Bladder injury
classification:
1- blunt trauma e.g RTA, FFA
2- penetrating injury e.g BULLET, STAB
3- iatrogenic(operative) e.g TUR FOR BLADDER TUMOR
clinical feature:
inability to pass urine, hematuria, suprapubic pain and tenderness in patient with history of trauma
diagnosis:
clinical according to history of trauma to lower abdomen with hematuria and on examination patient suprapubic pain and tenderness.
investigation: plain X-R of the pelvis show fracture of pubic bone
cystogram filling and voidind face with extravsation of the dye
CT cystogram sometimes is used
treatment: emergency treatment: IV fluid , preparation of blood, broad spectrum antibiotic and foly catheter with observation
surgical treatment: intraperitoneal injury: should be explored and bladder repaired using catgut suture by two layers while extraperitoneal injury if it is small can be treated by foly catheter and antibiotic with observation especially in endoscopic perforation if big extraperitoneal injury should explored and repair in same way of intraperitoneal injury.
complications:
1- incontinence of urine in case of injury extend to bladder neck
2- pelvic abscess
3- peritonitis in case of intraperitoneal injury if treated late