Bladder trauma: Difference between revisions
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*Gross hematuria is present in 95% of significant bladder injuries | *Gross hematuria is present in 95% of significant bladder injuries | ||
**Pelvic fracture + gross hematuria = bladder rupture | **Pelvic fracture + gross hematuria = bladder rupture | ||
**<1% of all blunt bladder injuries p/w UA | **<1% of all blunt bladder injuries p/w UA with <25 RBCs/HPF | ||
*Bladder Rupture | *Bladder Rupture | ||
**Extraperitoneal | **Extraperitoneal | ||
***Assoc | ***Assoc with pelvic fracture and laceration by bony fragments | ||
***Leakage of urine into perivesicular space | ***Leakage of urine into perivesicular space | ||
***"Tear drop" shape on imaging | ***"Tear drop" shape on imaging | ||
**Intraperitoneal | **Intraperitoneal | ||
***Assoc | ***Assoc with compresive force in presence of full bladder | ||
==Diagnosis== | ==Diagnosis== | ||
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**Gross hematuria | **Gross hematuria | ||
***Inability to void | ***Inability to void | ||
***Pelvic fracture in assoc | ***Pelvic fracture in assoc with microscopic hematuria | ||
***Clinical suspicion of bladder injury | ***Clinical suspicion of bladder injury | ||
**CT A/P | **CT A/P with IV contrast NOT sensitive enough for bladder rupture | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Management== | ==Management== | ||
*Extraperitoneal Rupture | *Extraperitoneal Rupture | ||
**Nonoperative management | **Nonoperative management with bladder cathether drainage | ||
*Intraperitoneal Rupture | *Intraperitoneal Rupture | ||
**Operative management | **Operative management | ||
Revision as of 06:09, 12 July 2016
Background
Clinical Features
- 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 with <25 RBCs/HPF
- Bladder Rupture
- Extraperitoneal
- Assoc with pelvic fracture and laceration by bony fragments
- Leakage of urine into perivesicular space
- "Tear drop" shape on imaging
- Intraperitoneal
- Assoc with compresive force in presence of full bladder
- Extraperitoneal
Diagnosis
- Imaging
- Retrograde cystogram (CT or plain film) indicated for:
- Gross hematuria
- Inability to void
- Pelvic fracture in assoc with microscopic hematuria
- Clinical suspicion of bladder injury
- CT A/P with 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 with bladder cathether drainage
- Intraperitoneal Rupture
- Operative management