Bladder trauma: a guideline of the guidelines.

OBJECTIVES: To identify and review the most up-to-date guidelines pertaining to bladder trauma in a unifying document as an updated primer in the management of all aspects relating to bladder injury. METHODS: In accordance with the PRISMA statement, the most recent guidelines pertaining to bladder injury were identified and subsequently critically appraised. An electronic search of PubMed and Scopus databases was carried out in September 2023. RESULTS: A total of six guidelines were included: European Association of Urology (EAU) guidelines on urological trauma (2023), EAU guidelines on paediatric urology (2022), Urotrauma: American Urological Association (AUA) (2020), Kidney and Uro-trauma: World Society of Emergency Surgery and the American Association for the Surgery of Trauma (WSES-AAST) guidelines (2019), Management of blunt force bladder injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma (EAST) (2019), and EAU guidelines on iatrogenic trauma (2012). Recommendations were summarised with the associated supporting level of evidence and strength of recommendation where available. CONCLUSION: Several widely recognised professional organisations have published guidelines relating to the diagnosis, investigation, classification, management, and follow-up related to bladder injury. There is consensus amongst all major guidelines in terms of diagnosis and management but there is some discrepancy and lack of recommendation with regards to the follow-up of bladder injuries, iatrogenic bladder injury, paediatric bladder trauma, and spontaneous bladder rupture. The role of increasing minimally invasive techniques seem to be gaining traction in the select haemodynamically stable patient. Further research is required to better delineate this treatment option.

Spontaneous (idiopathic) rupture of the urinary bladder: a systematic review of case series and reports.

OBJECTIVES: To perform a systematic review of all cases of spontaneous rupture of the urinary bladder (SRUB) and to describe the demographic data, associated comorbidities, clinical presentation, diagnosis, relevant laboratory findings, associated factors, management, morbidity and mortality associated with the presentation of SRUB. METHODS: The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). A search was carried out across the following electronic databases: PubMed, Web of Science, Scopus, Google Scholar and the Cochrane Database of Systematic Reviews. Full texts of selected studies were analysed, and data extracted. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS: A total of 278 articles comprising 240 case reports and 38 case series, with a total of 351 patients were included. The median (interquartile range [IQR]) age of all included patients was 47.5 (33-65) years. The median (IQR) time to presentation was 48 (24-96) h, with the major presenting symptom being abdominal pain (76%). In patients in whom the diagnosis was made prior to any intervention, the condition was misdiagnosed in 64% of cases. The diagnosis was confirmed during explorative open surgery in 42% of cases. Pelvic radiation (13%) and alcohol intoxication (11%) were the most common associated factors. Intraperitoneal rupture (89%) was much more common, with the dome of the bladder being most frequently involved (55%). The overall mortality was 15%. CONCLUSION: This review identified a number of key factors that appear to be associated with an increased incidence of SRUB. It also emphasized the high rate of misdiagnosis and challenge in confirming the diagnosis. Overall, it highlighted the importance of the need for increased awareness and maintaining a high index of suspicion for this condition.

Non-traumatic bladder rupture.

Spontaneous bladder rupture, while rare, carries a high risk of morbidity and mortality if left untreated. Here, we describe a case report of spontaneous bladder rupture in a patient initially presenting with foley malfunction. Despite foley replacement, the patient continued to endorse abdominal pain and clinically deteriorate, thus raising our suspicion for possible bladder rupture. Recognizing and understanding the different variations of spontaneous bladder rupture is paramount for timely appropriate intervention.

A marked elevation in serum creatinine/cystatin C ratio may indicate pseudo-acute kidney injury due to urinary ascites: a case report and literature review.

