Imaging Findings Associated With Failure of Conservative Management After Blunt Extraperitoneal Bladder Injury

To identify risk factors for failure of conservative management (CM) for uncomplicated extraperitoneal bladder injuries (EBI).

The trauma registry at a single Level 1 trauma center was queried for patients presenting with a blunt EBI between 2004 and 2022. Patients with CM and follow-up through at least 1 postoperative cystogram or catheter removal were included. A univariable analysis for associations with a composite outcome of either persistent leakage or delayed cystorrhaphy was completed.

Eighty-four patients with an EBI underwent CM. Seventy-eight (93%) patients had an associated pelvic fracture and 17 of 84 (20%) underwent embolization for pelvic hemorrhage. Thirty-four (41%) patients also had delayed-phase imaging, 17 (20%) of whom had extravasation from their bladder on delays. Six (7%) patients failed initial CM. There was no association between the composite outcome and pelvic fracture (P = .35) or embolization (P = .41). American Association for the Surgery of Trauma (AAST) grade 5 injuries (P = .01) and the presence of extravasation on delayed-phase Computed Tomography (P = .03) were associated with the composite outcome.

Contrast extravasation on initial delayed-phase imaging despite urethral catheter drainage and AAST injury grade were associated with failed CM after EBI. This may reflect injuries that mechanistically yield incomplete antegrade drainage with CM.