The bladder is the organ that is most often injured in operations in the basin. Such injuries can during a transurethral surgery, occurring in gynecological surgery (most common abdominal hysterectomy, cesarean section, excision of tumors in the pelvis), or bowel resection. Prädispositionierende factors are scars from previous surgery or radiation therapy, inflammation and extensive tumor burden.
External bladder injuries are caused either by blunt or penetrating injuries to the lower abdomen, the pelvis or the perineum. A blunt injury is the more common mechanism of injury, usually caused by a sudden deceleration, such as in a car accident at high speed, or a fall or by a shock from the outside brought about in the abdomen. The most commonly attached injury is a pelvic fracture, in which in> 95% of cases the bladder is ruptured by blunt trauma. Other associated injuries are fractures of the long bones, as well as injuries to the central nervous system and the chest. Penetrating injuries, mostly gunshot wounds, constitute <10% of bladder injuries. The bladder is the organ that is most often injured in operations in the basin. Such injuries can during a transurethral surgery, occurring in gynecological surgery (most common abdominal hysterectomy, cesarean section, excision of tumors in the pelvis), or bowel resection. Prädispositionierende factors are scars from previous surgery or radiation therapy, inflammation and extensive tumor burden. Bladder injuries, such as bruising or ruptures are classified according to the extent of the injury that are radiologically visible. You can be intra- and / or extraperitoneal or both. Among the complications of bladder injuries are Uroaszites (free urine into the abdominal cavity) by intraperitoneal rupture, infection (including sepsis), persistent hematuria, incontinence, bladder instability and fistulas. The mortality in a bladder rupture is approximately 20%, however, this rather by the associated organ injury than the bladder injury itself. Symptoms and signs Symptoms include suprapubic pain and Miktionsunfähigkeit. Furthermore, there are hematuria, suprapubic tenderness, overstretching, hypervolaemic shock (due to bleeding) and, in the case of intraperitoneal rupture, also signs of peritonitis. Blunt Blasenrupturen almost always go hand in hand with a pelvic fracture and gross hematuria. Bladder injuries that occur during the operation are identified intraoperatively in general. Among the findings Urinextravasation, a sudden increase in bleeding, appearance of the bladder catheter into the wound and, during the laparoscopy, expansion of the urine drainage bag belong with gas can. Diagnosis Retrograde cystography, usually with CT signs and symptoms are often subtle or nonspecific; Therefore, the diagnosis should be viewed with great suspicion. The diagnosis is suspected based on history and physical examination and by the findings and hematuria (mostly strong) confirmed. Confirmation is diluted contrast medium by retrograde Cystography with 350 ml in order to fill the bladder directly. Simple x-rays or CT can be used, but a CT is to present the added advantage of the accompanying intra-abdominal injuries and pelvic fractures. "Drainage movies" should only be taken if "clear film X-rays" are used. When an abnormality of the urethra is suspected in a male patient, a retrograde catheter placement should be avoided until the results of Urethrography present. A rectal examination should be performed in all patients with a blunt or penetrating injury mechanism to test for blood, which strongly suggests a simultaneous intestinal injury. Similarly, female patients should be tested for genital lacerations. Therapy catheter drainage Sometimes surgical correction all penetrating trauma and intraperitoneal ruptures by blunt trauma require surgical exploration and recovery. Bruises only require a catheter drainage until the severe hematuria has disappeared. Most extraperitoneal fractures require only a catheter drainage when the urine can flow freely and the bladder neck is spared. When the bladder neck is involved, surgical exploration and repair are necessary to minimize the likelihood of incontinence. Most bladder injuries during an operation are identified and repaired intraoperatively. Important Points Most bladder injuries caused by blunt mechanisms that are accompanied by pelvic fractures and Gross hematuria. Pull the diagnosis into consideration when a compatible mechanism of injury and suprapubic pain and tenderness, urinary retention, hematuria, bladder over-expansion and / or unexplained shock or Peritonealdialysezeichen present. Confirm the diagnosis with retrograde cystography. Contusions and most extraperitoneal ruptures can be treated only with catheter drainage. Intraperitoneal ruptures should be explored surgically. Most bladder injuries during the operation are identified and repaired intraoperatively.