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Urogenital
Trauma:
APractical Guide
SaidAbdallahAL-Mamari
123
Urogenital Trauma: A Practical Guide
SaidAbdallahAL-Mamari
Urogenital Trauma:
A Practical Guide
SaidAbdallahAL-Mamari
Department of Urology
The Royal Hospital
Muscat, Oman
ISBN 978-981-99-6170-2 ISBN 978-981-99-6171-9 (eBook)
https://doi.org/10.1007/978-981-99-6171-9
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore
Pte Ltd. 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721,
Singapore
Paper in this product is recyclable.
Foreword
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It gives me pleasure to introduce the book written by Said Abdallah Al-Mamari
from Muscat, Oman.
Urogenital trauma is a complex topic and Dr. Said Al-Mamari has assembled its
latest management. We always learn from the experience of others and the
guidelines- based approach. He has effortfully compiled various chapters on all
genito-urinary organs in a book that brings out practical points in the management
options for complex situations.
The book is handy to the ones treating trauma and to the ones in education.
I wish you all a good reading and congratulate Said Abdallah Al-Mamari for
this book.
SanjayB.Kulkarni
Kulkarni Reconstructive Urology Center
Pune, India
v
Preface
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While conceiving, writing, completing, and publishing a book is always a daunting
task, questions on the very interest of the present work were constantly troubling my
mind during its preparation. However, when remembering some confusing scenarios in urogenital trauma in my personal practice whose management was not clearly
predicted by the current guidelines, it became obvious that a thorough look at the
most relevant and most recent publications was necessary to learn more and
deeper about other centers’ experiences and to share my efforts with as many practitioners and researchers as possible.
While carrying out a broad review of the literature treating this subject, a delicate
approach was undertaken to summarize the most practical knowledge and present it
in a didactical and easily digestible way to the readers.
Abundant illustrations were added to this book to enhance the learning and memorizing process.
An account of life-saving minimally invasive interventions and invasive surgical
procedures was given as well as a detailed review of reconstructive operations of the
urinary tract and genital organs. Nevertheless, these are by no means intended to
be substituted for more comprehensive manuals of operative techniques and
will never replace attendance to workshops and assiduous observation and
participation in real-life situations in the operating theaters.
Apart from being useful in daily practice, I believe this book will also be a good
vade mecum for the students and residents, serving them as a last-day-revision
material before their Board or fellowship examinations.
It is my pleasure to acknowledge Professor Sanjay B.Kulkarni (Pune, India)
who kindly and promptly accepted to review the content of this manuscript and to
write his expert foreword that will surely add value to this manual and raise the
interest of the readers.
SaidAbdallahAl-Mamari
Urology Department, The Royal Hospital
Muscat, Oman
vii
Acknowledgment
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1. To Professor Sanjay Balwant Kulkarni, Kulkarni Reconstructive Urology Center,
Pune, India, President of the Urology Society of India, for reviewing this manual
and for his expert foreword.
2. To Dr. Ayman Mohamed Abozekry and Dr. Hamidreza Shemsheki, Urology
Department, The Royal Hospital, for their help in images collection and their
technical advices.
3. To all my colleagues who kindly shared relevant images (pictures, X-rays) from
their personal collection to illustrate this book.
4. To Mr. Naren Aggarwal, Mrs. Raman Shukla, Mrs. Neeraja Padmanabhan, and
Ms. Momoko Asawa, Editors and Executives for Springer Nature, for their
expert technical assistance in the production, nalization, and publication of
this book.
ix
Introduction
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Along with the improvement of trauma management, safety measures have been
implemented with appreciable efcacy as evidenced by a 31% decrease in the global
age-standardized injury-related disability-adjusted life year (DALY) rate between
1990 and 2013 [1]. Yet trauma remains unpredictable. It occurs anywhere, at any
time of the day, at any period of the year, and each medical practitioner must be
prepared for its occurrence in his/her daily practice.
With the development of modern transport technology, the increased dependence
on machinery in human daily activities, the intensive construction of higher buildings and highways, the widespread sports practice, the easy procurement of weapons, the development of urban criminality, and the multiplication of conicts in the
world, the magnitude of trauma and its consequences have become greater than
ever. In 2013, approximately 973 million people in the world sustained injuries of
various grades that required medical attention [1]. Global estimation of mortality
suggests that between 14,000 and 16,000 people lose their lives every day, i.e., 5.8
million each year, as a result of trauma, accounting for 10–11% of mortalities, and
being currently the sixth leading cause of death in the world [2, 3]. Projections made
by WHO suggest that by 2030, road trafc accidents (RTA) are likely to become
the fth leading cause of death and the third leading cause of disability in the world
[2]. In the USA, trauma is reported to be the leading cause of death among people
aged 1–44 years old and to be the third leading cause of death in all age groups.
Statistically, 214,000 people die in the USA from traumatic injuries every year,
which equals 586 persons every day [4]. In the UK, trauma is also the leading cause
of death in children and young adults (≤44 years) according to the Trauma Audit
and Research Network (TARN), and approximately 16,000 people die every year
after injury, or 44 daily, in England and Wales [5].
