Bladder Trauma & Retention PDF

# Bladder trauma This can be intraperitoneal 20%, extraperitoneal 80% ## What are the causes of bladder injury? * Intraperitoneal rupture is usally due to blow or fall on a distended bladder and more rarely due to surgical damage. * Extraperitoneal is usually due to blunt trauma or surgical damage....

# Bladder trauma This can be intraperitoneal 20%, extraperitoneal 80% ## What are the causes of bladder injury? * Intraperitoneal rupture is usally due to blow or fall on a distended bladder and more rarely due to surgical damage. * Extraperitoneal is usually due to blunt trauma or surgical damage. ## What are the suspected features of bladder injury? * Gross hematuria may be absent. * Intraperitoneal injury is associated with sudden sever pain in hypogastrium often accompanied by syncope. * Abdomen is distended and there is no desire to urinate. * Peritonitis does not follow immediately if urine is sterile. ## Who we can confirm the diagnosis? * CT scan is ideal investigation. * IVU may confirm the leak. * Retrograde cystography will confirm the diagnosis. ## Treatment of intraperitoneal injury: * Laparotomy: suturing of bladder by single layer 2/0 absorbable suture. * A suprapubic and urethral catheter are placed. ## Injury to bladder due to surgery The bladder may be injured in: 1. Inguinal or femoral herniotomy 2. hysterectomy 3. excision of rectum If the injury is recognized the bladder must be repaired and catheter drainage for 7 days. When extraperitoneal bladder injury occur during endoscopic resection, drainage of the bladder with a urethral catheter and administration of antibiotics usually suffice. A laparotomy will usually be required if an intraperitoneal perforation is caused by transurethral resection. # Acute retention of urine ## Causes ### Male 1. bladder outlet obstruction. 2. Urethral stricture. 3. Acute urethritis or prostatitis. 4. Phimosis. ### Female 1. Retroverted gravid uterus 2. Bladder outlet obstruction (rare) ## Both (male and female) 1. Blood clot 2. Urethral calculus 3. Rupture of urethra 4. Neurogenic bladder 5. Fecal impaction 6. Anal pain (haemorrhoidectomy) 7. Intensive postoperative analgesic treatment 8. Spinal anesthesia 9. Some drugs such as antihistamine, anticholinergics, antihypertensive and tricyclic antidepressant drugs ## Who is the patient with acute retention of urine present to you? 1. No urine is passed for several hours 2. Pain is present 3. The bladder is visible, palpable, tender and dull to percussion 4. Potential neurological causes should be excluded by checking reflexes in lower limbs and perianal sensation. ## Treatment Is to pass a fine urethral catheter (14 F-french guage is defined as the circumference in millimeters) and arrange urological management. If catheter not passed it is usually due to poor technique, lack of anesthesia, trauma of urethra or urethral stricture. If catheter cannot be passed a suprapubic catheter should be used. # Chronic retention of urine In chronic retention the re is no pain so the patient at risk of upper urinary tract dilatation because of high intravesical tension. Patient with impaired renal function may develop post obstructive diuresis and needs careful monitoring with replacement of losses with normal saline. They are also at risk of hematuria as the distended urinary bladder empties. Neglected retention of urine may cause overflow incontinence. # Acute neuropathic bladder Immediately after spinal cord injury, spinal shock occurs which may last for days or months. The detrusor cannot be contract, the bladder distended and overflow incontinence occur. Neglected bladder distension will leads to damage to detrusor, infection and may be renal failure ## The management should be 1. The bladder should be emptied during spinal shock by catheterization 2. Encourage high fluid intake 3. Commence intermittent catheterization 4. When patient is stable undertaken full urodynmic study.