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Definition

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

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:

• Surgeries of the pelvis or groin (such as hernia repair and removal of the uterus).
• Tears, cuts, bruises, and other injuries to the urethra. The urethra is the tube that carries urine out of the body. This is more common in men than women.
• 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
• Abdominal tenderness
• Bruising at the site of injury
• Blood in the urine
• Bloody urethral discharge
• Difficulty beginning to urinate or inability to empty the bladder
• Leakage of urine
• Painful urination
• Pelvic pain
• 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
• Decrease in blood pressure
• Pale skin
• Sweating
• Skin that is cool to the touch

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:

• Retrograde urethrogram (an x-ray of the urethra using dye) for injury of urethra
• Retrograde cystogram (imaging of bladder) for injury of the bladder
• CT scan

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 urinary catheter may be inserted once an injury of the urethra has been ruled out. This is a tube that drains urine from the bladder. 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
• Drain the urine
• Repair the injury
• Prevent complications

Emergency treatment of bleeding or shock may include:

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

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 (urologist) 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:

• 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 completely emptying the bladder.

When to Contact a Medical Professional

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

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

• Decrease in urine production
• Fever
• Blood in urine
• 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

Brandes SB, Eswara JR. Upper urinary tract trauma. Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 90.

Lang SC, Shewakramani SN. Genitourinary trauma. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 39.

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