Bladder Injury



  • 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


  • 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

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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