Bladder Injury

Description

• Blunt trauma is the most common mechanism
• 10% of pelvic fractures have serious bladder injury
• 80–90% of bladder ruptures have pelvic fracture
• Mortality: 17–22% overall; 60% if combined intraperitoneal/extraperitoneal rupture

Etiology

• Mechanism:
  • Trauma, 82%
  • Blunt trauma: Motor vehicle accident (MVA; 87%), falls (7%), assault (6%)
  • Penetrating: Gunshot wound (GSW) (85%), stabbings (15%)
  • Iatrogenic 14%: TURP and urologic procedures, gynecologic procedures, obstetric procedures, abdominal procedures, hernia repair, intrauterine device (IUD), orthopedic hip procedures, biopsies, indwelling Foley
  • Intoxication 2.9%
  • Spontaneous <1%
• Classification:
  • Extraperitoneal bladder rupture (62%):
    • Almost always associated with pelvic fractures
    • Caused by blunt force or fracture fragments
  • Intraperitoneal bladder rupture (25%):
    • Direct compression of distended bladder
    • Caused by rupture of the dome of the bladder
  • Combined extraperitoneal and intraperitoneal rupture (12%):
    • Highest mortality owing to associated injuries
  • Bladder contusion:
    • Damage to endothelial lining or muscularis layer with intact bladder wall
    • Gross hematuria after extreme physical activity (long-distance running)
    • Gross hematuria with normal imaging
    • Usually resolves without intervention

• In children, the bladder is an intra-abdominal organ and descends into the pelvis by age 20 yr
• Intraperitoneal rupture is more common in children than adults because the bladder is an abdominal organ
• Bladder injury is more common in children than in adults because the pediatric bony pelvis is less rigid and transmits more force to adjacent structures