Advances in the management of blunt traumatic bladder rupture: experience with 36 cases

OBJECTIVE: To assess how advances in urology, radiology and orthopaedics are changing the current management of bladder ruptures, by reviewing patients treated for bladder ruptures after blunt trauma. PATIENTS AND METHODS: Our database was screened for patients admitted with bladder ruptures between 1980 and 2008. Charts were reviewed for demographics, clinical variables, diagnostics, treatment and outcome. RESULTS: Thirty-six patients with extraperitoneal (EPR, 61%) and intraperitoneal (IPR) or combined ruptures (39%) were identified; 81% of them presented pelvic-ring fractures. Diagnosis relied on computed tomography cystography (CT-C), which has replaced plain-film cystography. The sensitivity of either type of cystography was > 90%. However, three bladder ruptures (11%) were missed on CT-C performed with insufficient bladder distension. All 14 patients with IPRs had immediate surgical repair, four of them by laparoscopy. Twelve of 22 EPRs (55%) were sutured during concomitant orthopaedic/visceral surgery or because of the urologist's apprehension of infection. Only eight of 22 patients with EPR (36%) completed conservative treatment. CONCLUSIONS: Diagnosis relies increasingly on CT-C, allowing simultaneous assessment of multiple organ systems. However, only specific CT-C guarantees an adequate sensitivity. Orthopaedists increasingly use open reductions and fixation of pelvic-ring fractures, prompting urologists to suture EPRs simultaneously. Our data indicate that this proactive management reduces infectious complications, and we have adopted it as the standard of care in our institution. Laparoscopic suture is an advantageous treatment of isolated IPR