Adult Bladder Trauma Management

Abstract

Bladder injuries occur in up to 10% of abdominal trauma cases, contributing to significant morbidity and mortality (10–22%). These injuries may result from blunt or penetrating trauma, as well as iatrogenic damage during surgical procedures. Accurate diagnosis and timely intervention are crucial to minimizing complications.

Bladder injuries are classified into extraperitoneal (EP), intraperitoneal (IP), or combined types. Mechanisms of injury vary, with blunt trauma, predominantly from motor vehicle accidents, accounting for 60–85% of cases, and penetrating injuries, such as gunshot wounds, comprising 15–51%. Evaluation includes clinical assessment, cystography, and CT imaging, supplemented by cystoscopy for iatrogenic cases. Management strategies range from conservative catheterization to surgical repair, depending on injury type and severity. EP injuries, the most common type (63%), are frequently associated with pelvic fractures, whereas IP injuries (32%) typically result from blunt trauma to a distended bladder. Conservative management with catheter drainage suffices for most EP injuries; however, IP injuries necessitate surgical intervention to mitigate risks such as sepsis and peritonitis. Outcomes are influenced by concomitant injuries, which are often more critical than the bladder injury itself.

Advanced imaging modalities, particularly CT cystography, offer high sensitivity and specificity for bladder injury diagnosis. While conservative management is preferred for minor injuries, indications for surgical repair include significant extravasation, ongoing urinary leakage, or associated injuries. Multidisciplinary approaches are essential for comprehensive trauma care.
Bladder injuries are rare but carry substantial risks if unrecognized or inadequately treated. Timely diagnosis, guided by clinical suspicion and imaging, coupled with appropriate management strategies, is essential to optimize outcomes and reduce complications.