Major bladder trauma: mechanisms of injury and a unified method of diagnosis and repair.

We reviewed 51 cases of bladder trauma seen at our hospital between 1976 and 1981. There were 32 nonpenetrating, 13 penetrating, 1 spontaneous and 5 iatrogenic injuries. Rupture of the bladder was confirmed at operation in all but 1 case. Extraperitoneal rupture was noted in 32 patients (62 per cent), intraperitoneal rupture in 13 (25 per cent), and combined intraperitoneal and extraperitoneal rupture in 6 (12 per cent). The most frequent clinical features were gross hematuria, abdominal tenderness and shock. Associated pelvic fractures were present in 30 of the 31 nonpenetrating ruptures. The most common area of bladder rupture was the dome in nonpenetrating injuries (35 per cent) and the lateral wall in penetrating injuries (42 per cent). Associated organ injuries were common (62 per cent of penetrating injuries and 93 per cent of nonpenetrating injuries). Cystography, including the use of drainage films, was accurate in all cases for which it was used. Mortality in this series was 22 per cent and reflects the severity of associated organ injury. Risk factors include older age status, pedestrian injuries and extensive associated organ injury rather than type of bladder rupture. To minimize mortality and morbidity in this high risk group of patients strict attention should be directed to rapid resuscitation, early diagnosis including cystography with drainage films and anticipation of associated organ injury at operation.