Feasibility of Conservative Management for Intraperitoneal Bladder Perforation: A Single-Institution Case Series

Area of Science:

• Urology
• Trauma Surgery
• Emergency Medicine

Background:

• Bladder injuries are categorized as extraperitoneal or intraperitoneal based on location.
• Current practice favors surgical repair for intraperitoneal bladder ruptures, with conservative management reserved for extraperitoneal injuries.
• The feasibility of conservative management for intraperitoneal bladder rupture requires further investigation.

Purpose of the Study:

• To evaluate the efficacy and success rate of conservative management for intraperitoneal bladder ruptures.
• To assess complications and outcomes associated with non-operative treatment of intraperitoneal bladder injuries.
• To determine if conservative management is a viable option for select patients with intraperitoneal bladder rupture.

Main Methods:

• Retrospective review of 290 patients with intraperitoneal bladder perforations treated between 2015 and 2023.
• Analysis focused on 16 patients who underwent initial conservative management with Foley catheterization.
• Data collected included patient demographics, CT-measured perforation size, management details, complications, and follow-up outcomes.

Main Results:

• Initial conservative management with Foley catheterization was successful in 15 out of 16 (94%) patients.
• Complications occurred in 25% of patients, including urinary incontinence, urinary tract infection, and pelvic abscess.
• The median duration of catheterization for successfully managed patients was 18 days.

Conclusions:

• Conservative management using prolonged Foley catheterization is a suitable and successful strategy for small intraperitoneal bladder ruptures.
• This approach offers a potentially less invasive option compared to surgical repair for carefully selected patients.
• Further research in larger patient cohorts is recommended to establish conservative management as a standard option for specific cases.