Lower urinary tract injuries following blunt trauma: a review of contemporary management

Abstract

Lower urinary tract trauma, although relatively uncommon in blunt trauma, can lead to significant morbidity when diagnosed late or left untreated; urologists may only encounter a handful of these injuries in their career. This article reviews the literature and reports on the management of these injuries, highlighting the issues facing clinicians in this subspecialty. Also presented is a structured review detailing the mechanisms, classification, diagnosis, management, and complications of blunt trauma to the bladder and urethra. The prognosis for bladder rupture is excellent when treated. Significant intraperitoneal rupture or involvement of the bladder neck mandates surgical repair, whereas smaller extraperitoneal lacerations may be managed with catheterization alone. With the push for management of trauma patients in larger centers, urologists in these hospitals are seeing increasing numbers of lower urinary tract injuries. Prospective analysis may be achieved in these centers to address the current lack of Level 1 evidence.

Keywords: Multiple trauma; Rupture; Urethra; Urinary bladder; Wounds; nonpenetrating.

Figure 1

Complex bladder neck injury with contrast extravasation into perineum on retrograde urethrogram.

Figure 2

Computed tomography image revealing mural irregularity and clot at the dome of the bladder.

Figure 3

(A) Extraperitoneal (EP) contrast extravasation on computed tomography cystogram. (B) EP injury with contrast tracking giving the appearance of intraperitoneal contrast extravasation.

Figure 4

(A) Intraperitoneal (IP) contrast on computed tomography image of the abdomen. (B) IP contrast detected on retrograde cystogram.

Figure 5

(A) Partial posterior urethral injury with contrast observed in bladder. (B) Complete urethral injury with starburst pattern of contrast extravasation seen on retrograde urethrogram. Bladder contrast present from previous imaging.