Bladder/Urethral injury

Question 1

Symptoms and signs of bladder injury

Answer 1

Haematuria
Suprapubic pain
Voiding inability
History of pelvic fracture

Irrigation of bladder → inability to retrieve all the fluid

Question 2

Investigations for bladder injury

Answer 2

IV urogram
Cystogram

Cystogram done if IVU CI:
Allergy
Renal impairment
Severe asthma
Pregnancy
Metformin

Question 3

Management for bladder injury

Answer 3

Extraperitoneal → conservative
Intraperitoneal → laparatomy

Question 4

Aetiology of bladder injury

Answer 4

Most bladder injuries occur due to blunt trauma (85% associated with pelvic fractures)
Up to 10% of male pelvic fractures are associated with urethral or bladder injuries

Question 5

Types of urethral injury

Answer 5

Bulbar rupture (most common): straddle type injury e.g. bicycles

Membranous rupture (extra or intraperitoneal): from pelvic fractures

Question 6

Symptoms and signs of urethral injury

Answer 6

Blood at the meatus (50%)
Bulbar:
1. Urinary retention
2. Perineal haematoma
3. Blood at the meatus

Membranous:
- Penile/perineal oedema
- Penile/perineal oedema haematoma
- Prostate displaced upwards

Question 7

Investigations for urethral injury

Answer 7

Ascending urethrogram

Question 8

Management for urethral injury

Answer 8

Suprapubic catheter