- Blunt trauma : 10% of pelvic fractures.
- Penetrating trauma :gunshots or stap wounds.
- Obestetric :- 0.3% with caeserean section.
- Gynaecological e.g.during a vaginal or abdominal hysterectomy.
- Urological e.g during cystescopy.
- Orthopaedic e.g. pins and screws can commonly perforate the urinary bladder, particularly during internal fixation of pelvic fractures.
- Extraperitoneal rupture bladder: Usually due to fracture pelvis,and Extravasation occur at the perivesical space and may extend up to the anterior abdominal wall,If the urogenital membrane is injuried.
- Intraperitoneal rupture bladder:(The most dangerous) Usually due to direct trauma when the bladder is full,associated with electrolyte disturbance and may passed unnoticed for along time.
- History of trauma or Operation.
- Clinical Picture:-
- Gross haematuria.
- Suprapubic pain.
- Difficulty to void.
(Intraperitoneal rupture bladder by Ascending cystogram : source)
(extraperitoneal rupture bladder by CT cystogram obtained after retrograde filling of the bladder shows an intravesicle air-contrast level (black arrow) and contrast material in the perivesicle extraperitoneal space (white arrows) : source)Complications:-
- Pelvic infection
- Some degree of urge incontinence, if the lesion extend to bladder neck.
- Emergency treatment of shock.
- Bladder injury:-
- Extraperitoneal rupture bladder: just fixation of a urethral catheter for 7 to 10 days but Surgical intervention must be done if :there is associated organ injuries,large vesical haematoma and injury to the bladder neck.
- Intraperitoneal rupture bladder: Surgical repair is the first choice in most of cases.
- The urethral catheter must be left 10 to 14 days
- Ascending cystogram must be done before removal of the catheter
- Leave the suprapubic tube till the patient void successfully.
- The patient could return to work 4 to 6 weeks later.