Surgical treatment of the ruptured bladder: 22 years reviewed

During the 22-year interval from 1964 to 1985, 36 patients with bladder injuries were treated at the Kaohsiung Medical College Hospital. Thirty-two cases were male (89%) and 4 cases were female (11%), the sex ratio of patients was 8 to 1, respectively. The average patient age was 33 years and 75% were less than 40 years of age. Hematuria was present in all of the patients and it was microscopic in 25%. Traffic accidents accounted for 55% of the injuries; penetrating trauma was responsible in only 6% of the patients. Of the 36 bladder trauma cases, 11 (30.5%) had intraperitoneal injury, 24 (66.7%) had extraperitoneal injury and 1 (2.8%) had intraperitoneal and extraperitoneal injury. Of the 28 cases with pelvic fracture and bladder trauma in this study, 18 (60%) had extraperitoneal rupture, and 9 (30%) had intraperitoneal rupture. The position of intraperitoneal rupture was mostly at the posterior wall and dome, whereas that of the extraperitoneal rupture was partly located at the anterior wall and the bladder neck. Bladder rupture was treated by operative repair of the defect, bladder drainage by suprapubic cystostomy and/or urethral catheter and drainage of the perivesical space. The mortality rate with the ruptured bladder was 17%. Multiple injuries associated with the ruptured bladder and postoperative complications especially septic shock, were the main causes of mortality.