Guidance for diagnosis and management of bladder injuries – is practice up to date?

Abstract

The BAUS consensus statement [1] provides the latest update to guidance on management of bladder injury (BI). Clinical guidelines are a particularly helpful tool for such cases, which are uncommon, but require timely diagnosis and management to optimise outcome.Before 2021, the European Association of Urology (EAU) Guidelines on Urological Trauma [2] and British Orthopaedic Association Standard for Trauma (BOAST)14 [3] provided guidance on the best practice for management of traumatic BI, which are commonly secondary to blunt trauma (e.g. road traffic accidents) and associated with multiple injuries, especially pelvic fracture. The EAU guidance [2] also details the suggested management of iatrogenic BI. Regardless of aetiology, the management of extra-and intraperitoneal injuries is distinct, therefore accurate diagnosis is important.

A case of blunt abdominal trauma resulting in significant bladder injury (AAST grade IV)

“…On the other hand, blunt abdominal trauma (e.g., from road traffic accident or fall) is the most common cause of bladder injury. However, because bladder injury is commonly associated with pelvic fractures (up to 60-90%) or other intra-abdominal injuries (44-68%) and due to its variability in presentation, an accurate diagnosis is often difficult and delayed [4]. Unfortunately, bladder injuries are associated with significant morbidity and mortality (10-22%) [3].…”

“…One patient required a urethral catheter for a longer period (52 days) with no further complications. The second patient who had sustained an iatrogenic injury after a complex pelvic mass removal was having ongoing pelvic collection and was still catheterized while the study was underway [4].…”