Current Management of Extraperitoneal Bladder Injuries: Results from the Multi-Institutional Genito-Urinary Trauma Study (MiGUTS).

PURPOSE: To study the current management trends for extraperitoneal bladder injuries (EBI) and evaluate the use of operative repair (OR) versus catheter drainage (CD), and the associated complications with each approach. METHODS: We prospectively collected data on bladder trauma from 20 Level-1 trauma centers across the United States from 2013-2018. We excluded patients with intraperitoneal bladder injury and those who died within 24 hours of hospital arrival. We separated EBI patients into two groups (CD vs. OR) based on their initial management within the first four days and compared the rates of bladder injury-related complications among them. Regression analyses were used to identify potential predictors of complications. RESULTS: From 323 bladder injuries, we included 157 patients with EBI. Concomitant injuries occurred in 139 (88%) patients with pelvic fracture seen in 79%. Sixty-seven patients (43%) initially underwent OR for their EBI. The three most common reasons for OR were: severity of injury or bladder neck injury (40%), injury found during laparotomy (39%), and concern for pelvic hardware contamination (28%). Significant complications were identified in 23% and 19% of the CD and OR groups, respectively (p=0.55). The only statistically significant predictor for complications was bladder neck or urethral injury (RR 2.69; 95% 1.21-5.97; p=0.01). CONCLUSIONS: In this large multi-institutional cohort, 43% of patients underwent surgical repair for initial management of EBI. We found no significant difference in complications between the initial management strategies of CD and OR. The most significant predictor for complications was concomitant urethral or bladder neck injury.