Bladder Injuries in Pediatric Age: A 12-Year Experience in a Tertiary Center

Bladder injuries are rare in pediatric age. They occur mainly after blunt trauma, frequently in motor vehicle accidents with a fastened seatbelt. When full, the bladder is more prone to rupture, and the dome is the most affected place. The common approach to intraperitoneal rupture is surgical treatment, and laparoscopic repair should be considered, although few cases have been described in pediatric age. We aim to present the cases of bladder injuries that occurred in a tertiary pediatric center in the last 12 years.

This study was conducted at the Centro Hospitalar Universitário de São João in Porto, Portugal. We performed a retrospective study including all cases of bladder injury (both extra and intraperitoneal) occurring between 2013 and 2024. We analyzed demographic data, etiology, associated lesions, clinical presentation, treatment, and follow-up.

Seven cases were identified, six of them due to trauma. The diagnosis was confirmed with computerized tomography in three cases, with retrograde cystography in two cases, with ultrasound with intravesical saline in one case and intraoperatively in one case. The extraperitoneal lesions were treated conservatively, and the intraperitoneal ruptures were submitted to surgical repair, in one case by laparoscopy. No complications occurred during follow-up.

Although rare in pediatric age, bladder lesions can occur and have multiple causes, requiring a high level of clinical suspicion according to the mechanism of lesion and symptoms. According to our data, retrograde cystography is not mandatory, especially when other exams can give the same dynamic image. This, however, should be interpreted cautiously, given the limited sample size of this study. Laparoscopy seems to be a feasible option for diagnosis and minimally invasive treatment, especially in the setting of isolated and non-complex lesions in a stable patient.