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Bladder trauma

Definition
Bladder trauma is defined as any injury to the bladder, often resulting from external trauma, such as blunt or penetrating injuries.
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Pathophysiology
The pathophysiology of bladder trauma often involves damage to the bladder wall due to pelvic fractures or penetrating injuries. This can lead to intraperitoneal or extraperitoneal bladder rupture, depending on the nature and force of the trauma.
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Epidemiology
The prevalence of bladder trauma is estimated at 10% in patients with abdominal trauma.
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Disease course
Clinically, patients with bladder trauma may present with gross hematuria, suprapubic or abdominal pain, and difficulty in voiding or the inability to void. Bladder trauma can also lead to complications such as urinary fistulas or infections.
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Prognosis and risk of recurrence
The prognosis of bladder trauma can vary based on the severity of the injury and the promptness of treatment. Early recognition and appropriate management can significantly improve outcomes.
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Key sources
The following summarized guidelines for the evaluation and management of bladder trauma are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2022), the Eastern Association for the Surgery of Trauma (EAST 2019), the World Society of Emergency Surgery (WSES/AAST 2019), the American College of Radiology (ACR 2019), and the American Urological Association (AUA 2014).
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Guidelines

1.Diagnostic investigations

Computed tomography: as per ACR 2019 guidelines, obtain pelvic CT with bladder contrast (CT cystography) for initial evaluation of suspected penetrating trauma to the lower urinary tract.
B
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  • Retrograde cystography

2.Medical management

Nonoperative management
As per EAU 2022 guidelines:
Offer nonoperative management in patients with uncomplicated blunt extraperitoneal bladder injuries.
B
Offer nonoperative management in patients with small uncomplicated intraperitoneal bladder injuries during endoscopic procedures.
B

3.Surgical interventions

Indications for surgery
As per EAU 2022 guidelines:
Perform surgery in patients with blunt extraperitoneal bladder injuries in cases of bladder neck involvement and/or associated injuries requiring surgical intervention.
A
Perform surgical exploration and repair in patients with blunt intraperitoneal injuries.
A

4.Follow-up and surveillance

Serial imaging assessment: as per EAU 2022 guidelines, obtain cystography to assess bladder wall healing after repair of a complex injury or in case of risk factors for wound healing.
A