BACKGROUND: Urinary ascites represents a scarcely observed pseudo-acute kidney injury in clinical settings. Protracted or missed diagnosis may hold grave ramifications for patient outcomes. CASE PRESENTATION: We reported a case involving an elderly female patient experiencing pseudo-acute kidney injury accompanied by ascites, wherein her renal dysfunction persisted despite medical intervention and hemodialysis. Urinary ascites was identified via a methylene blue test and by contrasting creatinine levels in serum and ascites. This patient's kidney function was multiple typified by a marked elevation in serum creatinine/Cystatin C ratio (> 2 L/dL), potentially serving as a clue for the clinical diagnosis of pseudo-acute kidney injury engendered by urinary ascites. CONCLUSIONS: This case suggested the potential diagnostic value of an asynchronous increase in serum creatinine and serum CysC (or an increased ratio of blood creatinine to blood CysC) in patients with pseudo-acute kidney injury.

Intraperitoneal Rupture of Urinary Bladder during Micturating Cystourethrography in a Child.

Micturating cystourethrography (MCUG) is a very commonly performed diagnostic procedure in pediatric urology. Although considered to be simple, safe, and cost-effective, it can incur some complications. Bladder rupture during MCUG is a very rare complication and only a handful of cases have been reported in world literature. We report the case of a 2.5-month-old boy who had intraperitoneal bladder rupture during an MCUG needing surgical repair. At operation, the child had a bladder tear at the dome of the bladder which was repaired successfully. The postoperative recovery was uneventful and the child is doing well in follow-up. Although individual management of bladder rupture may differ, a majority of infants need surgery for the same. Thorough vigil and attention to the technique are a must to prevent such incidents in children.

Fetal Bladder Rupture as a Complication of Adjunctive Therapy in Severe Maternal SARS-CoV-2 Pneumonia.

INTRODUCTION: A case of spontaneous fetal bladder rupture occurring in a woman with SARS-CoV-2 pneumonia receiving invasive ventilatory support is reported. CASE: A 33-year-old woman was admitted at 30.6 weeks' gestation with the diagnosis of severe pneumonia due to COVID-19. The patient required invasive mechanical ventilation on day 2. Propofol, fentanyl, midazolam, and dexmedetomidine were administered for sedation, pain relief, and to improve patient-ventilator interaction. A bedside ultrasound on day 3 revealed fetal megacystis. Follow-up scan two days later showed urinary ascites and a collapsed bladder. The diagnosis of fetal bladder rupture was confirmed postpartum. Bladder repair was performed on day 5, with an uneventful recovery. DISCUSSION: Transplacental transfer of opioids during invasive ventilatory support in pregnancy may cause acute fetal bladder atony leading to severe urine retention and, potentially, bladder rupture. This can be a serious complication of adjunctive therapy in women with severe SARS-CoV-2 pneumonia.

[Retrograde Transurethral Contrast-enhanced Ultrasound in the Diagnosis of Bladder Rupture:Report of Two Cases].

Bladder rupture refers to a series of diseases caused by bladder wall laceration and urine flowing into the abdominal cavity.Two cases of bladder rupture diagnosed by retrograde transurethral contrast-enhanced ultrasound were reviewed in this report.We discussed the value of retrograde transurethral contrast-enhanced ultrasound in the diagnosis,classification,and prognosis evaluation of bladder rupture,aiming to provide evidence for clinical diagnosis and treatment.

Intraperitoneal bladder rupture in a 1 year old: A very unusual accident.

Intraperitoneal bladder rupture is a rare event in the paediatric population. Road traffic accidents (RTA) and seat belt injuries are considered to be the main cause for the same. We report an interesting case of a 1-year-old girl who had a laparoscopic repair of intraperitoneal bladder tear following a non-RTA injury. This is the smallest child where intraperitoneal bladder rupture was repaired laparoscopically. This mechanism of injury-causing bladder rupture has also not been reported across world literature. The child was sleeping on the floor near the bed with her mother. The father who was sleeping on the bed accidentally fell onto this child. Imaging showed large amount of clear intraperitoneal fluid with no organ injury. Laparoscopy showed a 3.5 cm long tear on the posterior wall of the bladder. The tear was repaired using 3 mm instruments.

