Introduction & Objective :
Bladder rupture occurs in only 1.6% of blunt abdominopelvic trauma cases. Although rare, bladder rupture may result in significant morbidity if undiagnosed or inappropriately managed. AUA urotrauma guidelines suggest that urethral catheter drainage is a standard of care for both extraperitoneal and intraperitoneal bladder ruptures regardless of the need for surgical repair. However, no specific guidance is given regarding length of catheterization. The present study seeks to summarize management of bladder trauma at our center using 10 years of data, assess the impact of catheterization on bladder injuries and complications, and work towards a protocol for management of bladder injuries with respect to length of catheterization.
A retrospective review was performed on 34,413 blunt trauma cases to identify patients presenting with traumatic bladder ruptures over the past 10 years (January 2008 – January 2018) at our rural tertiary care facility. Patient data were collected including age, gender, BMI, mechanism of injury, and type of injury. The primary treatment modality (surgical vs catheter drainage), length of catheterization, and complications were also assessed.
Chart review identified 44 patients with bladder trauma. Mean age was 41.84 years, mean BMI was 24.8, 95% were Caucasian, and 55% were female. MVC was the most common mechanism, representing 45% of total injuries. Other mechanisms included falls (20%) and ATV accidents (13.6%). 31 patients had extraperitoneal injury and 13 were intraperitoneal. Pelvic fractures were present in 93% and 39% had additional solid organ injuries. Formal cystogram was performed in 59% on presentation and mean time to cystogram was 4 hours. Gross hematuria was associated with 95% of cases. Operative management was required of all intraperitoneal injuries and 35.5% of extraperitoneal cases. Bladder closure in operative cases was typically performed in 2 layers with absorbable suture in a running fashion. The intraperitoneal and extraperitoneal injuries managed operatively were compared and length of catheterization (28d v. 22d, p=0.46), time from injury to normal fluorocystogram (19.8d v. 20.7d, p=0.80), and time from injury to repair (4.3 v. 60.5h, p=0.23) were not statistically different between cohorts.
The present study provides a 10 year retrospective review characterizing the presentation, management, and follow up of bladder trauma patients at a rural tertiary care facility. Further study will seek to allow multidisciplinary trauma teams to standardize management, streamline care, and minimize complications for patients presenting with traumatic bladder injuries.