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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

 

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

Causes

 

Types of bladder injuries include:

  • Blunt trauma (such as a blow to the body)
  • Penetrating wounds (such as bullet or stab wounds)

The amount of injury to the bladder depends on:

  • How full the bladder was at the time of injury
  • What caused the injury

Traumatic injury to the bladder 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:

  • Surgeries of the pelvis or groin (such as hernia repair and removal of the uterus)
  • Tears, cuts, bruises, and other injuries to the urethra. Urethra is the tube that carries urine out of the body. This is most common in men.
  • Straddle injuries. This injury may occur if there is direct force that injures the area behind the scrotum
  • Deceleration injury. This injury may occur during a motor vehicle accident. Your bladder can get injured if it is full and you are wearing a seatbelt

Injury to the bladder or urethra may cause urine to leak into the abdomen. This may lead to infection.

 

Symptoms

 

Some common symptoms are:

  • Lower abdominal pain
  • Blood in the urine
  • Bloody discharge
  • Difficulty beginning to urinate or inability to empty the bladder
  • Loss of fluids
  • Painful urination
  • Pelvic pain
  • Severe bleeding
  • Small, weak urine stream
  • Abdominal distention or bloating

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

  • Decreased alertness, drowsiness, coma
  • Increased heart rate
  • Pale skin
  • Sweating
  • Skin that is cool to the touch

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:

  • Bladder injury or swollen (distended) bladder
  • Other signs of pelvic injury, such as bruising 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
  • Urine in the abdominal cavity

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:

  • Control symptoms
  • Repair the injury
  • Prevent complications

Emergency treatment of bleeding or shock may include:

  • Blood transfusions
  • Intravenous (IV) fluids
  • Monitoring in the hospital

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 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 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)

 

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

 

Possible Complications

 

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

  • Bleeding, shock.
  • Blockage to the flow of urine. This causes the urine to back up and injure one or both kidneys.
  • Scarring leading to blockage of the urethra.
  • Problems emptying the bladder completely.

 

When to Contact a Medical Professional

 

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

Call your provider if symptoms get worse 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 following these safety tips:

  • Do not insert objects into the urethra.
  • If you need self-catheterization, follow the instructions of your provider.
  • Use safety equipment during work and play.

 

 

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.

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: Elsevier Saunders; 2014:chap 47.

 
  • Bladder catheterization, female

    Bladder catheterization, female - illustration

    A catheter (a hollow tube, often with an inflatable balloon tip) may be inserted into the urinary bladder when there is a urinary obstruction, following surgical procedures to the urethra, in unconscious patients (due to surgical anesthesia, coma, or other reasons), or for any other problem in which the bladder needs to be kept empty (decompressed) and urinary flow assured. The balloon holds the catheter in place for a duration of time.

    Bladder catheterization, female

    illustration

  • Bladder catheterization, male

    Bladder catheterization, male - illustration

    Catheterization is accomplished by inserting a catheter (a hollow tube, often with and inflatable balloon tip) into the urinary bladder. This procedure is performed for urinary obstruction, following surgical procedures to the urethra, in unconscious patients (due to surgical anesthesia, coma, or other reasons), or for any other problem in which the bladder needs to be kept empty (decompressed) and urinary flow assured. The balloon holds the catheter in place for a duration of time. Catheterization in males is slightly more difficult and uncomfortable than in females because of the longer urethra.

    Bladder catheterization, male

    illustration

  • Female urinary tract

    Female urinary tract - illustration

    The female and male urinary tracts are relatively the same except for the length of the urethra.

    Female urinary tract

    illustration

  • Male urinary tract

    Male urinary tract - illustration

    The male and female urinary tracts are relatively the same except for the length of the urethra.

    Male urinary tract

    illustration

    • Bladder catheterization, female

      Bladder catheterization, female - illustration

      A catheter (a hollow tube, often with an inflatable balloon tip) may be inserted into the urinary bladder when there is a urinary obstruction, following surgical procedures to the urethra, in unconscious patients (due to surgical anesthesia, coma, or other reasons), or for any other problem in which the bladder needs to be kept empty (decompressed) and urinary flow assured. The balloon holds the catheter in place for a duration of time.

      Bladder catheterization, female

      illustration

    • Bladder catheterization, male

      Bladder catheterization, male - illustration

      Catheterization is accomplished by inserting a catheter (a hollow tube, often with and inflatable balloon tip) into the urinary bladder. This procedure is performed for urinary obstruction, following surgical procedures to the urethra, in unconscious patients (due to surgical anesthesia, coma, or other reasons), or for any other problem in which the bladder needs to be kept empty (decompressed) and urinary flow assured. The balloon holds the catheter in place for a duration of time. Catheterization in males is slightly more difficult and uncomfortable than in females because of the longer urethra.

      Bladder catheterization, male

      illustration

    • Female urinary tract

      Female urinary tract - illustration

      The female and male urinary tracts are relatively the same except for the length of the urethra.

      Female urinary tract

      illustration

    • Male urinary tract

      Male urinary tract - illustration

      The male and female urinary tracts are relatively the same except for the length of the urethra.

      Male urinary tract

      illustration

    A Closer Look

     

    Talking to your MD

     

      Self Care

       

        Tests for Traumatic injury of the bladder and urethra

         

         

        Review Date: 5/23/2016

        Reviewed By: Jennifer Sobol, DO, urologist with the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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