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- The bladder is well protected deep within the bony pelvis.
- Bladder injury is caused by trauma, iatrogenic surgical complication, or spontaneous rupture.
- The mechanism of traumatic injury is characterized as blunt or penetrating.
- Bladder injury can be classified as a contusion or rupture.
- Rupture is classified as intraperitoneal or extraperitoneal.
- Bladder injury is often associated with other traumatic injuries, most commonly pelvic fracture.
- 1.6% of blunt abdominal trauma cases have an associated bladder injury (1)[C].
- 80% of bladder injuries are associated with pelvic fracture.
- 10% of pelvic fractures are associated with bladder injury.
- 90% of bladder injuries due to blunt trauma are caused by motor vehicle collision (MVC).
- 15–40% of bladder rupture from penetrating trauma (2)[B]
- 85% secondary to gunshot wounds (GSW), 15% from stab wounds
- Bladder ruptures: 55% extraperitoneal, 40% intraperitoneal, and 5% combined (1)[C]
- The bladder is the most common organ damaged during pelvic surgery (1)[C].
- Obstetric injuries and gynecologic surgery are the most common causes of iatrogenic bladder injury.
Etiology and Pathophysiology
- Bladder contusion (1)[C]
- Damage to bladder mucosa or muscularis without full thickness injury, usually presenting with gross hematuria but no extravasation on cystogram
- Blunt bladder trauma is associated with rapid deceleration (1)[C].
- The bladder is well protected within the bony pelvis. It takes a significant amount of blunt force to cause a rupture.
- MVC, fall, or crush mechanism are most common.
- Fracture of the bony pelvis tears fascial attachments to the bladder, causing rupture.
- Bone fragments can directly lacerate the bladder, although this is less common.
- A blow to abdomen with a full bladder can lead to a rise in intravesical pressure and rupture at the dome with or without associated pelvic fracture.
- Penetrating bladder injuries (1)[C]
- GSW or stab injury to bladder
- Iatrogenic surgical injury
- Complication of open, laparoscopic, or robotic surgeries as well as cystoscopic procedure
- Spontaneous rupture (1)[C]
- Patients may have neurologic disease, bladder outlet obstruction, or prior urologic surgery.
- Rapid deceleration injury
- Pelvic fracture
- Penetrating trauma to the pelvis
- Prior pelvic surgery
- Prior pelvic radiation
- Seat belts
- Void prior to driving
Commonly Associated Conditions
80–94% blunt bladder trauma associated with injuries to other structures