0071643192.pdf

GENITOURINARY TRAUMA

Bladder

MECHANISMS

■ Usually due to blunt trauma, often associated with pelvic fracture

■ Bladder contusion: Hematoma causes bladder to change shape and shift

superiorly.

■ Intraperitoneal bladder rupture:Laceration of the dome of the bladder

with communication into peritoneum (see Figure 3.17)

■ Extraperitoneal bladder rupture: Laceration at bladder neck (no commu-

nication to peritoneum)

SYMPTOMS/EXAM

■ Abdominal pain and tenderness

■ Gross hematuria

■ Inability to void

■ Peritonitis (if intraperitoneal rupture)

DIAGNOSIS

■ Retrograde cystogram (plain film or CT)–300 mL (5 mL/kg in children) of

contrast is instilled into bladder via a Foley catheter.

■ Intraperitoneal rupture: Contrast will leak into cul-de-sac posterior to

bladder.

■ Extraperitoneal rupture: Contrast will extravasate into surrounding tissue

in a flame pattern.

TREATMENT

■ Surgery necessary only for intraperitoneal ruptureand penetrating injuries.

■ Catheter placement for incomplete lacerations or extraperitoneal rupture.

■ No intervention necessary for contusions.

TRAUMA

FIGURE 3.17. Intraperitoneal bladder rupture seen on retrograde cystogram with con-

trast surrounding loops of bowel.

(Reproduced, with permission, from Tanagho EA, McAninch JW. Smith’s General Urology,

17th ed. New York: McGraw-Hill, 2008:290.)

Isolated microscopic

hematuria does not mandate

further imaging.

Exceptions include:

■Rapid deceleration injuries

where renal pedicles can be

damaged with minimal to

no hematuria

■Hematuria in a patient with

even transient hypotension

■Hematuria following

penetrating trauma to the

flank

Degree of hematuria does not

always correlate with the

degree of injury.

IVP or cystogram in patients

who have received oral

contrast may be difficult to

interpret due to a background

of abdominal contrast.