Bladder trauma

Presentation

• Suprapubic pain, blood at meatus, inability to void
• Gross hematuria is present in 95% of significant bladder injuries
  • Pelvic fracture + gross hematuria = bladder rupture
  • <1% of all blunt bladder injuries p/w UA w/ <25 RBCs/HPF
• Bladder Rupture
  • Extraperitoneal
    • Assoc w/ pelvic fx and laceration by bony fragments
    • Leakage of urine into perivesicular space
    • "Tear drop" shape on imaging
  • Intraperitoneal
    • Assoc w/ compresive force in presence of full bladder

Management

• Imaging
  • Retrograde cystogram (CT or plain film) indicated for:
  • Gross hematuria
    • Inability to void
    • Pelvic fx in assoc w/ microscopic hematuria
    • Clinical suspicion of bladder injury
  • CT A/P w/ IV contrast NOT sensitive enough for bladder rupture
• Treatment
  • Extraperitoneal rupture - nonoperative management with bladder cathether drainage
  • Intraperitoneal rupture - primary surgical repair

See Also

GU Trauma