Bladder injuries are one of the most frequent urological injuries in trauma patients.

Bladder
injuries occur in 1.6% of blunt abdominal trauma cases.1,2 A mean of 80% are associated with
pelvic fracture and the rest occur from a blow to the lower abdomen with distended bladder.

1. Bhanot A, Bhanot A. Laparoscopic repair in intraperitoneal rupture of urinary bladder in blunt

trauma abdomen. Surg Laparosc Endosc Percutan Tech. 2007;17(1):58–59.

2. McAninch JW, Richardson JR. Diagnostic bladder ruptures. Acad. Radiol. 2001;8(5):215–217.

Therefore, several investigations have been carried out to find out whether a certain location of
the pelvic fractures is associated with an increased incidence of bladder injury.3

Bladder contusion with lesion of the bladder mucosa without bladder wall perforation is very
rare and its incidence is very difficult to assess.4

Extraperitoneal ruptures are the most common (about 55%), followed by intraperitoneal (38%)
and combined intra- and extraperitoneal (58%) ruptures.5

3. Vaccaro JP, Brody JM (2000) CT cystography in the evaluation of major bladder trauma.
Radiographics. 2000;20(5):1373–1381.

4. Morgan DE, Nallamala LK, Kenney PJ, et al. CT cystography:radiographic and clinical predictors of
bladder rupture. II AJR Am J Roentgeno. 2000;174(1):89–95.

5. Sandler СМ, Goldman SM, Kawashima A. Lower urinary tract trauma. World J Urol.
1998;16(1):69–75.

Bladder injuries are typically classified as blunt or penetrating. The bladder sits in the bony pelvis, which
protects it from injury. However, as the bladder fills, the dome rises into the lower abdomen making it
progressively more susceptible to injury.1 The bladder is retro-or extraperitoneal in nature. The bladder
dome is lined by the visceral peritoneum and is the least supported portion; accordingly, this part is the
most susceptible to injury.2

References 1. Corriere JN, Sandler CM. Diagnosis and management of bladder injuries. Urol Clin North
Am. 2006;33(1):67e71. Web.

2. Alsaigh NK, Petros FG. Penetrating bladder injuries in abdominal trauma: An experience from Iraq. J
Urol Suppl. 2008;179(4):21.

Compared to blunt bladder trauma, which accounts for most bladder ruptures, penetrating bladder
trauma is relatively uncommonwith percentages ranging from 14e49%.3

3. Deibert Christopher M, Spencer Benjamin A. The association between operative repair of bladder
injury and improved survival: results from the National Trauma Data Bank. J Urol. 2011;186(1):151e155.

Penetrating bladder injuries are also most likely to be associated with abdominal gunshot wounds
(87.3%).4 The most common entry points are via the anterior abdomen, rectum, and buttock. Therefore,
penetrating bladder injuries via the inner thigh are practically unheard of. Roughly 95% of injuries to the
bladder present with gross hematuria,5 and in the rare occasion that this is absent, microscopic
hematuria is still likely evident. Physical examination may also reveal suprapubic or lower abdominal
pain and distention.

4. Pereira Bruno Monteiro Tavares, De Campos Caio César Citatini, Calderan Thiago Rodrigues Araujo, et
al. Bladder injuries after external trauma: 20 years experience report in a population-based cross-
sectional view. World J Urol. 2012;31(4):913e917. 5. Morey AF, Iverson AJ, Swan A, et al. Bladder
rupture after blunt trauma: guidelines for diagnostic imaging. J Trauma. 2001;51(4):683e686.