eMedicine Specialties > Urology > Trauma

Bladder Trauma: Follow-up

Author: Raymond Rackley, MD, Professor of Surgery, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University; Staff Physician, Center for Pelvic Medicine and Pelvic Reconstruction, Glickman Urological Institute, Cleveland Clinic Foundation
Coauthor(s): Sandip P Vasavada, MD, Physician, Center for Female Pelvic Medicine and Genitourinary Reconstructive Surgery, The Glickman Urological and Kidney Institute; Joint Appointment with Women's Institute, Cleveland Clinic; Benjamin S Battino, MD, Consulting Staff, Urology Specialists of Wisconsin
Contributor Information and Disclosures

Updated: Aug 17, 2009

Outcome and Prognosis

Traumatic bladder ruptures, once uniformly fatal, are currently managed quite successfully. Timely evaluation and proper management are critical for optimal outcomes.

Gross hematuria is the hallmark of bladder injury. Physicians evaluating patients with blunt or penetrating lower abdominal trauma must have a high index of suspicion for urologic injury, especially bladder and urethral injuries.

Almost all extraperitoneal bladder ruptures are associated with pelvic fractures. Most extraperitoneal ruptures can be treated conservatively with catheter drainage alone; however, ensure that all intraperitoneal, combined intraperitoneal and extraperitoneal ruptures, and penetrating injuries are treated with immediate exploration and repair in the operating room.

Future and Controversies

Proper treatment of tiny intraperitoneal bladder perforations resulting from urologic transurethral instrumentation is controversial. Most authorities recommend an abdominal exploration and closure of the bladder perforation. Others advocate conservative management with an indwelling urethral Foley catheter and prolonged bladder rest. Currently, no published data support conservative management.

 


More on Bladder Trauma

Overview: Bladder Trauma
Treatment: Bladder Trauma
Follow-up: Bladder Trauma
Multimedia: Bladder Trauma
References
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References

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Further Reading

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Keywords

bladder trauma, ruptured bladder, bladder laceration, bladder injury, bladder rupture, bladder extravasation, bladder perforation, urinoma, pelvic fracture, urologic injury, crush injury, open book fracture

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Contributor Information and Disclosures

Author

Raymond Rackley, MD, Professor of Surgery, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University; Staff Physician, Center for Pelvic Medicine and Pelvic Reconstruction, Glickman Urological Institute, Cleveland Clinic Foundation
Raymond Rackley, MD is a member of the following medical societies: American Urological Association
Disclosure: Pfizer, Novartis, Proctor & Gamble, Allergan Honoraria None; Pfizer, Novartis, Proctor & Gamble, Allergan Consulting fee Other

Coauthor(s)

Sandip P Vasavada, MD, Physician, Center for Female Pelvic Medicine and Genitourinary Reconstructive Surgery, The Glickman Urological and Kidney Institute; Joint Appointment with Women's Institute, Cleveland Clinic
Sandip P Vasavada, MD is a member of the following medical societies: American Urogynecologic Society, American Urological Association, International Continence Society, and Society for Urology and Engineering
Disclosure: pfizer Honoraria Speaking and teaching; allergan Consulting fee Consulting; ndi medical, LLC Ownership interest Review panel membership; novartis Honoraria Speaking and teaching

Benjamin S Battino, MD, Consulting Staff, Urology Specialists of Wisconsin
Benjamin S Battino, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Shlomo Raz, MD, Professor, Department of Surgery, Division of Urology, University of California at Los Angeles School of Medicine
Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, and California Medical Association
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Bradley Fields Schwartz, DO, FACS, Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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