Evaluation and treatment of bladder rupture

The presence of urologic injury must be considered in patients who have sustained severe lower abdominal blunt trauma and in all patients with pelvic fracture. Physical findings that suggest the possibility of a bladder rupture include gross hematuria and an inability to urinate. A properly performed cystogram is diagnostic of bladder rupture and will define whether the rupture is intraperitoneal or extraperitoneal. Selected cases of extraperitoneal bladder rupture can be safely managed by catheter drainage, antibiotics, and close clinical observation. Intraperitoneal perforations require surgical exploration and bladder closure. Complications occurring as a result of bladder injury are minimized provided the injury is identified and repaired when indicated, and provided continuous unobstructive bladder drainage is achieved.