Trauma: Bladder Trauma

Bladder Trauma

General

  • Most Common in Blunt Trauma
  • 90% Associated with Pelvic Fractures
    • Most Common Associated Fracture: Obturator Ring

AAST Bladder Injury Scale

Bladder Trauma 1

Diagnosis

  • Sx: Gross Hematuria (Very Reliable, 95-100%), Pain & Low Urine Output
  • Dx: CT Cystography (Inject ≥ 300 cc Contrast Through Foley)
    • Intraperitoneal Leak: Outlines Loops of Bowel or Fills Cul-De-Sac
    • Extraperitoneal Leak: Flame or Starbursts
    • If Conventional Cystography (XR Fluoroscopy) Must Obtain Post-Drainage Films

Treatment

  • Extraperitoneal Rupture:
    • Uncomplicated: Foley (7-14 Weeks)
    • Complicated: Surgical Repair
      • Indications:
        • Open Pelvic Fracture with Bone Exposed in Bladder Lumen
        • Concurrent Vaginal/Rectal Injury (Risk for Fistula)
        • Bladder Neck Injury
        • Persistent Hematuria/Clots (Will Obstruct Foley)
  • Intraperitoneal Rupture: Surgical Repair & Foley
    • Use Absorbable Sutures in 2 Layers (Permanent Irritate Mucosa & Are Lithogenic)
    • Cystogram Every 7-10 Days to Evaluate for Foley Removal

Intraperitoneal Bladder Injury 2

Extraperitoneal Bladder Injury 3

References

  1. Ojewola RW, Tijani KH, Badmus OO, Oliyide AE, Osegbe CE. Extraperitoneally Ruptured, Everted, and Prolapsed Bladder: A Very Rare Complication of Pelvic Injury. Case Rep Urol. 2015;2015:476043. (License: CC BY-3.0)
  2. Vagholkar K, Vagholkar S. Posttraumatic Haematuria with Pseudorenal Failure: A Diagnostic Lead for Intraperitoneal Bladder Rupture. Case Rep Emerg Med. 2016;2016:4521827. (License: CC BY-4.0)
  3. Kim JH, Ha YC, Kim TH, Myung SC, Moon YT, Kim KD, Chang IH. Delayed presentation of intravesical bone penetration after pelvic ring fracture. Korean J Urol. 2012 Dec;53(12):887-9. (License: CC BY-NC-3.0)