|
Traumatic injury of the bladder and urethra Causes and Risks:
Traumatic injury to the bladder is uncommon. The bladder is located within the bony structures of the pelvis, and is protected from most external forces. Injury may occur if there is a blow to the pelvis that is severe enough to cause the bones to break and bone fragments to penetrate the bladder wall. It may occur secondary to surgery of the pelvis or groin, including hernia repair and abdominal hysterectomy . Injury to the urethra is slightly more common, especially in men. It is rare in women. Injury to the urethra includes cuts, tears, bruises, and similar injuries.
Injury to the bladder or urethra may cause urine to leak into the abdomen, leading to infection ( peritonitis ). There may be severe bleeding and loss of fluids. Scarring (stricture) or obstruction of the bladder or urethra from swelling may develop, leading to urinary retention. This may eventually cause vesicoureteric reflux or bilateral obstructive nephropathy . There is an increased chance of developing urinary tract infections after injury to the tissues of the urethra or bladder, caused by stasis (stagnation) of retained urine.
Prevention:
External damage to the bladder and urethra may be prevented by using general safety precautions. Use appropriate safety equipment during work and play. Do not insert objects into the urethra. If self-catheterization is required, follow the instructions of the health care provider.
Symptoms:
Emergency symptoms indicating shock or hemorrhage: Note: Symptoms follow a history of injury.
Signs and Tests:
Examination of the genitals may indicate injury to the urethra. Palpation (slight pressure) over the bladder may show tenderness. Palpation may indicate bladder fullness, caused by retention of urine. Examination of the abdomen and/or rectum may indicate bladder injury or may show distended bladder. There may be signs of hemorrhage or shock , including decreased blood pressure .
Cystoscopy (examination of the bladder using a scope inserted through the urethra) may allow the health care provider to see the area of injury.
A urinalysis may show blood in the urine .
Treatment:
The goals of treatment are control of symptoms, repair of the injury, and prevention of complications. Emergency treatment of bleeding , shock , or hemorrhage may include intravenous fluids or blood, and monitoring in the hospital.
Treatment of peritonitis may include emergency surgery to repair the injury and to drain the urine from the abdominal cavity. Antibiotics may be given to treat peritonitis and to prevent the development of urinary tract infections . Surgical repair of the injury is usually successful. The bladder may be drained by a catheter for days to weeks. This will prevent urine from accumulating in the bladder, which allows the injured bladder or urethra to more easily heal. This also prevents obstruction of urine flow caused by urethral swelling.
Prognosis:
Traumatic injury of the bladder and the urethra may range from minor and self limiting in some cases, to major and life threatening in other cases. There may be severe immediate or long-term complications.
Complications:
Call Your Healthcare Provider:
Go to the emergency room or call the local emergency number (such as 911) if symptoms of traumatic injury of the bladder or urethra occur, particularly if there is a history of injury to the area.
Call your health care provider if symptoms worsen or new symptoms develop, including symptoms of shock or hemorrhage (see symptoms), fever , severe abdominal pain , severe flank or back pain , or decrease in urine production.
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, etc.), or for any other problem in which the bladder needs to be kept empty (decompressed) and urinary flow assured.
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, etc.), or for any other problem in which the bladder needs to be kept empty (decompressed) and urinary flow assured. Catheterization in males is slightly more difficult and uncomfortable than in females because of the longer urethra.
This is an illustration of the female urinary tract. The female and male urinary tracts are relatively the same except for the length of the urethra. The positioning in the body and relative size of the organs are also demonstrated.
This is an illustration of the male urinary tract. The female and male urinary tract are relatively the same except for the length of the urethra. The positioning and relative size of the organs are also shown.
|
