Bladder trauma

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

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
  • Renal trauma
  • Ureter trauma
  • Bladder trauma
  • Urethral trauma
    • Traumatic foley catheter removal
• Genital
  • Penile trauma
    • Traumatic foley catheter removal
  • Testicular trauma
  • Vaginal trauma
• Other
  • Child abuse
  • Pelvic fracture (often accompanies)
  • Sexual assault

Management

• Extraperitoneal Rupture
  • Nonoperative management with bladder cathether drainage
• Intraperitoneal Rupture
  • Operative management

See Also

• GU Trauma