Intraperitoneal bladder rupture in a young child with vascular Ehlers-Danlos syndrome.

In this report, we present the case of a 3-year-old child with vascular Ehlers-Danlos syndrome (vEDS) previously known as Ehlers-Danlos syndrome type IV. After experiencing a minor traumatic injury to the abdomen, consisting of falling over a bathroom stool on the way to the restroom with a full bladder, the child developed acute abdominal pain. He was found to have an intraperitoneal bladder rupture that was successfully repaired with management techniques tailored to his known diagnosis of vEDS. While tissue fragility and internal organ rupture occurring with minor trauma are known complications of vEDS, this is the first case in the literature of a bladder rupture in a child with vEDS with a confirmed variant in the COL3A1 gene, to our knowledge. This case broadens the clinical presentation of vEDS, demonstrates that children can have life-threatening organ rupture at a young age, and may alert providers to consider this diagnosis when a child presents with bladder rupture.

Reservoir induced bladder rupture: a complication of inflatable penile prosthesis revision surgery.

Reservoir induced bladder rupture is a rare complication of inflatable penile prosthesis (IPP) revision surgery. Our aim is to review the literature and describe our experience with this complication using two case reports that involved reusing an in-situ reservoir. In each case, an episode of gross hematuria indicated that a bladder rupture had occurred. From our experience, we propose ways to possibly avoid and if necessary, manage this rare complication.

The reasons and countermeasures of Bladder Rupture caused by Transurethral Clot Evacuation.

OBJECTIVE: Bladder rupture caused by transurethral clot evacuation is rare in clinic, but an emergency operation is indeed needed in the patient with bladder rupture. We analyzed the reasons of bladder rupture caused by transurethral clot evacuation and provided the countermeasures to guide clinical surgeon to prevent the iatrogenic damage of bladder. METHOD: We retrospectively reviewed the records of 287 patients in our hospital, who had bladder tamponade resulting from clots of blood for various reasons and underwent transurethral clot evacuation from January 2007 to January 2019. Six male cases, aged from 28 to 76 years (mean 56.67±17.76) had bladder rupture. Four patients whose bladder ruptured intraperitoneally were changed to open surgery to repair bladder and clear the remanent blood clots. Two patients with extraperitoneal bladder rupture and a small bladder crevasse underwent a conservative therapy. RESULTS: We observed that the incidence rate of bladder rupture was not associated with bladder tamponade and the age, but may be associated with gender, bladder paracentesis preoperative and urinary retention preoperative. All six cases were male.. They had different period of urinary retention before operation. No supra-pubis bladder paracentesis was made before operation. The bladder crevasses located in the triangle zone and posterior wall of bladder entirely, and the length of the bladder crevasses ranged from 3 to 7cm (mean 4.83cm). The bladder crevasses were all lengthways, and four cases were of' bladders ruptured intraperitoneally while another two presented an extraperitoneal bladder rupture. CONCLUSIONS: The reasons of bladder rupture caused by transurethral clot evacuation may be related to gender, bladder paracentesis preoperative and urinary retention preoperative. We should decide to use expectant treatment or open surgery immediately according to the extent of the rupture when bladder rupture occurs.

Diagnostic accuracy of pneumo-CT-cystography in the detection of bladder rupture in patients with blunt pelvic trauma.

PURPOSE: To evaluate the diagnostic utility of bladder air distension (pneumo-CT-cystography) in the detection of bladder rupture in patients with blunt pelvic trauma. MATERIALS AND METHODS: 843 patients with blunt pelvic trauma were evaluated. Intravenous contrast-enhanced CT was performed for trauma staging. 97 of 843 patients had clinical and radiological signs of possible bladder injury and underwent retrograde air distension. RESULTS: Among 97 patients, 31/97 showed CT signs of bladder rupture, of which 5/31 (16%) intraperitoneal, 25/31 (81%) extraperitoneal and 1/31 (3%) combined. 23 of these patients underwent surgery, which confirmed bladder injury in 100% of cases. The other 8 patients were managed conservatively, and follow-up studies showed disappearance of free air. Among the 66/97 patients with no signs of bladder injury, 38/66 had surgery, which confirmed bladder integrity, while 28/66 were managed conservatively and showed no signs of bladder rupture at clinico-radiological follow-up examinations. CONCLUSIONS: CT evaluation of urinary bladder after retrograde air distension (pneumo-CT-cystography) may be a reliable diagnostic tool in the detection of bladder rupture in patients with blunt pelvic trauma. This technique is faster, cheaper and allows to overcome some of the limitations of conventional CT-cystography.

