What Is Bladder Trauma?

Closed injury: When the bladder is full, direct violence to the lower abdomen or pelvic fracture can cause bladder injury, which is more common in crushing injuries such as traffic accidents or collapse of houses and soil slopes.

Bladder trauma

Bladder trauma: The bladder is completely inside the pelvic cavity when empty, and its top is higher than the pubic symphysis during filling. If the lower abdomen is violent, the bladder is vulnerable to trauma. When a pelvic fracture occurs, the broken end can puncture the bladder, and it also occurs when the bladder is full. The incidence of bladder trauma is usually inferior to kidney and urinary tract trauma. With the development of modern transportation, it will increase, and it will occupy the first place in urinary trauma in wartime.

Classification of bladder trauma and causes of injury

Open injuries: They are more common in firearm injuries during wartime, and often involve abdominal internal organ trauma.

Iatrogenic trauma: Intravesical instruments such as cystoscopy, ureteroscopy, intraluminal lithotripsy can cause bladder damage. Intrapelvic surgery, tubal ligation, and hernia repair may injure the bladder by mistake. Compression of the fetal head during dystocia can also cause bladder vaginal fistulas.

Spontaneous rupture: Bladder with pathological changes such as tuberculosis, tumors, etc., are mostly caused by small external forces that are not noticed by the patient.

Bladder trauma injury type

I. Contusion: The violence is not great, the bladder wall is not ruptured, only the mucous membrane or muscular layer is injured, there is no extravasation of urine, and it can heal itself after rest.

2. Bladder rupture: The bladder is ruptured on the whole layer, and there is urinary extravasation. According to the location of the injury, the relationship between the mechanism and the peritoneum can be divided into:

(1) Intraperitoneal rupture: When the bladder is full, the lower abdomen is subjected to direct violence, which suddenly increases the pressure in the bladder, causing the weakest part of the bladder wall to rupture. It often occurs behind the top of the peritoneum, and a large amount of bladder urine overflows into the abdominal cavity. Causes peritoneal irritation.

(2) Extraperitoneal rupture: Mostly caused by pelvic fractures. The ruptures are in the anterior wall or neck without peritoneal coverage, so extravasation is around the peritoneal bladder.

(3) Mixed rupture: It is more common in firearm injuries or blade injuries, and there are both internal and external peritoneal ruptures. Most have other organs with injuries.

Bladder trauma diagnosis

First, a history of trauma to the lower abdomen or pelvic fracture, a history of surgery or instrument damage.

Second, the clinical manifestations: Shock can be caused by trauma or bleeding, especially in pelvic fractures, the amount of bleeding is often easy to occur. Frequent urination was felt after the injury, but no urine was excreted or only a small amount of blood was excreted.

Intraperitoneal rupture occurs with lower abdominal pain, often accompanied by nausea, vomiting, and bloating. The lower abdomen has extensive muscle tone, tenderness, and mobile dullness.

Extraperitoneal rupture due to extravasation of the urine around the bladder, lower abdominal pain and radiation to the perineum. There is muscle tension and tenderness in the lower abdomen, and the anal finger examination is full or fluctuating, but the prostate is immobile.

Open wounds: Urine can continue to flow out of the wound.

III. Catheterization and perfusion test: The urinary catheter was inserted smoothly, but there was no urine outflow or only a small amount of hematuria. A marked decrease or increase in the amount of saline that is drawn back after a given amount of sterile saline is indicative of a bladder rupture.

Sometimes the break is small, and the volume of the drawn injection fluid does not change significantly, so there may be false negatives.

Fourth, X-ray examination: injection of contrast agent for cystography can be seen with contrast agent extravasation, filming should pay attention to shooting from different angles, so as not to spill the contrast agent was covered by the bladder shadow and missed diagnosis. You can also inject a small amount of air. If you find that the liver dullness is reduced or disappeared or there is free gas under the diaphragm, you can confirm the diagnosis of intraperitoneal rupture.

Bladder Trauma Treatment

Bladder contusion: If there is no difficulty in urinating, there is no need to leave the catheter.

Bladder rupture: Once a bladder rupture is diagnosed, surgical exploration should be performed immediately. First explore the abdominal cavity for intra-peritoneal rupture or other abdominal organ damage. If there is no abnormality, close the peritoneum and then open the bladder for exploration. The principle of surgery is suture the cleft, bladder fistula and extraperitoneal drainage of extravasated blood and urine. Extravasation in the abdominal cavity and blood need not be drained after the urine is cleared. If the peritoneal rupture has a small crack and suture is difficult, the bladder can be used for ostomy fistula or indwelling catheterization, and the crack is not sutured.

Open injuries require surgical exploration. In addition to bladder trauma, corresponding injuries should be treated accordingly.

Clinical manifestations of bladder trauma

Mild bladder wall contusion only has lower abdominal pain, a small amount of end blood, and disappears on its own in a short period of time. Symptoms are evident when the bladder is ruptured at all layers. It depends on the location, size of the nick, the time of consultation after the injury, and the presence or absence of damage to other organs. Rupture of intraperitoneal type and extraperitoneal type has its own special symptoms. Bladder ruptures can generally have the following symptoms:

1. Shock: Severe trauma, pain, and heavy blood loss are the main causes of shock. For extensive trauma, accompanied by damage to other organs, such as pelvic fractures, piercing of the lower abdomen and pelvic vessels with fracture fragments can cause severe blood loss and shock. ^[1]

2. Pain: pain in the lower abdomen or pubic bone and rigidity of the abdominal wall, especially when the pelvis is squeezed with a pelvic fracture. Hematuria extravasation around the bladder and the posterior pubic space can cause local swelling, and the symptoms are more critical if cellulitis and sepsis occur after secondary infection. Symptoms of peritonitis can occur if urine leaks into the abdominal cavity. Peritoneal reabsorption of creatinine and urea nitrogen results in an increase in blood creatinine and urea nitrogen.

3. Hematuria and dysuria: patients have urgency or urination, but no urine is discharged or only a small amount of bloody urine is discharged. After the bladder is ruptured, no urine is discharged from the urethra due to sphincter spasm, clogging of the urethra with blood clots, extravasation of the urine around the bladder, or the abdominal cavity, etc. When the bladder is ruptured, only a small amount of bloody urine is seen. ^[1]

4. Urinary fistula: In open bladder injury, urine leaks from the wound. If it communicates with the rectum and vagina, bloody urine can be discharged through the anus and vagina. After the bladder rectal fistula is formed, fecal debris and gas can be discharged during urination. Repeated attacks can be accompanied by severe urinary tract infections and the formation of stones. 5. Late symptoms: urine overflows from the wound, or is discharged from the anus or vagina through the bladder rectal fistula or bladder vaginal fistula. The bladder is easy to shrink, causing frequent urination and urgency. May have recurrent urinary tract infection symptoms.