What causes bladder damage and what are the symptoms?

The bladder is an organ that stores and excretes urine. When the bladder is full, the thin and tense bladder wall is easily damaged. There are more reasons for bladder wall damage than just this one. Let's take a look at what other reasons there are.

(I) Etiology and pathology

1. Open injuries such as sharp objects or bullet penetration injuries are prone to cause urinary fistulas.

2. Closed injuries are caused by direct violence, which results in contusion and local bleeding leading to hematoma. In severe cases, rupture may occur.

(1) Extraperitoneal rupture of the bladder: This is often caused by bone fragments puncturing the bladder during pelvic compression injuries. Urine leaks into the extraperitoneal space, causing secondary infection and abscess formation.

(2) Intraperitoneal rupture of the bladder: This is often caused by a violent blow to the lower abdomen when the bladder is full. The injured area is mostly at the top and back wall of the bladder. Urine flows into the abdominal cavity and causes acute peritonitis.

3. Spontaneous rupture: The diseased bladder (such as tuberculosis, diverticulum) is over-inflated and ruptures.

(II) Clinical manifestations

1. Shock: Pelvic fractures are accompanied by massive bleeding, extrauria and peritonitis. Severe injuries often result in shock.

2. Inability to urinate and hematuria After the bladder ruptures, urine leaks out around the bladder or flows into the abdominal cavity. The patient feels the urge to urinate but is unable to urinate or only excretes a small amount of hematuria.

3. Abdominal pain: Urinary infiltration or hematoma, urine flowing into the abdominal cavity causing peritonitis, can all lead to abdominal pain.

4. Urinary fistula: Penetrating wounds may cause urine leakage from the body surface, rectum or vagina. Urinary fistula may also occur if a closed wound ruptures after extravasation of urine and becomes infected.

(III) The diagnosis is mainly based on the history of injury and clinical manifestations, and there is no difficulty in diagnosis.

1. Catheterization and leak test The catheter can be inserted into the bladder smoothly, but no urine flows out or only a small amount of hematuria is present. 200 ml of sterile saline is injected into the catheter and then aspirated. If the aspirated amount decreases, it indicates bladder rupture. If the aspirated amount increases, it may be due to the reflux of intraperitoneal fluid into the bladder, which also indicates the possibility of bladder rupture.

2. Cystography: Inject 300ml of contrast agent through the catheter and take an X-ray. After the contrast agent is emptied, take another X-ray to find that the contrast agent has leaked out of the bladder.

(IV) Treatment

1. There is no special treatment for bladder contusion. For patients with dysuria or severe hematuria, a urinary catheter can be placed to stop bleeding and antibiotics can be used to prevent infection.

2. Once the bladder rupture is confirmed, surgical repair should be performed immediately, and a cystostomy tube should be placed. After the repair of extraperitoneal bladder rupture, a drainage tube should be placed to fully drain the extravasated urine. For intraperitoneal bladder rupture, laparotomy should be performed to aspirate the urine in the abdominal cavity and treat the damage to other organs.

3. Other anti-shock treatments for severe cases, such as blood transfusion, infusion, sedation, analgesia and infection prevention.