What's new in urological trauma? 2012 update

Urologic trauma continues to be a dynamic and evolving subspecialty of urology. This is evident by the trauma papers published this past year. Highlights of the 2011 literature include a needed revision of renal trauma grading, increased use of large population-based datasets and multiple papers examining the use of angioembolization. Buckley and McAninch (1) revised the current American Association for the Surgery of Trauma Renal Injury Grading System producing a staging classification that is more clear and straightforward. Grade 1 (renal contusion), grade 2 (<1 cm laceration), grade 3 (>1 cm laceration without collecting system injury) remain unchanged. Grade 4 injuries now include all collecting system injuries. Grade 5 injuries denote major catastrophic vascular injury including main renal artery or vein laceration or avulsion of the main renal artery or vein thrombosis. This classification reflects that most injuries involving the renal parenchyma and segmental vessels can be managed conservatively while hilar injuries frequently will require surgery for salvage. The majority of manuscripts related to urologic trauma this past year are case reports and case series which in part reflects the low volume of injuries seen at most centers worldwide. Management consensus and practice guidelines continue to be based on large, seminal case series from high volume urologic trauma centers. Increasingly, population-based data sets are being utilized to study urologic trauma epidemiology and outcomes. This trend should continue given the rise and availability of inexpensive, powerful statistical software and large publically accessible data sets. Urologic trauma has lagged other urologic subspecialties such as cancer in the utilization of such data sets. The National Trauma Data Bank (NTDB) is a robust and publically available data repository. Managed by the American College of Surgeons, the NTDB contains trauma admissions of participating Level 1-5 trauma centers in the United States, totaling over 600,000 case records. Compared to case series, NTDB has the advantage of drawing from a large and diverse population from all regions of the country. Potential disadvantages include the reliance on administrative data and the inability to reexamine new variables in historical patients. A number of groups have utilized this data set to study urologic trauma this past year. Bjurlin et al. examined over 16,000 bicycle injuries and found GU organs involved 2% of cases (2). The kidneys were the most commonly injured GU organ among bicycle accidents. Among patients who sustained a vertebral fracture, concurrent bladder/urethra (38%) or a renal injury …