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Traumatic injury of the bladder and urethra

Definition

Traumatic injury of the bladder and urethra involves damage caused by an outside force.

Alternative Names

Injury - bladder and urethra; Bruised bladder; Urethral injury; Bladder injury; Pelvic fracture; Urethral disruption

Causes

Types of bladder injuries include:

The amount of injury to the bladder depends on how full the bladder was at the time of injury and what caused the injury.

Traumatic injury to the bladder is uncommon. The bladder is located within the bony structures of the pelvis. This protects it from most outside forces. Injury may occur if there is a blow to the pelvis severe enough to break the bones. In this case, bone fragments may penetrate the bladder wall. Less than 1 in 10 pelvic fractures lead to bladder injury.

Other causes of bladder or urethra injury include:

Injury to the bladder or urethra may cause urine to leak into the abdomen, leading to infection (peritonitis). This type of injury is more common if the bladder is full.

Symptoms


Shock or internal bleeding may occur after a bladder injury. This is a medical emergency. Symptoms include:

If there is no or little urine released, there may be an increased risk of urinary tract infections (UTI).

Exams and Tests

An exam of the genitals may show injury to the urethra. An x-ray of the urethra using dye (retrograde urethrogram) should be done if the health care provider suspects an injury.

The exam may also show:

A catheter (tube that drains urine from the body) may be inserted once an injury of the urethra has been ruled out. An x-ray of the bladder using dye to highlight any damage can then be done.

Treatment

The goals of treatment are to:

Emergency treatment of bleeding or shock may include:

You may need emergency surgery to repair the injury and drain the urine from the abdominal cavity in the case of peritonitis (inflammation of the abdominal cavity).

The injury can be successfully repaired with surgery in most cases. The bladder may be drained by a catheter through the urethra or the abdominal wall over a period of days to weeks. This will prevent urine from building up in the bladder. It will also allow the injured bladder or urethra to heal and prevent swelling in the urethra from blocking urine flow.

If the urethra has been cut, a urological specialist can put a catheter in place. If this cannot be done, a tube will be inserted through the abdominal wall directly into the bladder. This is called a suprapubic tube. It will be left in place until the swelling goes away and the urethra can be repaired with surgery. This takes 3 - 6 months.

Outlook (Prognosis)

Traumatic injury of the bladder and urethra can be minor or life threatening. Short- or long-term serious complications can occur.

Possible Complications

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number if you have symptoms of traumatic bladder or urethra injury -- especially if you have been injured in those areas.

Call your health care provider if symptoms get worse or new symptoms develop, including:

Prevention

Prevent outside injury to the bladder and urethra by following these safety steps:

References

Runyon MS. Genitourinary system. In Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Mosby Elsevier; 2013:chap 47.

Morey AF, Dugi III DD. Genital and lower urinary tract trauma. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 88.


Review Date: 6/2/2014
Reviewed By: Scott Miller, MD, Urologist in private practice in Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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