Dr. med. Dirk Manski



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Bladder Injury and Trauma

Review literature: (Machtens et al, 2000).

Definition and Epidemiology of Bladder Injury

Injuries of the urinary bladder are caused by blunt or penetrating trauma. A less common pattern of injury is surgery of the pelvis or transurethral operations.

Etiology (Causes) of Bladder Injury

Pelvic Fracture:

Injury of the bladder due to a pelvic fracture is caused by perforation of the bladder by sharp fracture fragments. The location of the bladder injury is usually extraperitoneal.

Bladder Rupture:

If a filled bladder is exposed to a blunt trauma of the lower abdomen, the sudden pressure increase of the urinary bladder may cause a bladder rupture. The location of the bladder perforation is usually intraperitoneal at the bladder roof.

Sign and Symptoms of Bladder Injury

Pelvic fracture:

Pelvic pain, pelvic instability, shock, gluteal hematoma, abdominal tenderness.

Bladder Injury:

Hematuria, oligouria, lower abdominal pain, peritonitis, increasing retention parameters due to the resorption of urine.

Diagnostic Work-Up in Suspected Bladder Injury

X-ray of the pelvis, retrograde urethrography and cystography.

An abdominal CT with a contrast media filled bladder can substitute all above mentioned imaging studies except for retrograde urethrography.


fig. CT of an intraperitoneal bladder rupture injury   

CT of an intraperitoneal bladder rupture: bladder injury can be seen at the apex, in addition intraperitoneal fluid up to the diaphragma. Mit freundlicher Genehmigung, Prof. Dr. K. Bohndorf, Augsburg.


Treatment of Bladder Injury

Conservative Treatment:

Small extraperitoneal bladder injuries can be treated by inserting a transurethral catheter only. Important is the exclusion of fracture fragments, which protrude into the bladder and continue to maintain bladder perforation.

Surgical Treatment:

Surgical treatment is necessary for large extraperitoneal bladder injuries and all intraperitoneal bladder ruptures.

A midline laparotomy to the lower abdomen is done. Check the abdominal cavity for further injury. The bladder dome is opened and the bladder is inspected for injury. The injury is closed in three layers (mucosa – muscularis – peritoneum).







Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z



References

Machtens u.a. 2000 MACHTENS, S.. ; STIEF, C. G. ; HAGEMANN, J. ; PFINGST, G. ; GäNSSLEN, A. ; POHLEMANN, T. ; TRUSS, M. C. ; KUCZYK, M. A. ; BECKER, A. J. ; JONAS, U.:
Management traumatischer Läsionen von Harnblase und Urethra.
In: Urologe B
40 (2000), S. 560–571


  Deutsche Version: Verletzung der Harnblase