Bladder injury

Bladder injury

OVERVIEW:

Due to its well protected location, bladder rupture is unusual. Injury most often secondary to penetrating or blunt trauma and classified as contusion, intraperitoneal or extraperitoneal rupture.

System(s) affected: Renal/Urologic
Genetics: N/A
Incidence/Prevalence in USA: N/A
Predominant age: N/A
Predominant sex: N/A

SIGNS AND SYMPTOMS:

• Suprapubic pain
• Urinary retention
• Hematuria (94%)
• Muscle rigidity over lower abdomen
• No peritonitis

CAUSES:

• Forceful blunt or penetrating blow to lower abdomen, particularly with a full bladder

RISK FACTORS:

• Distended bladder at the time of trauma
• Congenital malformation of bladder
• Prior pelvic or bladder surgery
• Frequently associated with pelvic fractures

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS:

• Rupture of the urethra
• Rupture of abdominal viscus
• Pelvic fracture with hematoma

LABORATORY:

Hematuria on urinalysis

Drugs that may alter lab results: None
Disorders that may alter lab results: None

PATHOLOGICAL FINDINGS:

• Jagged irregular tear in the bladder
• Perforation at the dome of bladder near urachus (blunt trauma)
• Extensive perivesical hematoma

SPECIAL TESTS:

None

IMAGING:

• Cystogram with drain out film
• Urethrogram

DIAGNOSTIC PROCEDURES:

• Rarely is cystoscopy indicated

TREATMENT

APPROPRIATE HEALTH CARE:

Inpatient

GENERAL MEASURES:

• Extraperitoneal rupture, insert foley, admit, comfort care
• Antibacterial coverage, broad spectrum
• Anticholinergics for spasm
• Pain medication as required
• Catheter removal in 10-14 days

SURGICAL MEASURES:

• Intraperitoneal rupture, immediate surgical repair
• Blunt trauma, contusion, comfort care
• Penetrating injury, exploration, surgical repair

ACTIVITY:

Full activity when associated injuries permit

DIET:

No special diet

PATIENT EDUCATION:

Printed material available from multiple sources

MEDICATIONS

DRUG(S) OF CHOICE:

• Broad spectrum coverage, ciprofloxacin (Cipro) 500 mg bid
• Opium and belladonna suppositories q 6-8 hr prn spasms
• Oxybutynin (Ditropan) 5-10 mg tid for spasms
• Adequate pain control as required

Contraindications: Refer to manufacturer's profile of each drug
Precautions: Avoid quinolones (e.g., ciprofloxacin) in children
Significant possible interactions: Refer to manufacturer's profile of each drug

ALTERNATIVE DRUGS:

• Other quinolones
• Other antispasmodics; e.g., flavoxate

FOLLOW UP

PATIENT MONITORING:

• Cystogram repeat in 7-10 days
• Remove catheter when bladder sealed
• Periodic check for infection and stricture formation

PREVENTION/AVOIDANCE:

• Use seat belts
• Auto air bag

POSSIBLE COMPLICATIONS:

• Infection
• Fistula formation (rare)
• Peritonitis (rare)

EXPECTED COURSE AND PROGNOSIS:

• Complete recovery
• Stricture (uncommon) - only long term complication

MISCELLANEOUS

ASSOCIATED CONDITIONS:

• Frequently associated with pelvic fractures

AGE-RELATED FACTORS:

Pediatric: Position of bladder makes intraperitoneal rupture more common
Geriatric: N/A
Others: N/A

PREGNANCY:

N/A

SYNONYMS:

N/A

ICD-9-CM:

596.9 Unspecified disorder of bladder

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Medical Diagnosis » B » Bladder injury