Bladder trauma: Difference between revisions
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==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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**Intraperitoneal | **Intraperitoneal | ||
***Assoc w/ compresive force in presence of full bladder | ***Assoc w/ compresive force in presence of full bladder | ||
== | |||
==Diagnosis== | |||
*Imaging | *Imaging | ||
**Retrograde cystogram (CT or plain film) indicated for: | **Retrograde cystogram (CT or plain film) indicated for: | ||
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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 | ||
==Management== | |||
*Extraperitoneal rupture - nonoperative management with bladder cathether drainage | |||
*Intraperitoneal rupture - primary surgical repair | |||
==See Also== | ==See Also== | ||
Revision as of 03:51, 13 June 2012
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
Management
- Extraperitoneal rupture - nonoperative management with bladder cathether drainage
- Intraperitoneal rupture - primary surgical repair