Search

Background: Noncompressible torso hemorrhages (NCTH) are now recognized as the leading cause of preventable death in the context of severe military and civilian injuries. Approximately 20% of all trauma patients still die from uncontrolled bleeding associated with rapidly evolving disorders of blood coagulation function., Objective: Summary of recent advances in the field of nonsurgical and surgical management, presentation of current treatment concepts and future research directions., Material and Methods: Selective literature review and analysis., Results: The concepts for the early treatment of NCTH have considerably evolved over the last decade. The updated definition of NCTH includes a combination of high-grade anatomic body trunk injury, hemodynamic instability, urgent need for hemorrhage control, and aggressive hemostatic treatment. The treatment concepts consider the following 3 aspects: controlling the source of bleeding (close the tap), maintaining organ perfusion and restoring hemostasis (fill the tank) and increasing the body's resistance to ischemia (upgrade the armor). New tools, well-established damage control concepts and early and aggressive therapeutic intervention for hemostatic failure have significantly improved the outcomes., Conclusion: Future research needs to refine and validate the current concepts for further clinical application., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

In light of recently published international guidelines concerning the diagnosis, treatment, and aftercare of urethral strictures and stenoses, the objective of this study was to synthesize an overview of guideline recommendations provided by the American Urological Association (AUA, 2023), the Société Internationale d'Urologie (SIU, 2010), and the European Association of Urology (EAU, 2023). The recommendations offered by these three associations, as well as the guidelines addressing urethral trauma from the EAU, AUA, and the Urological Society of India (USI), were assessed in terms of their guidance on posterior urethral stenosis. On the whole, the recommendations from the various guidelines exhibit considerable alignment. However, SIU and EAU place a stronger emphasis on the role of repeated endoscopic treatment compared to AUA. The preferred approach for managing radiation-induced bulbomembranous stenosis remains a subject of debate. Furthermore, endoscopic treatments enhanced with intralesional therapies may potentially serve as a significant treatment modality for addressing even fully obliterated stenoses., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Copyright of Der Urologe A is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Urologe A is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Urologe A is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Severely injured patients with associated genitourinary (GU) injuries have only rarely been investigated in the current literature. If at all, analyses are commonly focussed on renal injuries, marginalising other GU traumas such as ureteral injuries. In this study, we would like to characterise patients with GU injuries and analyse the impact of such injuries on mortality and length of stay., Materials and Methods: The inclusion criteria for this retrospective analysis of TraumaRegister DGU® data were: Injury Severity Score ≥ 16 within the period between 2009 and 2016 with available data on age and length of stay. A descriptive analysis was used to compare patients with and without GU injuries. The impact of GU injuries on mortality and length of hospital stay was evaluated by means of multivariate regression analyses., Results: In all, 90,962 patients met the inclusion criteria; 5.9% of them had suffered GU injuries (n = 5345). The prevalence in patients with pelvic fractures was up to 19%. On average, patients with GU trauma were 10 years younger (42.9 vs. 52.2 years) and more severely injured (ISS: 31.8 vs. 26.4). The multivariate analyses demonstrated that GU injuries in severely injured patients are no independent risk factor for mortality. However, particularly bladder and genital injuries result in longer hospitalisation., Conclusion: GU injuries do not represent an additional risk factor for mortality. However, after adjusting for established prognosis factors, they can cause prolonged periods of hospitalisation of severely injured patients., (© 2021. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Injuries of the urinary bladder can be associated with blunt and penetrating abdominal or pelvic trauma. In addition, they can be an iatrogenic complication in open, laparoscopic, and endoscopic urogenital or abdominal surgery.Objectives: The present article reviews relevant causes of bladder injuries and the subsequent diagnostic and treatment modalities. [ABSTRACT FROM AUTHOR]

Background: In severely injured patients, urologic trauma is diagnosed in about 10 % of patients. Renal trauma is most common, while ureteral trauma is in the majority of cases iatrogenic. These two urologic injuries influence the clinical course, morbidity, and mortality. Thus, rapid identification, sufficient diagnostic workup, and adequate therapy of renal and ureteral injuries are essential.Theme: This article reviews the actual diagnostic procedures, classification, and stage-dependent therapy options in renal and ureteral injuries. [ABSTRACT FROM AUTHOR]

Background: In addition to epididymitis and testicular torsion, emergencies of the external genital are rare. Rapid diagnosis and therapy are essential so that immediate therapy can be provided, which is important for survival (Fournier gangrene) of the patient or for the preservation of erectile function (priapism and penile fracture). A detailed patient history and clinical examination are generally sufficient for correct diagnosis.Results: Under certain circumstances, it might be useful to perform ultrasound, computed tomography scan or magnetic resonance imaging or retrograde urethrography. A urine analysis is obligatory. In case of penetrating injuries and genital trauma in females, additional imaging should be performed because these are often associated with concomitant injuries of the rectum, vagina, or bladder. Special cases are gunshot wounds, in which caliber and type of weapon play an important role for the degree of damage, and animal or human bites. For animal bites, the risk for rabies infection and in case of a human bite the risk for transmission of HIV and hepatitis should be taken into consideration and post-exposure prophylaxis should possibly be offered. [ABSTRACT FROM AUTHOR]

Copyright of Der Urologe A is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)