Tutorial bladder trauma
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This document discusses bladder trauma, including its causes, classification, clinical features, investigations, and management. Bladder trauma occurs in 10% of trauma cases and is most commonly caused by blunt trauma from motor vehicle accidents. Bladder injuries are classified based on CT cystography findings or type of injury. Clinical features include gross hematuria and abdominal tenderness. Cystography is the gold standard for diagnosis. Management involves treating shock, catheterization if indicated, and determining the extent of peritoneal extravasation. Extraperitoneal ruptures are managed with catheter drainage alone while intraperitoneal ruptures require surgical repair.
Tutorial bladder trauma
- 1. BLADDERTRAUMANOOR HAFIZAH BINTI HASSAN2007287236
- 2. REFERENCES:SMITHāS GENERAL UROLOGY 17th EDGUIDELINES ON UROLOGICAL TRAUMA, EUROPEAN ASSOCIATION OF UROLOGY, FEBRUARY 2003
- 3. INCIDENCE10% of trauma: involve GU system
- 4. Bladder trauma: 60-80% are due to BLUNT TRAUMA
- 5. Highly associated with pelvic # (70-97%)
- 6. Most common complication of bladder trauma -> BLADDER RUPTURE (90%)CAUSES OF BLADDER TRAUMABLUNT TRAUMA (67-86%)MVA
- 7. DECELERATING INJURYPENETRATING INJURY (14-33%)HIGH VELOCITY GUNSHOT
- 8. STAB WOUND IATROGENICMEDICAL PROCEDURECLASSIFICATION OF BLADDER INJURYBASED ON FINDINGS ON CT CYSTOGRAPHY:
- 9. Grade II:Subtle intraperitoneal contrast material between small bowel loopsGrade III:Focal lenticular thickening of the bladder wall due to interstitial hematoma and likely muscular disruption
- 10. Grade IVa:Extravasated contrast material into confined to the perivesical space within extraperitoneal pelvisGrade IVb:Complex extraperitoneal spread-> extension into rectus abdominis muscle as well as subcutaneous fascia
- 11. 2) BASED ON TYPES OF INJURY:
- 12. PERITONEAL EXTRAVASATIONBELOW PERITONEAL REFLECTION (EMPTY BLADDER): EXTRAPERITONEAL SPREADABOVE PERITONEAL REFLECTION (FULL BLADDER):INTRAPERITONEAL SPREAD
- 13. EXTRAPERITONEAL BLADDERRUPTURE (80 %)Associated with pelvic fracture (80-100%)Direct laceration of the bladder by the bony fragments> severe fracture, degree of bladder injury āCystographic finding: contrast extravasation around base of bladder confined to perivesical space
- 14. Extravasation seen outside the bladder in the pelvis
- 15. INTRAPERITONEAL BLADDERRUPTURE (20 %)Direct blow to a distended bladderFull bladder -> muscle fibers are widely separated -> entire bladder wall is thin -> offer little resistanceInjury -> ā intravesical pressure -> horizontal tear along intraperitoneal portion of bladder wallCystographic finding: contrast extravasation into peritoneal cavity, lining loops of bowel
- 16. Contrast enters the peritoneal cavity & outlines the bowel loopsSterileurineInfectedurine
- 19. Others: inability to void, bruises over suprapubic regionON EXAMINATION:Abdominal tenderness
- 20. Per rectal: to exclude rectal injury : assess prostate position
- 21. INVESTIGATIONCYSTOGRAPHYGold standard for dx bladder rupture (85-100%)Dx: injected contrast are out of the bladderRequire plain film, filled film and post-drainage filmCT CYSTOGRAPHY: bladder is inadequately distended to allow extravasation through perforated bladder
- 22. MANAGEMENTIMMEDIATE MEASURES:Treat shock and hemorrhage, if any
- 23. Catheterization: if blood noted at urethral meatus, donāt insert Foleyās catheter -> retrograde urethrogram2) DETERMINE EXTENT OF PERITONEAL EXTRAVASATION : RETROGRADE CYSTOGRAPHY
- 24. EXTRAPERITONEAL RUPTURE:Catheter drainage only, even in the presence of extensive retroperitoneal or scrotal extravasationHealing takes 10 days -> 3 weeksSurgical intervention?bladder neck involvement
- 25. presence of bone fragments in the bladder wall
- 26. evacuation of pelvic hematoma/drainage of pelvic abscessINTRAPERITONEAL RUPTURE:Always managed surgically:Transperitoneal approachPeritoneum closed carefully over the area of injuryAll extravasated fluid should be removedBladder is closed in separate layer