Bladder trauma

The only trauma to the bladder considered clinically and therapeutically relevant is the tearing of the bladder wall, bladder rupture. The rupture of the bladder wall is rarely an isolated trauma and most often combined, in 5% of blunt abdominal trauma or 25-30% of pelvic fractures. Depending on the localisation of the lesion we distinguish between extra- and intraperitoneal ruptures of the bladder (intraperitoneal is when the bladder contents flow into the abdominal cavity). In combination with pelvic fractures the bladder usually ruptures extraperitoneally often with perforation by bone fragments. Intraperitoneal ruptures are caused by direct trauma such as impression by the steering wheel in automobile accidents. In general, a full bladder ruptures more easily than an empty bladder.

The clinical symptoms are pain in the lower abdomen, blood in the urine, occasionally imperative urinary urge, difficulty in voiding or urinary retention. Symptoms of the extraperitoneal form are often masked by those of the pelvic fracture. If the rupture is not recognized and adequately treated in time, a severe complication with urinary phlegmona may develop. This is a serious infection with fever, shaking chills and high mortality. Typical of  intraperitoneal rupture are the usually more severe symptoms of peritonitis, nausea, vomiting, and paralytic ileus (loss of bowel function).

The diagnosis, aside from anamnesis and physical findings and after ruling out an additional urethra injury, is made by retrograde urethrocystography (filling of the urethra and bladder with contrast medium). 

Therapy depends on the size of the lesion: catheter drainage is adequate for small lesions. Larger lesions usually require surgical exploration and closure of the defect in order to prevent urosepsis (bacterial blood poisoning) by extraperitoneal ruptures or a urinary peritonitis by intraperitoneal ruptures.