Major Bladder Trauma: Mechanisms of Injury and a Unified Method of Diagnosis and Repair

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Abstract
Cases (51) of bladder trauma seen between 1976-1981 were reviewed. There were 32 nonpenetrating, 13 penetrating, 1 spontaneous and 5 iatrogenic injuries. Rupture of the bladder was confirmed at operation in all but 1 case. Extraperitoneal rupture was noted in 32 patients (62%), intraperitoneal rupture in 13 (25%), and combined intraperitoneal and extraperitoneal rupture in 6 (12%). The most frequent clinical features were gross hematuria, abdominal tenderness and shock. Associated pelvic fractures were present in 30 of the 31 nonpenetrating ruptures. The most common area of bladder rupture was the dome in nonpenetrating injuries (35%) and the lateral wall in penetrating injuries (42%). Associated organ injuries were common (62% of penetrating injuries and 93% of nonpenetrating injuries). Cystography, including the use of drainage films, was accurate in all cases for which it was used. Mortality in this series was 22% and reflects the severity of associated organ injury. Risk factors include older age status, pedestrian injuries and extensive associated organ injury rather than type of bladder rupture. To minimize mortality and morbidity in this high risk group of patients strict attention should be directed to rapid resuscitation, early diagnosis including cystography with drainage films and anticipation of associated organ injury at operation.