Bladder and urethral injuries

Dr Tim Fotheringham
The Royal London Hospital, UK
Nordic Trauma Society, Oslo 2008

Bladder trauma
Blunt trauma 90%
Penetrating trauma
10% pelvic fractures
have bladder injury
85-94% have pelvic
fractures
 Immediate concerns
20-44% Mortality
Haemorrhage
Pelvis
Abdo organs
Other sites
Sepsis
Rectal injury
 Cystography
No firm guidelines
Retrospective studies
Blunt and penetrating trauma
Haematuria not quantified
 4 centre experience
53/53 10% gross haematuria
45/53 85% pelvic fracture
38/53 72% axial bone fracture
12/53 23% urethral injury
6/53 11% blood at meatus
3/53 6% high riding prostate
J Trauma 2001;51:683-6
 Diagnosis
CT alone 13%
Cystogram alone 46%
CT and cystogram 13%
Laparotomy 28%
CT and CT cystogram now preferred

J Trauma 2001;51:683-6

Blunt trauma
Pelvic fracture
Gross haematuria: 29%
Microhaematuria 0.6%
Gross haematuria/no pelvic fracture
Usually renal
0.4% have bladder and renal injuries
 CT classification
1 Bladder contusion
2 Intraperitoneal rupture
3 Interstitial bladder injury
4 Extraperitoneal rupture
A simple
B complex (bladder neck involved)
5 Combined bladder injury
Sandler et al Radiology 1986

CT cystography
Urinary bladder catheterisation
Contrast 50mls of 300mg/ml with 450 of
saline
CT scan performed after administration of
250-300mls via urinary catheter
Post drainage images not required
Extraperitoneal bladder rupture
Pelvic vessels
Complex extraperitoneal injury
Bladder herniation
Post operative intraperitoneal rupture

Bladder neck injury

 Management of bladder injuries
Contusions, interstitial damage and simple
extraperitoneal rupture managed by bladder
decompression with urinary catheter
Intraperitoneal and complex extraperitoneal
and combined injuries need to be managed
surgically
 Urethral trauma
With pelvic fracture seen in
25% males
6% females
Blind urethral catheterization in trauma patients
suffering from lower urinary tract injuries not
associated with worsening of injury
Shlamovitz GL and McCullough L.. J Trauma.
2007;62:330-35.

Urethral trauma
Failure of urethral
catheterisation
Suprapubic catheter
inserted
Urethrogram
performed
Surgical repair
Membranous urethra
 Conclusion
High incidence with pelvic fractures
Haematuria nearly always present
Gentle urethral catheterisation
Surgery for:
Haemorrhage control
Intraperitoneal bladder rupture
Bladder and urethral injury
Urethral transection
Foley catheter initial treatment for simple
extraperitoneal bladder rupture
Thank you

The END