalities, improvements and renovations of surgical technique, and critical review of outcomes data have impacted on the management of Genitourinary Trauma and will be likely to influence the way we treat Trauma patients in the future.
Sorena Keihani - One of the best experts on this subject based on the ideXlab platform.
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Clinical and Radiographic Factors Associated With Failed Renal Angioembolization: Results From the Multi-institutional Genitourinary Trauma Study (Mi-GUTS).
Urology, 2020Co-Authors: Manuel Armas-phan, Judith C. Hagedorn, Sorena Keihani, Douglas Rogers, Nnenaya Agochukwu-mmonu, Andrew J. Cohen, Sherry S. Wang, Joel A. Gross, Ryan P. Joyce, Bryan B. VoelzkeAbstract:Objective To find clinical or radiographic factors that are associated with angioembolization failure after high-grade renal Trauma. Material and Methods Patients were selected from the Multi-institutional Genito-Urinary Trauma Study. Included were patients who initially received renal angioembolization after high-grade renal Trauma (AAST grades III-V). This cohort was dichotomized into successful or failed angioembolization. Angioembolization was considered a failure if angioembolization was followed by repeat angiography and/or an exploratory laparotomy. Results A total of 67 patients underwent management initially with angioembolization, with failure in 18 (27%) patients. Those with failed angioembolization had a larger proportion ofgrade IV (72% vs 53%) and grade V (22% vs 12%) renal injuries. A total of 53 patients underwent renal angioembolization and had initial radiographic data for review, with failure in 13 cases. The failed renal angioembolization group had larger perirenal hematoma sizes on the initial Trauma scan. Conclusion Angioembolization after high-grade renal Trauma failed in 27% of patients. Failed angioembolization was associated with higher injury grade and a larger perirenal hematoma. Likely these characteristics are associated with high-grade renal Trauma that may be less amenable to successful treatment after a single renal angioembolization.
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The associations between initial radiographic findings and interventions for renal hemorrhage after high-grade renal Trauma: Results from the Multi-Institutional Genitourinary Trauma Study.
The journal of trauma and acute care surgery, 2019Co-Authors: Sorena Keihani, Bryn Putbrese, Douglas Rogers, Chong Zhang, Raminder Nirula, Xian Luo-owen, Kaushik Mukherjee, Bradley J. Morris, Sarah Majercik, Joshua PiotrowskiAbstract:Background Indications for intervention after high-grade renal Trauma (HGRT) remain poorly defined. Certain radiographic findings can be used to guide the management of HGRT. We aimed to assess the associations between initial radiographic findings and interventions for hemorrhage after HGRT and to determine hematoma and laceration sizes predicting interventions. Methods The Genitourinary Trauma Study is a multicenter study including HGRT patients from 14 Level I Trauma centers from 2014 to 2017. Admission computed tomography scans were categorized based on multiple variables, including vascular contrast extravasation (VCE), hematoma rim distance (HRD), and size of the deepest laceration. Renal bleeding interventions included angioembolization, surgical packing, renorrhaphy, partial nephrectomy, and nephrectomy. Mixed-effect Poisson regression was used to assess the associations. Receiver operating characteristic analysis was used to define optimal cutoffs for HRD and laceration size. Results In the 326 patients, injury mechanism was blunt in 81%. Forty-seven (14%) patients underwent 51 bleeding interventions, including 19 renal angioembolizations, 16 nephrectomies, and 16 other procedures. In univariable analysis, presence of VCE was associated with a 5.9-fold increase in risk of interventions, and each centimeter increase in HRD was associated with 30% increase in risk of bleeding interventions. An HRD of 3.5 cm or greater and renal laceration depth of 2.5 cm or greater were most predictive of interventions. In multivariable models, VCE and HRD were significantly associated with bleeding interventions. Conclusion Our findings support the importance of certain radiographic findings in prediction of bleeding interventions after HGRT. These factors can be used as adjuncts to renal injury grading to guide clinical decision making. Level of evidence Prognostic and Epidemiological Study, Level III and Therapeutic/Care Management, Level IV.
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Contemporary management of high-grade renal Trauma: Results from the American Association for the Surgery of Trauma Genitourinary Trauma study.
The journal of trauma and acute care surgery, 2018Co-Authors: Sorena Keihani, Raminder Nirula, Kaushik Mukherjee, Joshua Piotrowski, Angela P. Presson, James M. Hotaling, Christopher M. Dodgion, Cullen M. Black, Bradley J. MorrisAbstract:BACKGROUNDThe rarity of renal Trauma limits its study and the strength of evidence-based guidelines. Although management of renal injuries has shifted toward a nonoperative approach, nephrectomy remains the most common intervention for high-grade renal Trauma (HGRT). We aimed to describe the contemp
Jamie M. Bartley - One of the best experts on this subject based on the ideXlab platform.
