Bladder trauma

Background

Clinical Features

  • Suprapubic pain, blood at meatus, urinary retention
  • 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 with <25 RBCs/HPF
  • Bladder Rupture
    • Extraperitoneal
      • Associated with pelvic fracture and laceration by bony fragments
      • Leakage of urine into perivesicular space
      • "Tear drop" shape on imaging
    • Intraperitoneal
      • Associated with compressive force in presence of full bladder

Evaluation

  • Imaging
    • Retrograde cystogram (CT or plain film) indicated for:
      • Gross hematuria
      • Inability to void
      • Pelvic fracture in associated with microscopic hematuria
      • Clinical suspicion of bladder injury
      • Penetrating injuries of the buttock, pelvis, or lower abdomen with any hematuria
    • CT A/P with IV contrast NOT sensitive enough for bladder rupture: bladder must be distended with 350mL contrast

Differential Diagnosis

Genitourinary trauma

Management

  • Extraperitoneal Rupture
    • Nonoperative management with bladder cathether drainage (Foley vs suprapubic catheter)
  • Intraperitoneal Rupture
    • Operative management

See Also