Evaluating specialty-based management of urologic trauma: A retrospective analysis of surgical interventions and...

Urotrauma requiring intervention can be managed by trauma surgery (TS), urologic surgery (US) or interventional radiology (IR). There is no clear consensus on preferable specialty for intervention, and limited data compare outcomes by specialty. This study aims to characterize interventions for urotrauma by specialty and analyze outcomes at our institution.

We conducted a retrospective review of patients at our Level I Trauma Center with urotrauma requiring intervention from 2020-2023. We performed a descriptive analysis of demographics, injury type, specialty involved, intervention type, injury severity score (ISS), and post-operative course.

Of 387 patients identified, 23 % (87/387) required intervention with median age 32 (IQR 24-48) years. Kidney injuries were most common (68 %, 59/87), followed by ureteral (13 %, 11/87) and bladder (13 %, 11/87). TS performed most of the interventions (47 %, 41/87), followed by US (41 %, 36/87), and IR (12 %, 10/87). TS performed nephrectomy at a higher rate than US (67 %, 24/36 vs 8 %, 1/13). Of the cohort, 20 % (17/87) were readmitted, with 65 % (11/17) requiring a procedure and 63 % (7/11) of which were related to initial urologic injury. US was not initially consulted in nearly 60 % (4/7) of cases requiring urologic intervention upon readmission. The rate of urologic intervention upon readmission was 38 % (3/8) among patients who had an initial urologic consultation, compared to 100 % (4/4) among those who did not. Median length of stay (LOS) for readmitted patients was 76.7 h among those who received an initial US consultation and 134.1 h among those who did not. Follow-up occurred in 86 % (24/28) and 70 % (27/37) of patients treated by US and TS, respectively.

TS conducted most urotrauma interventions, while US managed most non-renal cases. The nephrectomy rate for renal trauma was lower when managed by US, suggesting a more organ-preserving approach. Patients without initial US consultation had a nearly 3-fold higher rate of readmission for urologic intervention, longer readmission hospital LOS, and lower follow-up rates. These clinically meaningful trends suggest that US consultation may improve outcomes by reducing the need for nephrectomy, minimizing reinterventions, reducing hospitalization length, and improving continuity of care. Multidisciplinary collaboration should be pursued in the management of urotrauma.