Bladder Injuries

The bladder is a hollow organ that is normally protected behind the pelvic rami. However, an appropriate mechanism and sufficient force can still result in injury if pelvic fracture is incurred. As the bladder fills, it rises above the pelvic structures making the bladder more easily injured during compressive or shear forces. Bladder injuries occur in 1.6% of blunt abdominal trauma cases. Of all bladder injuries, 60–80% are from blunt trauma and 15–40% are from penetrating. Pelvic fractures, blunt trauma to the lower abdomen, abdominal seatbelt sign, and penetrating injuries to the lower abdomen or pelvis are associated with a high risk of bladder injury. The cardinal sign for bladder injury is gross hematuria which is found in about 95% of the cases. CT cystogram or flexible cystoscopy should be performed to diagnose bladder injury, with retrograde urethrogram performed if there is concern for urethral injury. Extraperitoneal bladder injuries are typically managed non-operatively, while intraperitoneal injuries require operative repair.