Bladder trauma: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Suprapubic pain, blood at meatus, | *Suprapubic pain, blood at meatus, [[urinary retention]] | ||
*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 with <25 RBCs/HPF | **<1% of all blunt bladder injuries p/w UA with <25 RBCs/HPF | ||
*Bladder Rupture | *Bladder Rupture | ||
Revision as of 16:35, 5 September 2016
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
- Extraperitoneal
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
- 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