Abstract

Objectives: We aimed to review our diagnostic and treatment protocols for patients with injured bladders by blunt and penetrating traumas. 

Materials and methods: Fifty-two patients with injured bladders hospitalized in the Urology and General Surgery clinics between January 1996 and January 2009 were retrospectively evaluated.

Results: Of the patients 43 (81%) were males and 9 (19%) were females, and their ages were between 17 and 70 (mean 31.9±12.11). Twenty eight (54%) of the patients were injured by penetrating and 24 (46%) by blunt traumas. The mean transportation time to hospital was 155±34.12 (range 30-1440) min. Retrograde cystographies could only be done in 28 patients. In the remaining hemodynamically unstable 24 patients, bladder injuries were diagnosed during laparatomy. Totally 41 (79%) patients including all 28 penetrating injuries and 13 of 24 blunt injuries had intraperitoneal bladder rupture. The rupture was retroperitoneal in the remaining 11 (21%) patients injured by blunt traumas. Intraabdominal adjacent organ injuries were more frequent in intraperitoneally ruptured cases. In extraperitoneally ruptured patients bone fractures were the main adjacent pathologies. Intraperitoneal rupture of all 41 patients was sutured primarily and we replaced a cystostomy tube in 14 of these patients. In 7 of 11 cystographically diagnosed retroperitoneal ruptures we only replaced a urethral Foley catheter for treatment. In the remainining 4 patients the bladder was sutured primarily because wide rupture and diffuse extravasation. One patient was lost because of acute respiratory distress syndrome developed following surgery. Wound infections, pneumonia, intraabdominal abcess, enterocutaneous fistula, and evisceration were seen as postoperative complications in 4, 2, 1, 1, and 1 patients, respectively. 

Conclusions: When diagnosed early the success rate of treatment in bladder injuries was quiet high. The adjacent organ injuries were the main pathologies increasing the postoperative morbidity and mortality.