North of Scotland major trauma guidelines
Classification
- Intraperitoneal (50%) – direct blow or sudden increase in abdominal pressure
- Extraperitoneal (40%) – usually form a pelvic fracture
- Combined.
Background
- RTCs and falls from height cause most bladder injuries.
- 75% of patients with bladder injuries have a pelvic fracture
- 55% of patients with a bladder injury have abdominal injuries.
- 13% of patients with a bladder injury will have a urethral injury
- 4% of patients with pelvic fractures will have a bladder injury.
Imaging
- Perform a CT cystogram in the following scenarios:
- Frank Haematuria and any Pelvic fracture
- Microscopic haematuria with
- >1cm displacement disruption of the pelvic ring or
- >1cm pubic symphysis diastasis
- Inability to void or inadequate urine output
- Abdominal tenderness or distension due to urinary ascites or signs of urinary ascites on imaging
- Uraemia and elevated creatinine due to intraperitoneal reabsorption
- Suspected penetrating traua.
Cystography must be performed using 400-500ml of dilute contrast (50/50) to fill the bladder.
Management
Conservative:
Extraperitoneal injuries are often managed conservatively with a urinary catheter and antibiotic prophylaxis.
Surgery:
Surgery should be performed in the following patients:
- Extraperitoneal Injuries AND:
- Bladder neck involvement
- Bone fragment in bladder wall
- Rectal or vaginal injury
- Entrapment of the bladder wall
- Patients undergoing ORIF for a pelvic fracture
- Patients undergoing a laparotomy for other injuries
- All intraperitoneal injuries
- All penetrating injuries (unless minor and isolated extraperitoneal).
Follow-up
Perform cystography in patients 10-14 days after injury.