Health Topics

Traumatic injury of the bladder and urethra

Traumatic injury of the bladder and urethra involves damage caused by an outside force. Causes Injuries to the bladder can be divided into:
Blunt trauma (such as a blow to the body) Penetrating wounds (such as bullet or stab wounds)

The nature of the 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. Only about 8 - 10% of pelvic fractures are associated with bladder injury. Because the bladder is located within the bony structures of the pelvis, it is protected from most outside forces. Injury may occur if there is a blow to the pelvis that is severe enough to break the bones and cause bone fragments to penetrate the bladder wall. Other causes of bladder or uretal injury include:
Surgeries of the pelvis or groin (including hernia repair and abdominal hysterectomy) Tears, cuts, bruises, and other injuries to the urethra (the tube that carries urine out of

the body) -- most common in men.

Straddle injuries (direct force accidents that injury the scrotum area between a man's

legs) Deceleration injury (for example, a motor vehicle accident that occurs with a full bladder while wearing seatbelt) 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

Abdominal pain, lower Blood in the urine or at the urethral opening Difficulty beginning to urinate or inability to empty the bladder Loss of fluids Painful urination Pelvic pain Severe bleeding Small, weak urine stream

Emergency symptoms indicating shock or hemorrhage:

Decreased alertness o Coma o Drowsiness, lethargy

Increased heart rate Pale skin Sweating Skin cool to touch

Note: Symptoms follow a history of injury. Scarring (stricture) or obstruction of the bladder or urethra from swelling may develop. If urine retention occurs, there may be an increased risk of urinary tract infections (UTI). Exams and Tests An examination of the genitals may show injury to the urethra. If the health care provider suspects an injury, an x-ray of the urethra using dye (retrograde urethrogram) should be done to show the structure of the lower urinary tract. Examination may also show:
Bladder injury or swollen (distended) bladder If the bladder lining has been disturbed, urine may escape from the bladder into the

abdominal cavity.
Other signs of pelvic injury, such as brusing over the penis, scrotum, and perineum Signs of hemorrhage or shock, including decreased blood pressure -- especially in cases

of pelvic fracture
Tenderness and bladder fullness when touched (caused by urine retention) Tender and unstable pelvic bones

A catheter (a tube that drains urine from the body) may be inserted once an injury 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:

Control symptoms Repair the injury Prevent complications

Emergency treatment of bleeding or shock may include:

Blood transfusions Intravenous (IV) fluids Monitoring in the hospital

Treatment of peritonitis (inflammation of the abdominal cavity) may include emergency surgery to repair the injury and drain the urine from the abdominal cavity. Antibiotics may be given to treat peritonitis and to prevent urinary tract infections.

Surgical repair of the injury is usually successful. 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, allowing the injured bladder or urethra to heal. This also prevents swelling in the urethra from blocking urine flow. If the urethra has been cut, a urological specialist can place a catheter. If this cannot be done, a tube will be inserted through the abdominal wall and directly into the bladder. This is called a suprapubic tube. It will be left in place until swelling goes away and the urethra can be surgically repaired. This typically takes 3 - 6 months. Outlook (Prognosis) Traumatic injury of the bladder and the urethra may range from minor to major and lifethreatening. There may be severe, immediate, or long-term complications. Possible Complications

Acute bilateral obstructive uropathy Bleeding, hemorrhage, shock Chronic bilateral obstructive uropathy Peritonitis Scar formation, obstruction of the urethra Urinary retention Vesicoureteric reflux

When to Contact a Medical Professional Go to the emergency room or call the local emergency number (such as 911), if you have symptoms of traumatic injury of the bladder or urethra -- particularly if there is a history of injury to the area. Call your health care provider if symptoms worsen or new symptoms develop, including:

Decrease in urine production Fever Severe abdominal pain Severe flank or back pain Shock or hemorrhage

Prevention Prevent outside injury to the bladder and urethra by using general safety precautions:
Do not insert objects into the urethra If you need self-catheterization, follow the instructions of your health care provider Use appropriate safety equipment during work and play

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

References Morey AF, Rozanski TA. Genital and lower urinary tract trauma. In: Wein AJ, ed. CampbellWalsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 83. Runyon MS. Genitourinary system. In: Marx JA, ed. Rosens Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 44. Update Date: 6/21/2010 Updated by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. Browse the Encyclopedia MedlinePlus Topics

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