Spontaneous bladder rupture secondary to warfarin overdose: a case report.

BACKGROUND: Warfarin, a vitamin K antagonist, is a widely used medication for the treatment and prophylaxis of thromboembolic events. Patients with various clinical conditions due to warfarin overdose present to emergency departments. Although there may be serious bleeding due to a warfarin overdose, no bleeding may also be seen in some clinical conditions. Some of these bleedings may be life-threatening and result in death. Warfarin overdose and related cases of spontaneous bladder rupture are not frequently observed in the literature. We present a case of spontaneous bladder rupture due to warfarin overdose that was unexpectedly seen in a patient using warfarin for coronary artery disease and arrhythmia. CASE PRESENTATION: A 77-year-old Caucasian male patient was admitted to the emergency department with abdominal pain, haematuria, and a reduced volume of urine lasting for three days. The patient's amount of urine was reduced, and he came to the hospital for the first time with this complaint. The patient had local bruises on his arms and legs. From the ultrasound, retrograde cystography and computed tomography images, it was thought that there was blood accumulation due to bladder rupture to the intraperitoneal region. Spontaneous bladder rupture secondary to warfarin overdose was considered for this patient who also had an international normalized ratio (INR) level of 13.4. After the INR level was normalized with vitamin K and a prothrombin complex concentrate, the patient underwent surgery. During the operation, a catheter was placed in the bladder, and the bladder mucosa and muscle were closed separately with a primary repair performed by a urologist. The patient was discharged on the 8th postoperative day without any complications. CONCLUSION: In addition to the known findings of warfarin overdose in these patients presenting to the emergency department, we think that the emergency department staff should suspect bladder rupture, which is a fatal complication in the presence of signs such as oliguria, haematuria, anuria, abdominal pain, and syncope.

Imaging of Gastrointestinal and Abdominal Emergencies in Binge Drinking.

Excess alcohol consumption is a leading cause of preventable morbidity and mortality globally. The pattern of consumption of alcoholic beverages has changed in our society in the recent past, with binge drinking becoming more and more common, especially among young adults. Abdominal pain following alcohol consumption can be secondary to a wide range of pathologies, the treatment algorithm of which can range from medical supportive treatment to more invasive life-saving procedures such as transarterial embolization and emergency laparotomy. Correct diagnosis, differentiation among these conditions, and implementing the correct management algorithm is heavily reliant on accurate and appropriate imaging. We review the pathophysiology, clinical presentation, imaging features and management options of acute abdominal emergencies secondary to binge drinking, based on a selection of illustrative cases.

Bladder rupture after a fall on the ground in a patient with total uterine prolapse.

OBJECTIVE: The aim of this work is to present a case of traumatic bladder rupture in a patient with total uterine prolapse. Additionally, we provide a brief description of this issue. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, 3rd Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague; Departement of Radiology, 3rd Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague. RESULTS: We present a case report of a patient with a total uterine prolapse that has been examined for a lower abdominal pain, hematuria and difficulties with urination. The problems arose suddenly after the fall on the ground. These symptoms are typical for bladder rupture, but other more frequent causes have to be ruled out. CT scan showed a contrast agent leak from the bladder. The patient was indicated for surgical revision and suture of the bladder wall. CONCLUSION: Separately, rupture of the bladder occurs rarely. Most often, this injury is part of a wider trauma - especially after car crashes. However, our case report suggests that this option should be considered.

