Management of blunt injury to the lower urinary tract

Rupture of the bladder and of the urethra are serious injuries, which, if not recognized or treated adequately, can cause considerable morbidity, even death. The possibility of such injuries should be considered in patients who have lower abdominal trauma, especially in association with a fractured pelvis. Retrograde urethrography should be done when urethral injury is likely. A properly performed cystogram is reliable in diagnosing bladder rupture, which, with the possible exception of small extraperitoneal tears, should be treated by surgical exploration. Treatment of urethral injury remains controversial and the choice of primary repair or primary suprapubic cystostomy will depend on the philosophy and experience of the surgeon. Posterior urethral injury is associated with a high rate of stricture, incontinence and impotence. Suprapubic cystostomy and delayed treatment of any resulting stricture yields excellent long-term results and should be the treatment of choice when the patient is seriously ill or the surgeon inexperienced in urethral surgery.