Management of bladder injury

* Urine extravasation from the bladder on retrograde cystogram or CT.

¶ Bladder injury confirmed by inspection, or based on intraoperative retrograde cystogram, with or without retrograde urethrogram.

Δ Blunt intraperitoneal bladder injuries are typically large and will not heal spontaneously. Surgical repair prevents peritoneal urine extravasation, which causes ileus and peritonitis. Small iatrogenic intraperitoneal bladder injuries might be managed with drainage alone if there is no ileus or peritonitis.

◊ Urethral catheter drainage alone is often all that is necessary for management of extraperitoneal bladder injury. A suprapubic catheter can be considered for complex injuries or for patients with severe associated injuries.

§ Surgical management of bladder injuries depend on clinical status; control of bleeding from other injuries takes priority over bladder repair. If repair is not possible during trauma exploration, provide urinary drainage for later repair or reconstruction. Refer to UpToDate topics discussing specific techniques for bladder repair.