What type of urinary bladder pathology can occur during traumatic injury?

From the Guidelines

Bladder trauma can result in several pathological conditions, primarily bladder contusion, intraperitoneal bladder rupture, and extraperitoneal bladder rupture, which require different management approaches based on the severity and location of the injury. According to the guidelines by Coccolini et al. 1, the management of these conditions varies:

• Bladder contusion requires no specific treatment and might be observed clinically (GoR 1C) 1.
• Intraperitoneal bladder rupture should be managed by surgical exploration and primary repair (GoR 1B) 1.
• Extraperitoneal bladder injuries may be managed non-operatively, with urinary drainage via a urethral or suprapubic catheter in the absence of other indications for laparotomy (GoR 1C) 1. Some key points to consider in the management of bladder trauma include:
• The use of laparoscopy in repairing isolated intraperitoneal injuries in case of hemodynamic stability and no other indications for laparotomy (GoR 2B) 1.
• The consideration of urinary diversion via bladder and perivesical drainage or external ureteral stenting in case of severe intraperitoneal bladder rupture during damage control procedures (GoR 1C) 1.
• The importance of surgical repair of complex extraperitoneal bladder ruptures, such as those involving the bladder neck or associated with pelvic ring fracture and/or vaginal or rectal injuries (GoR 1C) 1.
• The recommendation for urinary drainage with a urethral catheter after surgical endoscopic realignment, with definitive surgical management delayed for 14 days if no other indications for laparotomy exist (GoR 1B) 1.
• The use of suprapubic cystostomy in pediatric patients (GoR 2C) 1. It is essential to note that the management of bladder trauma should be individualized based on the patient's specific condition, hemodynamic stability, and associated injuries.

From the Research

Types of Bladder Injuries

• Bladder contusions: a diagnosis of exclusion, often associated with blunt abdominal trauma 2
• Extraperitoneal bladder ruptures: almost exclusively associated with pelvic fractures, commonly managed conservatively with catheter drainage 3, 4
• Intraperitoneal ruptures: traditionally require surgical exploration and closure 3, 4

Diagnosis of Bladder Injuries

• Gross hematuria: a common indicator of bladder injury, especially in the setting of pelvic fractures 3, 4, 2
• Cystography: a procedure of choice for diagnosis of bladder injury, with retrograde cystogram having an accuracy rate of 95.9% 3
• CT cystography: has become the initial imaging method of choice in the acute setting, providing comparable accuracy to conventional cystography 5

Management and Outcome of Bladder Injuries

• Patient outcome is determined by the severity of injury, not by the severity of bladder injury 3
• Early detection and treatment are essential to reduce morbidity and mortality 4, 6
• Mortality rates for bladder rupture and ureteral injury are 8% and 7%, respectively 6