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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Lumen N, Kuehhas FE, Djakovic N, et al. Review of the current management of lower urinary tract injuries by the EAU Trauma Guidelines Panel. [Review]. European Urology. 67(5):925-9, 2015 May.Eur Urol. 67(5):925-9, 2015 May. Review/Other-Dx N/A To review the current management of lower urinary tract injuries by the EAU Trauma Guidelines Panel No results stated in abstract. 4
2. Morey AF, Brandes S, Dugi DD 3rd, et al. Urotrauma: AUA guideline. Journal of Urology. 192(2):327-35, 2014 Aug.J Urol. 192(2):327-35, 2014 Aug. Review/Other-Dx N/A To review the urologic trauma literature to guide clinicians in the appropriate methods of evaluation and management of genitourinary injuries. Guideline statements were created to inform clinicians on the initial observation, evaluation and subsequent management of renal, ureteral, bladder, urethral and genital traumatic injuries. 4
3. Bryk DJ, Zhao LC. Guideline of guidelines: a review of urological trauma guidelines. [Review]. BJU International. 117(2):226-34, 2016 Feb. Review/Other-Dx N/A To review the guidelines released in the last decade by several organisations for the optimal evaluation and management of genitourinary injuries (renal, ureteric, bladder, urethral and genital). Most recommendations are guided by the American Association for the Surgery of Trauma (AAST) organ injury severity system. Grade A evidence is rare in genitourinary trauma, and most recommendations are based on Grade B or C evidence. The findings of the most recent urological trauma guidelines are summarised. All guidelines recommend conservative management for low-grade injuries. The major difference is for haemodynamically stable patients who have high-grade renal trauma; the SIU guidelines recommend exploratory laparotomy, the EAU guidelines recommend renal exploration only if the injury is vascular, and the AUA guidelines recommend initial conservative management. 4
4. Shenfeld OZ, Gnessin E. Management of urogenital trauma: state of the art. Curr Opin Urol. 2011; 21(6):449-454. Review/Other-Dx N/A To summarize the most relevant studies published within the last 3 years on the management of urogenital trauma. CT grading of renal trauma is an excellent predictor of the need for surgery and the final renal outcome in these patients, as most patients can be treated conservatively. CT cystography has become the standard for the diagnosis of bladder rupture in which the indications for surgical intervention may be changing. The most common urethral trauma is posterior urethral injury due to pelvic fracture. The best results in adults and children are achieved by urethroplasty. The diagnosis and treatment of genitourinary trauma is still evolving. The long-term sequels of these injuries may best be treated by urologists expert in urogenital reconstruction. In the future, tissue engineering may have an important place in the treatment of these patients. 4
5. Gomez RG, Ceballos L, Coburn M, et al. Consensus statement on bladder injuries. BJU Int. 2004; 94(1):27-32. Review/Other-Dx N/A Recommendations by an International Consensus panel on bladder injuries. Experts describe blunt, penetrating and iatrogenic injuries and their management. Combined intraperitoneal and extraperitoneal ruptures are present in 5%-8% of all bladder ruptures and mainly diagnosed during surgery. Important to have prompt diagnosis and treatment. A static or CT cystogram can be used for diagnosis. 4
6. Vaccaro JP, Brody JM. CT cystography in the evaluation of major bladder trauma. [Review] [12 refs]. Radiographics. 20(5):1373-81, 2000 Sep-Oct. Review/Other-Dx N/A To review CT cystographic technique and the characteristic imaging features of types of bladder injury. CT cystography is highly accurate as an adjunct to routine abdomino-pelvic CT in the trauma setting. 4
7. Sandler CM, Hall JT, Rodriguez MB, Corriere JN Jr. Bladder injury in blunt pelvic trauma. Radiology. 158(3):633-8, 1986 Mar. Observational-Dx 97 patients Review clinical and radiologic findings in patients with bladder injury secondary to blunt pelvic trauma. All cases (n=55) of extraperitoneal rupture were demonstrated cryptographically.In 15 cases in this group, the injury was complex, with extravasation of contrast material beyond the confines of the perivesical space. In two additional patients, incomplete bladder injury termed "interstitial bladder rupture" was identified. Study proposes a classification of bladder injury based on cystographic patterns of extravasations. 4
8. Colapinto V, McCallum RW. Injury to the male posterior urethra in fractured pelvis: a new classification. J Urol. 118(4):575-80, 1977 Oct. Review/Other-Dx 15 patients Propose a new classification of membranous urethral rupture in cases of fractured pelvis.Type 1: The prostate or urogenital diaphragm is dislocated but the membranous urethra is merely stretched and not severed. Type 2: The membranous urethra is ruptured above the urogenital diaphragm at the apex of the prostate. Type 3: The membranous urethra is ruptured above and below the urogenital diaphragm. Study recommends a more widespread use of retrograde urethrography in patients with a suspected posterior urethral rupture. 4
