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Bladder Injury and Trauma
Definition and Epidemiology of Bladder Injury
Injuries of the urinary bladder are caused by pelvic fracture, blunt or penetrating trauma or iatrogenic injury (Machtens u.a., 2000). EAU Guidelines: Urological Trauma.
Etiology (Causes) of Bladder Injury
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.
If a filled bladder is exposed to a blunt trauma of the lower abdomen (most commen high-velocity accidents), 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 dome.
Stab or gunshot wounds to the lower abdomen cause intraperitoneal bladder injury and and concurrent injury of the bowel or large vessels.
by pelvic or transurethral surgery: caesarean section, vaginal hysterectomies, retropubic slings and transurethral resection of the bladder.
Sign and Symptoms of Bladder Injury
Pelvic pain, pelvic instability, shock, gluteal hematoma, abdominal tenderness.
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) and provides additional information about concurrent 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
Small extraperitoneal bladder injuries can be treated by inserting a transurethral catheter only. Important is the exclusion of bone fragments, which protrude into the bladder and continue to maintain bladder perforation.
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
- 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