Examining the Impact of Renal Trauma Guidelines on Urologists in UK.

Objective: To investigate whether urologists in UK utilise and adhere to recently published renal trauma guidelines.

Methods: A one-page anonymous questionnaire was created based on recently published guidelines. Thirteen questions were used to investigate the current patterns of practice. The questionnaire was posted to 500 consultants in UK.

Results: Out of 500 questionnaires, 152 (30%) were returned; 109 (70%) respondents saw an estimated five or less cases of renal trauma per year; 104 (71%) respondents used guidelines but these differed; 79 (52%) respondents believed that the published guidelines were appropriate for UK practice; 8 (5%) did not feel that they were appropriate and 48 (32%) were unsure, and 30 (20%) used local guidelines. In stable patients with dipstick hematuria, 121 (80%) respondents requested imaging with ultrasound (76) the most popular. In stable patients with gross hematuria, all respondents requested imaging with CT scanning (126) the most popular. In stable children with suspected renal trauma, all respondents who managed pediatric cases would request imaging. Re-imaging following initial ultrasound was common. Imaging was described as easy or possible to obtain during regular working hours by 147 (97%) respondents. This fell to 131 (86%) out of hours with 14 (9%) respondents having difficulty with obtaining imaging. Only 27 (18%) respondents had interdepartmental protocols to facilitate the imaging process in suspected renal trauma.

Conclusion: Only 74 (50%) responding urologists utilized the recently published guidelines in the management of renal trauma, and adherence to the recommendations - by those urologists who claimed to use the guidelines - was very variable. To facilitate the best practice in the management of renal trauma, it would be ideal if urologists and trauma surgeons were encouraged to adhere to established guidelines. As diagnostic imaging has a crucial role in the majority of cases, informed discussion with the local radiology department would probably help in achieving the standards required.