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Bladder Injury

Bladder Injury is a topic covered in the 5-Minute Emergency Consult.

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Basics

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%):
      • 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

Pediatric Considerations
  • 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.

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Citation

Rosen, Peter, et al., editors. "Bladder Injury." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307455/all/Bladder_Injury.
Bladder Injury. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307455/all/Bladder_Injury. Accessed April 25, 2019.
Bladder Injury. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307455/all/Bladder_Injury
Bladder Injury [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307455/all/Bladder_Injury.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Bladder Injury ID - 307455 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307455/all/Bladder_Injury PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -