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Imaging Findings Associated With Failure of Conservative Management After Blunt Extraperitoneal Bladder Injury
George E Koch1, Marie-Therese Valovska2, Reno Maldonado3
1Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH.; Department of Urology, The University of Washington, Seattle, WA.
Urology
|October 2, 2024
Summary
Conservative management for extraperitoneal bladder injuries (EBI) may fail if contrast extravasation is seen on delayed imaging or if the injury is severe (AAST grade 5). These factors indicate incomplete drainage, suggesting a need for closer monitoring.
Area of Science:
- Trauma Surgery
- Urology
- Radiology
Background:
- Extraperitoneal bladder injuries (EBI) are often managed conservatively.
- Identifying risk factors for conservative management (CM) failure is crucial for optimizing patient outcomes.
Purpose of the Study:
- To determine predictors of failed conservative management in patients with uncomplicated extraperitoneal bladder injuries.
Main Methods:
- A retrospective review of patients with blunt EBI managed conservatively was conducted.
- Univariable analysis identified factors associated with persistent leakage or delayed cystorrhaphy.
Main Results:
- Of 84 patients, 6 (7%) failed CM. Pelvic fracture and embolization were not associated with failure.
- AAST grade 5 injuries and contrast extravasation on delayed CT imaging were significantly associated with CM failure.
Conclusions:
- Contrast extravasation on delayed imaging and high AAST injury grade are risk factors for CM failure in EBI.
- These findings suggest mechanistic issues with antegrade drainage during conservative management.
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