Bladder injury in blunt pelvic trauma.

Area of Science:

• Urology
• Radiology
• Trauma Surgery

Background:

• Bladder injuries are a significant complication of blunt pelvic trauma.
• Accurate diagnosis is essential for appropriate patient management and outcomes.

Purpose of the Study:

• To review clinical and radiologic findings in patients with bladder injuries from blunt pelvic trauma.
• To evaluate the diagnostic utility of cystography and urography in bladder rupture.
• To propose a classification system for bladder injuries based on cystographic findings.

Main Methods:

• Retrospective review of clinical and radiologic data from 97 patients with bladder injuries.
• Analysis of cystography and urography findings in relation to surgical confirmation.
• Categorization of bladder injuries into extraperitoneal, intraperitoneal, interstitial, and combined types.

Main Results:

• Of 97 patients, 55 had extraperitoneal rupture, 35 intraperitoneal, 2 interstitial, and 5 combined.
• Cystography demonstrated all extraperitoneal ruptures, with 15 complex cases showing perivesical extravasation.
• Two surgically confirmed intraperitoneal ruptures were false-negative on cystography; urography missed two intraperitoneal ruptures diagnosed by cystography.
• Interstitial bladder injury was identified in two patients.

Conclusions:

• Cystography is a reliable method for diagnosing extraperitoneal bladder rupture.
• While cystography is valuable, false negatives and missed diagnoses can occur, particularly with intraperitoneal ruptures.
• A cystography-based classification of bladder injury patterns is proposed to aid in diagnosis and management.