The Epidemiology of Urinary Tract Trauma: Results from the GRAND Study

TL;DR

This study analyzed urinary tract trauma in Germany from 2005 to 2023, showing increasing rates of ureteral, bladder, and urethral injuries and highlighting differences in patient demographics and treatment outcomes.

Contribution

The study provides the first nationwide epidemiological analysis of urinary tract trauma in Germany, revealing trends and clinical outcomes over an 18-year period.

Findings

Kidney trauma was the most common, affecting younger males with a 2.4% in-hospital mortality rate.

Ureteral, bladder, and urethral trauma increased over time and affected older, multimorbid patients with higher mortality and transfusion rates.

Surgical interventions like ureteral anastomosis and bladder repair were frequently required for these injuries.

Abstract

Background: Urinary tract trauma encompasses injuries to the kidneys, ureters, urinary bladder, and urethra and can result from both external and iatrogenic causes. We aimed to evaluate the epidemiology, clinical characteristics, and in-hospital outcomes of urinary tract trauma in Germany. Methods: We analyzed data from the GeRmAn Nationwide inpatient Data (GRAND) registry, provided by the Research Data Center of the Federal Bureau of Statistics, from 2005 to 2023. We included patients admitted to the hospital with kidney, ureteral, urinary bladder, or urethral trauma. We assessed baseline characteristics, perioperative outcomes, surgical interventions, in-hospital all-cause mortality, and trends. Results: We identified 239,657 patients with urinary tract trauma: 109,376 with kidney, 34,330 with ureteral, 57,886 with bladder, and 38,065 with urethral trauma. While the incidence of kidney trauma declined, the incidence of ureteral, bladder, and urethral trauma steadily increased over time. Kidney trauma was the most common trauma, affecting younger males (median age of 47 years), and was associated with in-hospital all-cause mortality of 2.4% and transfusion rates of 15%. Ureteral stenting was necessary in 9.3% and nephrectomy in 2.6% of all patients with kidney trauma. Moreover, ureteral, bladder, and urethral trauma predominantly affected older, multimorbid patients, leading to higher rates of transfusion (22–25%), intensive care unit admission (12–15%), and mortality (3.2–6.4%). Ureteral anastomosis was necessary in 14% of all ureteral injuries. Bladder repair was required in 53% of all patients with bladder injury, while 1% of these patients required cystectomy. Accordingly, urethral reconstruction was performed in 7.2% of all patients with urethral trauma. Conclusions: These findings highlight the evolving landscape of urinary tract trauma and underscore the need for tailored management strategies and preventive measures.

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