Delayed diagnosis of spontaneous bladder rupture: a rare case report.

BACKGROUND: Bladder rupture caused by trauma or pelvic fracture is very common, and can be easily diagnosed. However, Spontaneous rupture of the bladder is rare. Reported by Peters PC. (Peters, Urol Clin N Am 16:279-82, 1989): The incidence of spontaneous bladder rupture is 1: 126000. During childbirth, the occurrence rate of this disease is lower than that of the former. It is very difficult to make an early diagnosis of the spontaneous rupture of the bladder during childbirth, which eventually results in high maternal mortality. Due to peritoneal reabsorption, the patient may show high levels of serum creatinine and potassium, and this would easily be misdiagnosed as acute renal failure. However, these patients have normal renal function, hence the diagnosis of renal failure is incorrect. CASE PRESENTATION: A 23 year-old female patient had her first pregnancy and delivered a full-term healthy baby girl. After delivery, the patient developed fever, oliguria, massive ascites, high serum creatinine and high serum potassium. The patient was initially diagnosed with acute renal failure, however treatment for her condition was ineffective. After further examination, the patient was diagnosed with intraperitoneal bladder rupture. The patient was treated for bladder rupture, made a full recovery and was discharged. CONCLUSIONS: Sudden onset of massive ascites and renal failure due to abnormal serum biochemical characteristics after delivery should be first diagnosed as spontaneous bladder rupture. However, bladder radiography may suggest a false negative result, hence cystoscopy should be performed to confirm the diagnosis. The ratio between ascites creatinine and serum creatinine would be helpful for early diagnosis and to determine the time of rupture. Conservative management or surgical repair should be used to treat bladder rupture.

In utero spontaneous bladder rupture in a fetus with posterior urethral valve: A case report of prenatal diagnosis and management.

Posterior urethral valve (PUV) rarely causes bladder rupture. We experienced hydronephrosis due to ureteral obstruction after the natural repair of a ruptured bladder in a fetus with PUV. Fetal ascites and oligohydramnios were diagnosed at 26 weeks' gestational age. While we followed up with ultrasonography, we regularly removed the fetal ascites via abdominal puncture, injecting warm saline instead of amniotic fluid. At 35 weeks' gestational age, the infant was diagnosed with severe bilateral hydronephrosis, absent of ascites and oligohydramnios. Therefore, a Caesarean section was performed. After birth, the infant was diagnosed with hydronephrosis due to ureteral obstruction after the natural repair of a ruptured bladder associated with PUV. Thus, a ruptured bladder in a fetus with PUV that has naturally repaired should be closely monitored via ultrasonography for hydronephrosis due to ureteral obstruction.

Idiopathic bladder rupture.

Deaths due to hemoperitoneum are not rare and can result from a variety of underlying pathologic processes, including natural disease as well as trauma. Whenever hemoperitoneum is identified at autopsy, it is incumbent upon the pathologist to identify the source of the hemorrhage. The authors present a case of probable traumatic rupture of the urinary bladder that resulted in lethal intra-abdominal hemorrhage, occurring in a young man who was found dead the morning after drinking heavily.

Spontaneous rupture of the urinary bladder (SRUB): Recovery from cardiopulmonary arrest.

Spontaneous rupture of the urinary bladder (SRUB) is rare and results in a lethal condition, i.e., pan peritonitis. However, early and accurate diagnosis of SRUB is very difficult. A 54-year-old woman was transported to our hospital with suspicion of pan peritonitis after spontaneous return of circulation with pulseless electrical activity. Laboratory investigation seemed to indicate acute renal failure. Namely, her serum urea and creatinine levels were grossly elevated. Exploratory laparotomy showed unexpected rupture of urinary bladder. Her recovery after surgery was relatively smooth. SRUB should be considered in the differential diagnosis of pan peritonitis, because urgent appropriate surgical intervention can rescue patients from this rare lethal disease.