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Traumatic injury of the bladder and urethra
Traumatic injury of the bladder and urethra involves damage caused by an outside force.
Injury - bladder and urethra; Bruised bladder; Urethral injury; Bladder injury; Pelvic fracture; Urethral disruption
Causes, incidence, and risk factors
Injuries to the bladder can be divided into:
The amount of injury to the bladder depends on how full the bladder was at the time of injury and what caused the injury.
Traumatic injury to the bladder is uncommon. Only about 8 - 10% of pelvic fractures lead to bladder injury. Because the bladder is located within the bony structures of the pelvis, it is protected from most outside forces. Injury may occur if there is a blow to the pelvis severe enough to break the bones and cause bone fragments to penetrate the bladder wall.
Other causes of bladder or urethra injury include:
Injury to the bladder or urethra may cause urine to leak into the abdomen, leading to infection (peritonitis). This type of injury is more common if the bladder is full.
Emergency symptoms that could be signs of shock or hemorrhage:
Note: Symptoms occur after an injury.
If there is no or little urine released, there may be an increased risk of urinary tract infections (UTI).
Signs and tests
An examination of the genitals may show injury to the urethra. If the health care provider suspects an injury, an x-ray of the urethra using dye (retrograde urethrogram) should be done to show the structure of the lower urinary tract.
Examination may also show:
A catheter (tube that drains urine from the body) may be inserted once an injury has been ruled out. An x-ray of the bladder using dye to highlight any damage can then be done.
The goals of treatment are to:
Emergency treatment of bleeding or shock may include:
Treatment of peritonitis (inflammation of the abdominal cavity) may include emergency surgery to repair the injury and drain the urine from the abdominal cavity. Antibiotics may be given to treat peritonitis and to prevent urinary tract infections.
Surgical repair of the injury is usually successful. The bladder may be drained by a catheter through the urethra or the abdominal wall over a period of days to weeks. This will prevent urine from building up in the bladder, allowing the injured bladder or urethra to heal. This also prevents swelling in the urethra from blocking urine flow.
If the urethra has been cut, a urological specialist can place a catheter. If this cannot be done, a tube will be inserted through the abdominal wall and directly into the bladder. This is called a suprapubic tube. It will be left in place until swelling goes away and the urethra can be surgically repaired. This typically takes 3 - 6 months.
Traumatic injury of the bladder and the urethra may range from minor to major and life-threatening. There may be severe, immediate, or long-term complications.
Calling your health care provider
Go to the emergency room or call the local emergency number (such as 911), if you have symptoms of traumatic bladder or urethra injury -- especially if you have been injured in those areas.
Call your health care provider if symptoms get worse or new symptoms develop, including:
Prevent outside injury to the bladder and urethra by using general safety precautions:
Morey AF, Dugi III DD. Genital and lower urinary tract trauma. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 88.
Runyon MS. Genitourinary system. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 44.
Reviewed by:Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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