Method of urinary diversion in nonurethral traumatic bladder injuries: retrospective analysis of 70 cases

Management of intraperitoneal, nonurethral bladder injuries by urinary diversion using suprapubic (SP) catheters versus transurethral (TU) Foley catheters was examined retrospectively in a attempt to determine which were most effective. A total of 8500 trauma admissions (6/89-1/96) were screened for bladder injuries. Mechanism, degree, treatment, and morbidity of injury in association with SP or TU Foley catheter placement were evaluated. Of the total of 70 bladder injuries identified, the diagnosis in 40 patients (57%) whose injuries resulted from blunt trauma was made by cystogram (55%), CT scan alone (15%), or by exploration (30%). Of these, 22 patients (55%) were treated nonoperatively with a TU catheter for extraperitoneal extravasation or partial bladder wall laceration. Gunshot wounds accounted for 43 per cent (30 patients); of these patients, all but one had celiotomies and bladder repair. SP catheters were placed in three blunt trauma patients, preoperatively in 1 patient, and intraoperatively in 17 patients who had sustained penetrating trauma. A total of 50 patients (71%), 27 with repair and TU catheter and 23 with TU catheter alone, were treated without an SP catheter. All bladder or urethral morbidity occurred in the SP group (35%): 3 strictures, 2 urinary retentions, 1 SP infection, and 1 urinary infection. Degree of bladder injury was no different with or without an SP catheter. No urethral strictures, urinary tract infections, or retention occurred in isolated bladder injuries treated with TU catheters alone. Average SP and TU catheter duration was 42 and 13 days, respectively. TU catheters for management of blunt and penetrating bladder trauma are effective, cause fewer strictures and less morbidity, and may be removed more rapidly than SP catheters for any degree of bladder injury.