Bladder trauma

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

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

• Bladder trauma
• Urethral trauma
• Testicular trauma
• Penile trauma
• Vaginal trauma
• Sexual assault
• Child abuse

Management

• Extraperitoneal Rupture
  • Nonoperative management with bladder cathether drainage (Foley vs suprapubic catheter)
• Intraperitoneal Rupture
  • Operative management

See Also

• GU Trauma

Authors

Ross Donaldson, Tianjiang Ye, Neil Young, Claire, Jordan Swartz, Daniel Ostermayer