Bladder trauma: Difference between revisions
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==Presentation== | ==Background== | ||
==Clinical Presentation== | |||
*Suprapubic pain, blood at meatus, inability to void | *Suprapubic pain, blood at meatus, inability to void | ||
*Gross hematuria is present in 95% of significant bladder injuries | *Gross hematuria is present in 95% of significant bladder injuries | ||
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***Clinical suspicion of bladder injury | ***Clinical suspicion of bladder injury | ||
**CT A/P w/ IV contrast NOT sensitive enough for bladder rupture | **CT A/P w/ IV contrast NOT sensitive enough for bladder rupture | ||
==Differential Diagnosis== | |||
{{Lower GU trauma DDX}} | |||
==Management== | ==Management== | ||
*Extraperitoneal Rupture | *Extraperitoneal Rupture | ||
Revision as of 03:39, 4 January 2015
Background
Clinical 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
- Extraperitoneal
Diagnosis
- 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
Differential Diagnosis
Genitourinary Trauma
- Urinary system
- Genital
- Other
- Child abuse
- Pelvic fracture (often accompanies)
- Sexual assault
Management
- Extraperitoneal Rupture
- Nonoperative management w/ bladder cathether drainage
- Intraperitoneal Rupture
- Operative management