Failure of conventional retrograde cystography to detect bladder ruptures in pelvic trauma

Conventional retrograde cystography is often used to investigate patients with suspected bladder ruptures in pelvic trauma. Clinical indicators suggestive of a rupture include haematuria and suprapubic tenderness and should increase the suspicion of bladder and urinary tract injury and prompt the clinician to undertake further investigations. Two patients with high-energy pelvic fractures had bladder ruptures detected intraoperatively despite normal preoperative retrograde cystogram. Both patients had significant clinical indicators suggestive of underlying bladder and urinary tract injury. In both cases, a routine conventional retrograde cystogram was performed but failed to identify the full extent of the bladder injury. A possible reason for misdiagnosis in these cases is the delay between injury and investigation due to tertiary referral of care.