Bladder Trauma Guidelines

Updated: Mar 26, 2019
  • Author: Bradley C Gill, MD, MS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Guidelines Summary

Guidelines for the treatment of bladder trauma have been released by the following organizations:

  • American Urological Association (AUA)
  • European Association of Urology (EAU)

The guidelines concur on the following recommendations [4, 27] :

  • Retrograde cystography (plain film or CT) should be performed in stable patients with gross hematuria and pelvic fracture 
  • Uncomplicated extraperitoneal bladder injuries should be treated by catheter drainage 
  • Complicated extraperitoneal bladder injury should be treated by surgical repair
  • Intraperitoneal bladder rupture in the setting of blunt or penetrating external trauma must be treated by surgical repair

Additional recommendations from the AUA include: [4]

  • Retrograde cystography should be performed in stable patients with gross hematuria and a mechanism concerning for bladder injury, or in those with pelvic ring fractures and clinical indicators of bladder rupture
  • Following surgical repair of bladder injuries, urethral catheter drainage without suprapubic (SP) cystostomy should be performed

Additional recommendations from the EAU include [27] :

  • Cystography should be performed with filling of the bladder with at least 350 mL of dilute contrast. Passive bladder filling by clamping the catheter during the excretory phase of CT or IVP is insufficient for diagnosis. 
  • Cystoscopy should be performed after suburethral sling operations via the retropubic route and after major gynaecological operations. It is optional after any other type of sling procedure or transvaginal mesh procedure.
  • Conservative management is an option for small, uncomplicated, iatrogenic intraperitoneal bladder perforations