Morbidity associated with nonoperative management of extraperitoneal bladder injuries

Foley catheter drainage alone has become routine management for extraperitoneal bladder ruptures in many medical centers, and few reports address treatment failures with this approach. Over the last 10 years, 70 patients with bladder ruptures were managed at our institution. Thirty-six of these had extraperitoneal injuries caused by blunt trauma, and 29 of these were treated by catheter drainage alone. Of those patients managed nonoperatively, 74% had spontaneous healing within 10 to 14 days; however, 26% had significant complications, including delayed healing, vesicocutaneous fistula, septic events, bladder calculi, or death. Although our results confirm previous reports in the literature that most patients with extraperitoneal bladder ruptures do well with nonoperative management, they also point out that a significant subset of patients do not. We were unable to identify presenting features that would predict an unfavorable outcome, although patients with multiple pelvic fractures seem to be at high risk. The maintenance of adequate catheter drainage and use of antibiotic prophylaxis seems to have a significant impact on outcome.