030IC - Urotrauma: Guidelines, Controversies, and Challenging Cases

Course Description: This course provides a comprehensive, case-based approach to the assessment and management of all types of urological injury, while focusing on trauma due to external violence (as opposed to iatrogenic injury). The course is highly relevant to both our domestic and international attendees, as we demonstrate diagnostic and treatment approaches that are relevant in both the technology-replete, as well as austere care environments. Given ongoing military conflicts abroad, we have expanded the discussion on military GU injuries, based on the large amount of data gathered during U.S. conflicts in Iraq and Afghanistan. Emphasis on the critical elements of related reconstructive surgery techniques are provided with case-based illustrations. Opportunities for audience participation are present throughout the course. The optimal working relationships between the urologist, the trauma surgeon, and other surgical and non-surgical specialists, are addressed. Specifically, learners will be able to take the following back to their respective practices after attending:
1. Obtain a full understanding of the most recent version of the AUA Urotrauma Guidelines.
2. Apply principles of damage control surgery to the management of unstable trauma patients with urological injuries.
3. Renal trauma: Understand the importance of nonoperative management of most renal injuries, reserving prompt intervention for those with high grade injury and ongoing hemorrhage and/or continued urinary extravasation.
4. Ureteral trauma: Maintain a high index of suspicion for ureteral trauma in high risk patients. Understand the importance of early intervention for ureteral injuries during the primary laparotomy when able. Consider endourologic or percutaneous approaches when ureteral injuries are diagnosed in a delayed manner.
5. Bladder trauma: Understand the importance of operative repair (intraperitoneal and complex extraperitoneal injuries) and nonoperative management (simple extraperitoneal injuries).
6. Urethral trauma: Diagnose and localize urethral injuries with retrograde urethrography. Appropriately manage urethral injuries based on injury mechanism and anatomical location.
7. Genital trauma: Stage and manage genital injuries with an appreciation for injury mechanism whether focal (i.e. penile fracture, penile amputation) or multi-system (i.e. blast trauma observed in military/combat settings). Understand the importance of long-term multidisciplinary care for genital injuries, given the potential for secondary interpersonal and mental health effects.

The course is divided into four sections, with the first three based on injury anatomy: Kidney/ureter, bladder/urethra, and external genitalia (male and female). These sections each begin with a didactic portion, focusing on injury evaluation and management (based on AUA guidelines) illustrated with numerous representative clinical cases. Each didactic portion is then augmented with an interactive portion, where attendees are invited to ask questions about their own complex and/or controversial clinical cases. In the fourth section, at least five interactive cases will be presented with clinical information and pictures/illustrations. The faculty will serve as a panel, addressing each of the cases. During this portion, the audience members are invited to the microphone to work through cases with the faculty panel and/or presenting difficult cases of their own. We believe that alternating between didactic and interactive formats throughout the course will lead to an energetic, engaging, and highly informative session.

Learning Objective 1: Describe guidelines-driven, evidence-based treatment algorithms for injuries to the kidney, ureter, bladder, urethra and external genitalia.

Learning Objective 2: Apply principles of damage control surgery to the management of unstable trauma patients with urological injuries.

Learning Objective 3: Distinguish between urological injuries that require non-operative surveillance, immediate surgery, and adjunctive interventions such as angio-embolization or endourologic management.

Learning Objective 4: Describe the unique challenges created by genitourinary injuries sustained in military/battlefield environments.

Learning Objective 5: Identify the importance of long-term multi-disciplinary care for the urinary, sexual, reproductive, interpersonal, and mental health sequelae which can result after urological injury.