9. Ingram MD, Watson SG, Skippage PL, Patel U. Urethral injuries after pelvic trauma: evaluation with urethrography. [Review] [14 refs]. Radiographics. 28(6):1631-43, 2008 Oct. Review/Other-Dx N/A To review role of urethrography in the evaluation of urethral injuries. Although CT is usually used for the initial imaging evaluation of patients with polytrauma, urethral injury is better assessed and classified by using urethrography. 4
10. Sandler CM, Goldman SM, Kawashima A. Lower urinary tract trauma. [Review] [14 refs]. World J Urol. 16(1):69-75, 1998. Review/Other-Dx N/A Review and illustrate bladder and urethral injuries, including their mechanisms of injury, imaging diagnosis, systems for classification, and the accuracy/pitfalls of the diagnostic methods. Emphasis is on lower urinary tract injuries. Lower urinary tract injuries resulting from high speed, wide impact blunt trauma is the most common mechanism of lower urinary tract injury encountered in civilian practice. 4
11. Chapple CR. Urethral injury. BJU Int. 2000; 86(3):318-326. Review/Other-Dx N/A Review management and diagnosis of urethral injury. CT (preferably spiral CT) is the first choice for evaluating intra abdominal urinary tract trauma. This provides an accurate evaluation of the kidneys 4
12. Schneider RE.. Genitourinary trauma. Emerg Med Clin North Am. 11(1):137-45, 1993 Feb. Review/Other-Dx N/A Examine genitourinary trauma and patients at risk for urology injury, review physical findings and describe present radiographic procedures that allow for proper diagnosis and treatment. A retrograde urethrogram is the diagnostic procedure of choice in all cases of suspected urethral injury. Recommends retrograde cystography or retrograde CT cystography for suspected bladder injury. 4
13. Horstman WG, McClennan BL, Heiken JP. Comparison of computed tomography and conventional cystography for detection of traumatic bladder rupture. Urol Radiol. 1991; 12(4):188-193. Observational-Dx 25 patients To compare conventional cystograms and CT examinations for detection of traumatic bladder rupture. 5 of 25 had bladder ruptures. All 5 were detected by both CT and conventional cystogram. If properly performed, CT is as sensitive for detection of bladder injuries as conventional cystography. 3
14. Chan DP, Abujudeh HH, Cushing GL, Jr., Novelline RA. CT cystography with multiplanar reformation for suspected bladder rupture: experience in 234 cases. AJR. 2006; 187(5):1296-1302. Observational-Dx 234 patients Retrospective review was performed to determine the accuracy of CT cystography and the role of multiplanar reformation in the diagnosis of bladder injury. From the total of 234 examinations, 216 (92.3%) were interpreted as negative and 18 examinations (7.7%) were interpreted as positive. On the 18 positive examinations, 11 were extraperitoneal bladder rupture, five were intraperitoneal bladder rupture, and two were combined intraperitoneal and extraperitoneal bladder rupture. Surgical bladder exploration and repair were performed in nine of the 18 cases. Seven (77.8%) of the nine cases had operative findings consistent with the CT cystogram findings. The overall sensitivity and specificity of CT cystography in diagnosing bladder rupture were each 100%. For extraperitoneal bladder rupture, the sensitivity and specificity were 92.8% and 100%, respectively. For intraperitoneal rupture, the sensitivity and specificity were 100% and 99%, respectively. CT cystography is accurate for diagnosing bladder rupture. Sagittal and coronal multiplanar reformations may be helpful in identifying most sites of bladder rupture. 3
15. Bigongiari LR, Zarnow H. Traumatic, inflammatory, neoplastic and miscellaneous lesions of the bladder. In: Medical radiology of the lower urinary tract. Lang EK ed. Berlin: Springer-Verlag. 1994:70-147. Review/Other-Dx N/A Book chapter. N/A 4
16. Cass AS.. Diagnostic studies in bladder rupture. Indications and techniques. [Review] [26 refs]. Urol Clin North Am. 16(2):267-73, 1989 May. Review/Other-Dx N/A Review indications and techniques in the diagnosis of bladder rupture. Retrograde cystogram with bladder filling of 400 ml of radiopaque dye followed by a washout film will diagnose intraperitoneal and extraperitoneal ruptures of the bladder. False-negative cystograms occur with penetrating injuries of the bladder when only 250 ml or less of contrast medium is used to fill the bladder. 4
17. Hsieh CH, Chen RJ, Fang JF, et al. Diagnosis and management of bladder injury by trauma surgeons. American Journal of Surgery. 184(2):143-7, 2002 Aug. Observational-Dx 51 patients Retrospective review to analyze how bladder injuries have been managed as part of multiple traumas. 33 patients had abdominal CT, but only 20 were correctly diagnosed with accuracy of 60.6%. 24 patients had retrograde cystogram, with accuracy of 95.9% (23 of 24). Retrograde cystogram was performed in fewer than half of the patients (24 of 51), which means it is not feasible in many situations. 3
