Trauma/Reconstruction/Diversion
Steven Hudak, MD
UT Southwestern Medical Center
Yooni Blair, MD
Assistant Professor
University of Michigan
Michael Coburn, MD
Baylor College of Medicine Houston, Texas
Course Description: This course, which has been offered at the AUA Annual Meeting for many years, 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. Emphasis on the critical elements of related reconstructive surgery techniques is 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 nonsurgical 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 recently updated 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 endourological 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 multisystem (i.e., high energy polytrauma). Understand the importance of long-term multidisciplinary care given the potential for secondary interpersonal and mental health effects.
The course is divided into three sections, based on injury anatomy: kidney/ureter, bladder/urethra and external genitalia (male and female). Each section begins 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. The faculty then serve as a panel, addressing each of the attendees’ cases. The course concludes with a 30-minute session where audience members are invited to the microphone to work through cases presented by course faculty. It has been our observation that alternating between didactic and interactive formats throughout the course leads to an energetic, engaging and highly informative session.