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Urologic Trauma guidelines: a 21^st century update
Nature Reviews Urology, 2010Co-Authors: Richard A. Santucci, Jamie M. BartleyAbstract:In 2009, the European Association of Urology published guidelines for the evaluation and management of Genitourinary Trauma. In this Review, the authors discuss these guideline and provide an overview for clinicians involved in the treatment of patients with renal, ureteral, bladder, urethral and genital Trauma. The Genitourinary system is involved in 10% of all Trauma cases The kidney is the most commonly injured abdominal organ in cases of Trauma, but most injuries are managed nonoperatively Ureteral injuries are often iatrogenic; diagnosis requires high clinical suspicion and site-specific repair Bladder injuries are associated with pelvic fractures, which may be life threatening; extraperitoneal injuries can be managed with catheter drainage, while intraperitoneal injuries require open repair Catheter realignment can be successful in patients with urethral injuries; posterior distraction defects require delayed primary urethroplasty, while open anterior injuries require immediate exploration and primary repair External genital injuries can be diagnosed by history and physical examination; emergent exploration and repair is indicated in cases with marked hematoma, penile fracture or testicular disruption Trauma is the leading cause of death between the ages of 1 and 44 years in the USA. While stabilization of life-threatening injuries is the primary goal in the evaluation of all Trauma patients, subsequent diagnosis and treatment of secondary injuries are requirements for good Trauma care. The Genitourinary system is involved in 10% of Trauma cases, and these injuries can be associated with considerable morbidity and mortality. Accordingly, physicians involved in the initial evaluation and subsequent management of Trauma patients should be aware of the diagnosis and treatment of injuries that can occur in the Genitourinary system. In 2009, the European Association of Urology provided specific recommendations for the evaluation, diagnosis and management of Genitourinary Trauma. Here, we review and discuss these recommendations in order to provide a concise summary for clinicians involved in the evaluation and management of Trauma patients and their associated Genitourinary injuries.
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Urologic Trauma guidelines: a 21st century update.
Nature reviews. Urology, 2010Co-Authors: Richard A. Santucci, Jamie M. BartleyAbstract:In 2009, the European Association of Urology published guidelines for the evaluation and management of Genitourinary Trauma. In this Review, the authors discuss these guideline and provide an overview for clinicians involved in the treatment of patients with renal, ureteral, bladder, urethral and genital Trauma.
Bradley J. Morris - One of the best experts on this subject based on the ideXlab platform.
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The associations between initial radiographic findings and interventions for renal hemorrhage after high-grade renal Trauma: Results from the Multi-Institutional Genitourinary Trauma Study.
The journal of trauma and acute care surgery, 2019Co-Authors: Sorena Keihani, Bryn Putbrese, Douglas Rogers, Chong Zhang, Raminder Nirula, Xian Luo-owen, Kaushik Mukherjee, Bradley J. Morris, Sarah Majercik, Joshua PiotrowskiAbstract:Background Indications for intervention after high-grade renal Trauma (HGRT) remain poorly defined. Certain radiographic findings can be used to guide the management of HGRT. We aimed to assess the associations between initial radiographic findings and interventions for hemorrhage after HGRT and to determine hematoma and laceration sizes predicting interventions. Methods The Genitourinary Trauma Study is a multicenter study including HGRT patients from 14 Level I Trauma centers from 2014 to 2017. Admission computed tomography scans were categorized based on multiple variables, including vascular contrast extravasation (VCE), hematoma rim distance (HRD), and size of the deepest laceration. Renal bleeding interventions included angioembolization, surgical packing, renorrhaphy, partial nephrectomy, and nephrectomy. Mixed-effect Poisson regression was used to assess the associations. Receiver operating characteristic analysis was used to define optimal cutoffs for HRD and laceration size. Results In the 326 patients, injury mechanism was blunt in 81%. Forty-seven (14%) patients underwent 51 bleeding interventions, including 19 renal angioembolizations, 16 nephrectomies, and 16 other procedures. In univariable analysis, presence of VCE was associated with a 5.9-fold increase in risk of interventions, and each centimeter increase in HRD was associated with 30% increase in risk of bleeding interventions. An HRD of 3.5 cm or greater and renal laceration depth of 2.5 cm or greater were most predictive of interventions. In multivariable models, VCE and HRD were significantly associated with bleeding interventions. Conclusion Our findings support the importance of certain radiographic findings in prediction of bleeding interventions after HGRT. These factors can be used as adjuncts to renal injury grading to guide clinical decision making. Level of evidence Prognostic and Epidemiological Study, Level III and Therapeutic/Care Management, Level IV.
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Contemporary management of high-grade renal Trauma: Results from the American Association for the Surgery of Trauma Genitourinary Trauma study.
The journal of trauma and acute care surgery, 2018Co-Authors: Sorena Keihani, Raminder Nirula, Kaushik Mukherjee, Joshua Piotrowski, Angela P. Presson, James M. Hotaling, Christopher M. Dodgion, Cullen M. Black, Bradley J. MorrisAbstract:BACKGROUNDThe rarity of renal Trauma limits its study and the strength of evidence-based guidelines. Although management of renal injuries has shifted toward a nonoperative approach, nephrectomy remains the most common intervention for high-grade renal Trauma (HGRT). We aimed to describe the contemp