External Bladder Trauma (Injury)

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External bladder injuries are caused by either blunt or penetrating trauma to the lower abdomen, pelvis, or perineum. Blunt trauma is the more common mechanism, usually by a sudden deceleration, such as in a high-speed motor vehicle crash or fall, or from an external blow to the lower abdomen. The bladder is the most frequently injured organ during pelvic surgery.

Causes

Injury during transurethral surgery

Gynecologic procedures like abdominal hysterectomy, cesarean section, pelvic mass excision,

Colon resection

Scar from prior surgery 

Radiation therapy

Inflammation

Extensive tumor burden

Classification of Bladder injuries

They are classified as contusions or ruptures based on the extent of injury seen radiographically. They can be extraperitoneal, intraperitoneal, or both.

Complications of bladder injuries

Uroascites (free urine in the peritoneal cavity) due to intraperitoneal rupture

Infection (including sepsis)

Ppersistent hematuria

Incontinence

Bladder instability 

Fistula

Symptoms 

Suprapubic pain

Hematuria

Suprapubic tenderness

Distention

Hypovolemic shock (due to hemorrhage)

Diagnosis

Retrograde cystography, usually with CT

A rectal examination should be done in all patients with a blunt or penetrating mechanism of injury to assess for blood which is highly suggestive of a concomitant bowel injury. Similarly, female patients should be examined for genital lacerations.

Treatment

Catheter drainage

Surgical repair