Bladder Injuries: Evaluation and Management

Bladder rupture is rare and is often associated with other serious injuries and a high mortality rate. The preferred evaluation is by retrograde computed tomography (CT) cystogram to classify the injury as intra or extraperitoneal. Intraperitoneal injuries will always require open repair, while extraperitoneal injuries can be managed with catheter drainage alone in a majority of cases, with some notable absolute exceptions (bone fragment projecting into the rupture, open pelvic fracture, and rectal perforation). Other relative indications for open repair of extraperitoneal ruptures include associated intraperitoneal injuries requiring laparotomy and pelvic fractures requiring open anterior repair, when the bladder can be repaired without subjecting the patient to additional surgery. Acute complications after repair are uncommon (5%), primarily clot retention and infection. Chronic complications after repair are also uncommon (5%), primarily frequency, urgency and dysuria. Patients with extraperitoneal ruptures treated conservatively have higher rates of acute complications (12-26%), and these tend to be more serious (fistula, failure to heal, sepsis). Chronic complications are also more common in this population (21%) and include bladder neck stricture and frequency/urgency.