Contrary to malignancies, heart and renal diseases, hypertension, diabetes mellitus, and other degenerative disorders which mostly affect older people, the higher
likelihood of trauma affecting the young population in the productive age provokes
grim economic consequences that cannot be overlooked. Indeed, in addition to
direct medical costs, ve other components should be considered in the estimation
of the total socio-economic costs of any serious injury: production loss, human
costs (quality of life and life-years lost), administrative costs (police, re service,
insurance, legal costs), material damage (vehicles, infrastructure, freight, etc.), and
others (trafc congestion, vehicle unavailability, funeral costs) [6]. Statistics have
xi
xii
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Introduction
shown that over 2.8 million people are hospitalized in the USA every year because
of trauma, with estimated annual costs of $406 billion including medical management and lost productivity [7]. Moreover, when this calculation was revisited by a
recent study including the human costs, the estimated total burden steeply rose to
$4.2 trillion per year, comprising $327 billion for medical management, $69 billion
for productivity loss, and $3.8 trillion for the losses of statistical life and quality of
life [8]. There is a wide disparity in the serious injuries cost, and a European study
has shown that this may vary from €28,205 to €975,074, and the estimated total
burden might represent between 0.04% and 2.7% of a country’s gross domestic
product (GDP) [6].
Regrettably, there is a disparity in the budget allocated for trauma research compared to other health problems. Thus in 2018, the American National Institute of
Health (NIH) funded an estimated $639 million to traumatic injury research projects, representing less than 2% of its budget and only a tenth of the estimated amount
allocated to cancer research ($6.3 billion). The great paradox is that trauma accounts
for more years of potential life lost (YPLL) before 75 years than cancer with 24.1%
and 21.3%, respectively [4], and the greater negative impact of this nancial disparity is observed in lower socio-economic status victims who have higher recorded
mortality than the richer population following minor trauma [9].
Specically, urogenital trauma (UGT) of various anatomopathology and grade
is a common condition presenting to the hospital. Its causes and circumstances are
multiform and comprise a broad spectrum that includes RTAs (renal trauma, pelvic
trauma with membranous urethra injury, bladder rupture, external genital injuries),
home, recreational, or sports accidents where the external genitals are mostly
involved, assaults, work accidents (falling astride with bulbar urethral injury), iatrogenic injuries occurring either during gyneco-obstetrical interventions (bladder or
ureteral injury in cesarean section or hysterectomy), colorectal operations (ureteric
injury), endourological interventions (urethral, bladder, or ureteral injury of various
degrees) or percutaneous nephrolithotomy (PCNL). Rarely do patients present with
self-inicted genital trauma, and this entity will be dealt with in a special section.
The management of UGT has been addressed by many retrospective research
articles (meta-analyses, systematic reviews, series, national databases, populationbased studies, and case reports). However, due to a lack of funding in the eld of
trauma on the one hand [4], and the stressful patient’s presentation potentially
requiring urgent life-saving management; on the other hand, there is not enough
room left for prospective randomized controlled trials. This paucity of high-quality
research causes a lack of high level of evidence to support authoritative guidelines;
therefore, recommendations from expert panels are seldom strong [10]. Nonetheless,
there are robust retrospective research and strong clinical experience pleading for
many consensuses in this eld that are published by experts’ panels. Because of the
complexity of the UGT, each injury has got its special approach guided by the
mechanism of the trauma, the anatomopathology of the lesion, the organ involved,
and the patient’s condition at presentation.
In this book, a systematic approach will be adopted, summarizing all available
data and progressing from proximal to distal throughout the urogenital system.
Introduction
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xiii
However, female genital trauma will not be discussed in this manual since it would
better be addressed by gynecological experts. At the same time, efforts were made
to avoid oversaturating the didactic material and to provide the readers with pieces
of useful and practical knowledge about the management of this entity.
References
1. Haagsma JA, Graetz N, Bolliger I, et al. The global burden of injury: incidence, mortality,
disability-adjusted life years and time trends from the Global Burden of Disease study 2013.
Inj Prev. 2016;22(1):3–18. https://doi.org/10.1136/injuryprev- 2015- 041616. Epub 2015 Dec 3.
2. World Health Organization. Global status report on road safety: time for action. Geneva:
WHO; 2009.
3. Greaves I, Porter K, Garner J, editors. Trauma care manual. 3rd ed. CRC Press. 2021. https://
doi.org/10.1201/9781003197560.
4. Dowd B, McKenney M, Boneva D, Elkbuli A. Disparities in National Institute of Health
trauma research funding: the search for sufcient funding opportunities.Medicine (Baltimore).
2020;99(6):e19027. https://doi.org/10.1097/MD.0000000000019027.
5. The TraumaAudit and Research Network (TARN). Trauma care in England and Wales. https://
tarndev.exchdev.man.ac.uk/#:~:text=Welcome,left%20severely%20disabled%20for%20life.
6. Schoeters A, Wijnen W, Carnis L,etal.Costs related to serious road injuries: a European per-
spective.Eur Transp Res Rev2020;12:58. https://doi.org/10.1186/s12544- 020- 00448- 0.
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trauma outcomes: is it time to set research best practices to further enhance its impact?J Am
Coll Surg.2012;214(5):756–68.
8. Peterson C, Miller GF, Barnett SB, Florence C.Economic cost of injury—United States, 2019.
MMWR Morb Mortal Wkly Rep. 2021;70:1655–6.
9. McHale P, Hungerford D, Taylor-Robinson D, Lawrence T, Astles T, Morton B.Socioeconomic
status and 30-day mortality after minor and major trauma: a retrospective analysis of the Trauma
Audit and Research Network (TARN) dataset for England. PLoS One. 2018;13(12):e0210226.
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10. Sharma DM, Serafetinidis E, Sujenthiran A, Elshout PJ, Djakovic N, Gonsalves M, Kuehhas
FE, Lumen N, Kitrey ND, Summerton DJ, EAU Guidelines Panel on Urological Trauma.
Grey areas: challenges of developing guidelines in adult urological trauma. Eur Urol Focus.
2016;2(1):109–10. https://doi.org/10.1016/j.euf.2015.11.005. Epub 2015 Dec 8.
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