18. Corriere JN, Jr., Sandler CM. Diagnosis and management of bladder injuries. Urol Clin North Am. 2006; 33(1):67-71, vi. Review/Other-Dx N/A Review diagnosis and treatment of injuries to the bladder. Diagnosis is made by a retrograde static cystogram performed by filling the bladder with contrast through a urethral catheter. 4
19. Chou CP, Huang JS, Wu MT, et al. CT voiding urethrography and virtual urethroscopy: preliminary study with 16-MDCT. AJR Am J Roentgenol. 184(6):1882-8, 2005 Jun. Review/Other-Dx 13 men CT voiding urethrography exams were prospectively performed with 16-MDCT to demonstrate CT voiding urethrography and CT virtual urethroscopy. The full urethral structure was clearly shown by CT voiding urethrography and virtual urethroscopy in all patients. The results of CT voiding urethrography and conventional methods correlated closely with the urethral diseases being imaged. 4
20. Kim B, Kawashima A, LeRoy AJ. Imaging of the male urethra. [Review] [47 refs]. Semin Ultrasound CT MR. 28(4):258-73, 2007 Aug. Review/Other-Dx N/A To describe imaging techniques, anatomy, and findings of various urethral and periurethral pathology in the male. Cross-sectional imaging techniques of US, CT and MRI have been increasingly used for urethral and periurethral abnormalities in recent times. These studies are useful as an adjunctive tool in patients with the complex anatomical derangements. 4
21. Koraitim MM, Reda IS. Role of magnetic resonance imaging in assessment of posterior urethral distraction defects. Urology. 2007; 70(3):403-406. Observational-Dx 21 men To determine value of MRI in the assessment of posterior urethral distraction defects. Compared MRI and urethrographic findings and correlated with operative findings. MRI findings were also correlated with the incidence of posttraumatic impotence. On MRI, the length of urethral defect and type of prostatic displacement could be correctly determined in 86% and 89% of the patients, respectively. MRI precisely delineated the extent of scar tissue and revealed the presence of paraurethral false tracks in 3 patients. MRI also showed avulsion of the corpus cavernosum, as well as lateral prostatic displacement in all 6 patients with posttraumatic impotence. 4
22. Jankowski JT, Spirnak JP. Current recommendations for imaging in the management of urologic traumas. Urol Clin North Am. 2006; 33(3):365-376. Review/Other-Dx N/A Review current recommendations for imaging in urologic traumas. Choice of modality is based on mechanism of injury and patient presentation. For pelvic injuries and gross hematuria, CT cystography or conventional cystography is recommended. For scrotal trauma when physical exam is inconclusive, US is recommended. For patients with penetrating trauma to the external genitalia, retrograde urethrography is recommended. 4
23. Stine RJ, Avila JA, Lemons MF, Sickorez GJ. Diagnostic and therapeutic urologic procedures. Emerg Med Clin North Am. 1988; 6(3):547-578. Review/Other-Dx N/A Review urologic procedures useful for the diagnosis and management of urinary tract disorders. Examine urinalysis, diagnostic radiologic modalities and urologic procedures. Retrograde cystourethrography is recommended for evaluation of the lower urinary tract. It should be performed whenever urethral or bladder injury is suspected. US is not usually recommended on an emergency basis despite its many advantages. 4
24. Baniel J, Schein M. The management of penetrating trauma to the urinary tract. J Am Coll Surg. 1994; 178(4):417-425. Review/Other-Dx N/A Review management of penetrating trauma to the urinary tract. IVP correctly diagnosed 16% of the cases while retrograde cystography demonstrated all perforations. Retrograde cystography is recommended in the assessment of injury to the bladder. 4
25. Carroll PR, McAninch JW. Major bladder trauma: the accuracy of cystography. J Urol. 1983; 130(5):887-888. Observational-Dx 51 patients To study accuracy of retrograde cystography in diagnosing traumatic bladder rupture. Extravasation was observed in 32 cases for which retrograde cystograms were available, including 3 (9%) in which additional infusion of contrast medium was required to demonstrate extravasation. Of the 32 cystograms 4 (13%) showed rupture on the drainage film only. If drainage radiographs and adequate distension of the bladder with contrast medium had been omitted, the rate of diagnostic accuracy of the cystogram would have been reduced to 79%. If attention is paid to adequate distension of the bladder with contrast material and to obtaining drainage films, diagnostic retrograde cystography for trauma should be almost totally accurate and delays or errors in diagnosis should be rare. 4
26. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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