Bladder Trauma Overview

Bladder Trauma

• Bladder trauma can be intraperitoneal (20%) or extraperitoneal (80%).
• Intraperitoneal rupture is often caused by a blow or fall on a distended bladder, or rarely by surgical damage.
• Extraperitoneal rupture is usually due to blunt trauma or surgical damage.
• Symptoms of intraperitoneal injury may include sudden severe pain in the lower abdomen, often accompanied by fainting. The abdomen may swell, urination may not be possible, and peritonitis (inflammation of the abdomen) might not immediately follow if the urine is sterile.
• Gross hematuria (blood in the urine) may or may not be present.
• Diagnosing a bladder injury can be done with a CT scan (computed tomography). An IVU (intravenous urogram) or retrograde cystography can also confirm the leak.
• Treatment for intraperitoneal injury often involves a laparotomy (abdominal incision) to suture the bladder with absorbable sutures. A suprapubic catheter and a urethral catheter are typically inserted.

Injury to Bladder Due to Surgery

• During surgery, the bladder can be injured in certain procedures.
• Examples include inguinal or femoral herniotomy, hysterectomy, or rectum excision.
• If the injury is identified, the bladder must be repaired and catheter drainage maintained for at least 7 days.

Acute Retention of Urine (Causes)

• Male: Bladder outlet obstruction, urethral stricture, acute urethritis or prostatitis, phimosis.
• Female: Retroverted gravid uterus, bladder outlet obstruction.
• Both (male and female): Blood clot, urethral calculus, rupture of the urethra, neurogenic bladder, fecal impaction, anal pain, intensive post-operative analgesic treatment, spinal anesthesia, and certain medications (like antihistamines, anticholinergics, antihypertensives, and tricyclic antidepressants).

Extraperitoneal Bladder Injury (Endoscopic Resection)

• Drainage of the bladder with a urethral catheter and antibiotic administration often resolves extraperitoneal injuries during endoscopic resection.
• Laparotomy may be needed if intraperitoneal perforation occurs during transurethral resection.

Chronic Retention of Urine

• Chronic retention is often painless, leading to a higher risk of upper urinary tract dilation due to high intravesical pressure.
• Patients with impaired kidney function may develop post-obstructive diuresis (excessive urination), so careful monitoring and normal saline replacement are necessary.
• The distended urinary bladder may cause hematuria (blood in the urine). Often ignored, neglected chronic retention causes overflow incontinence.

Acute Neuropathic Bladder

• Spinal shock after spinal cord injury can cause a temporary inability of the bladder to contract.
• Overflow incontinence occurs due to bladder distention, and if neglected, damage to the bladder, infection, and kidney failure can occur.
• Bladder emptying during spinal shock necessitates catheterization.

Treatment for Acute Urinary Retention

• Encourage high fluid intake.
• Commence intermittent catheterization.
• Perform a full urodynamic study once the patient is stable.