Injury severity score associated with concurrent bladder injury in patients with blunt urethral injury.

BACKGROUND: Delayed diagnosis of concurrent bladder damage in a patient with blunt urethral trauma can lead to a high rate of morbidity. In patients with a high index of suspicion, genitourinary workup is recommended. In complicated patients with multi-trauma, this workup has a risk of being delayed. A proven prognostic indicator to evaluate the likelihood of bladder injury in this population has not been established. The aim of this study was to determine if there was a clinical association between the Injury Severity Score (ISS) and bladder injury involvement among these patients. METHODS: Retrospective analysis was performed on a cohort of 98 patients who presented with blunt urethral trauma to R. Adams Cowley Shock Trauma Center between 2002 and 2014. Univariate analysis was performed to determine if there was an association between concurrent bladder injuries and ISS among other factors. A receiver operating characteristic curve plot was performed to analyze the association between ISS and bladder involvement. RESULTS: Of the 98 patients with blunt urethral trauma, 28 had concurrent bladder injury. ISS was shown to have a significant correlation with concurrent bladder injury (OR = 2.2 per 10 unit change in ISS, p = 0.0001). ROC curve analysis showed an area under the curve for the prediction of bladder injury. Patients with ISS ≥ 34 had a 54% chance of bladder injury, while patients with ISS < 34 had a 13% chance. CONCLUSION: ISS ≥ 34, a score in the range of severe multi-trauma, may be a clinical indicator of bladder injury in patients presenting with blunt urethral trauma. FUNDING: This research was supported in part by the Proposed Research Initiated by Students and Mentors (PRISM) Program, University of Maryland School of Medicine Office of Student Research.

A Review of Imaging Modalities Used in the Diagnosis and Management of Scrotal Trauma.

Genitourinary tract injuries account for 3 to 10% of trauma patients, and scrotal trauma is particularly prevalent in males 10 to 30 years of age. Prompt diagnosis and timely surgical intervention are essential to prevent future complications of infertility, delayed orchiectomy, infection, and testicular atrophy. While clinical examination provides valuable information, it may be inconclusive due to soft tissue swelling and difficult to perform due to testicular pain with palpation. Conversely, testicular rupture does not always present with pain or tenderness. Imaging can contribute additional support for surgical evaluation in scrotal trauma. Current AUA guidelines support ultrasound in blunt scrotal trauma to confirm testicular rupture while recommending early exploration in penetrating injuries due to the high incidence of testicular rupture. This review discusses the existing literature on the use of various imaging modalities in assessment of blunt and penetrating scrotal trauma and common imaging findings.

Twitter Mentions and Academic Citations in the Urologic Literature.

OBJECTIVE: To quantify the relationship between the number of Twitter mentions and the number of academic citations a urologic publication receives. MATERIALS AND METHODS: Two hundred and thirteen papers from 7 prominent urologic journals were examined 37 months after publication. Articles were evaluated with 2 citation based "bibliometrics" (Scopus, Google Scholar) and Twitter mentions were tracked using the Altmetric Bookmarklet. The number of article citations and Twitter mentions were compared using one-way Analysis of variance (ANOVA) and bivariate fit analysis. RESULTS: Seventy-three percent of articles had at least 1 Twitter mention. Forty-two percent of Twitter mentions occurred within the first week of the online publication date. Articles mentioned on Twitter had 2.0-fold more Scopus citations (P <.01), and 2.3-fold more Google Scholar citations (P <. 01) compared to articles with no Twitter mentions. Female urologic articles had the greatest number of Twitter mentions (5.7 mentions/article) while pediatric urology had the fewest mean number of Twitter mentions (0.8 mentions/article). A total of 8.9% of papers were tweeted by their authors. Author tweeted articles were associated with a 12.3 (2.0-fold) and 15.5 (1.8-fold) mean citation increase for Scopus and Google Scholar (P <. 01 and P = . 01) compared to articles not shared by their authors on Twitter. CONCLUSION: The majority of urologic publications are being shared on Twitter. The number of citations a urologic publication receives up to 3 years after release is positively associated with the number of mentions it has on Twitter. Twitter activity may be an early indicator of ultimate academic impact of an academic urologic paper.

Contemporary Practice Patterns in the Management of Acute Obstructing Ureteral Stones.

PURPOSE: To elucidate current practice patterns among Endourological Society members for acutely obstructing ureteral stones necessitating intervention. METHODS: A practice pattern survey was sent to members of the Endourological Society using Survey Monkey. The following question stem was given: "Patient presents to the ER with acute renal colic and intractable pain, no signs of infection, i.e. afebrile and no pyuria. Stone is obstructing, and causing intractable pain; thus observation or medical expulsive therapy is not appropriate." A follow-up stem was provided for specific scenarios: "Calculus measuring x mm at x location. What is your preferred management option?" The options given for immediate management included shockwave lithotripsy (SWL), ureteroscopy (URS), stent placement, or percutaneous management. RESULTS: Four hundred and sixteen complete responses of approximately 2000 were received. There was a significant difference in management choice based on stone location (P<0.001) and stone size (P<0.001). URS was the predominant modality used for urgent treatment of acute proximal ureteral stones from 5, 10, and 15 mm except for calculi of 20 mm, where the preference was for percutaneous management. Immediate URS was the preferred choice for all distal and midureteral stones, regardless of size. The use of stents vs percutaneous nephrostomy drainage was similar (18% vs 16%, respectively) for proximally obstructing calculi, while stent insertion was preferred over nephrostomy for mid and distal stones. CONCLUSIONS: Current practice patterns among endourologists indicate a strong preference for immediate URS management over stent placement or SWL for acutely obstructing ureteral calculi. Not surprisingly, 20-mm stones in the proximal ureter had percutaneous management.