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

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Basics

Description

  • 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.

Epidemiology

Incidence
  • 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.

Pediatric Considerations
Lower rates of bladder injury in children with blunt trauma and pelvic fracture (1)[C]

Risk Factors

  • Rapid deceleration injury
  • Pelvic fracture
  • Penetrating trauma to the pelvis
  • Prior pelvic surgery
  • Prior pelvic radiation

General Prevention

  • Seat belts
  • Void prior to driving

Commonly Associated Conditions

80–94% blunt bladder trauma associated with injuries to other structures

  • Pelvic fracture is the most common associated injury.
  • Urethral injury occurs in 15% of cases of bladder rupture (1)[C].

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Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Bladder Injury ID - 116077 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116077/all/Bladder_Injury PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -