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Traumatic injury of the bladder and urethra

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

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

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Bladder catheterization, female
Bladder catheterization, male
Female urinary tract
Male urinary tract

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Causes

Types of bladder injuries include:

The amount of injury to the bladder depends on:

Injury to the bladder due to trauma is not very common. The bladder is located within the bones 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 pierce 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. This may lead to infection.

Symptoms

Some common symptoms are:

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 for urinary tract infections (UTI) or kidney damage.

Exams and Tests

An exam of the genitals may show injury to the urethra. If the health care provider suspects an injury, you may have the following tests:

The exam may also show:

A catheter may be inserted once an injury of the urethra has been ruled out. This is a tube that drains urine from the body. 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:

Emergency surgery may be done to repair the injury and drain the urine from the abdominal cavity in case of extensive injury or peritonitis (inflammation of the abdominal cavity).

The injury can be repaired with surgery in most cases. The bladder may be drained by a catheter through the urethra or the abdominal wall (called a suprapubic tube) 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 try to 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 to 6 months.

Outlook (Prognosis)

Injury of the bladder and urethra due to trauma can be minor or fatal. Short or long-term serious complications can occur.

Possible Complications

Some of the possible complications of injury of the bladder and urethra are:

When to Contact a Medical Professional

Call the local emergency number (911) or go to the emergency room if you have an injury to bladder or urethra.

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

Prevention

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

Related Information

Hysterectomy
Peritonitis
Reflux nephropathy
Obstructive uropathy
Urinary tract infection - adults

References

Morey AF, Zhao LC. Genital and lower urinary tract trauma. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 101.

Shewakramani SN. Genitourinary system. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 40.

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Review Date: 5/31/2018  

Reviewed By: Sovrin M. Shah, MD, Assistant Professor, Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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