1. BLADDERTRAUMA NOOR HAFIZAH BINTI HASSAN 2007287236

2. REFERENCES: SMITH’S GENERAL UROLOGY 17th ED GUIDELINES ON UROLOGICAL TRAUMA, EUROPEAN ASSOCIATION OF UROLOGY, FEBRUARY 2003

4. Bladder trauma: 60-80% are due to BLUNT TRAUMA

5. Highly associated with pelvic # (70-97%)

9. Grade II: Subtle intraperitoneal contrast material between small bowel loops Grade III: Focal lenticular thickening of the bladder wall due to interstitial hematoma and likely muscular disruption

10. Grade IVa: Extravasated contrast material into confined to the perivesical space within extraperitoneal pelvis Grade IVb: Complex extraperitoneal spread-> extension into rectus abdominis muscle as well as subcutaneous fascia

11. 2) BASED ON TYPES OF INJURY:

13. EXTRAPERITONEAL BLADDERRUPTURE (80 %) Associated with pelvic fracture (80-100%) Direct laceration of the bladder by the bony fragments > severe fracture, degree of bladder injury ↑ Cystographic finding: contrast extravasation around base of bladder confined to perivesical space

14. Extravasation seen outside the bladder in the pelvis

15. INTRAPERITONEAL BLADDERRUPTURE (20 %) Direct blow to a distended bladder Full bladder -> muscle fibers are widely separated -> entire bladder wall is thin -> offer little resistance Injury -> ↑ intravesical pressure -> horizontal tear along intraperitoneal portion of bladder wall Cystographic finding: contrast extravasation into peritoneal cavity, lining loops of bowel

16. Contrast enters the peritoneal cavity & outlines the bowel loops Sterile urine Infected urine

18. Abdominal tenderness

20. Per rectal: to exclude rectal injury : assess prostate position

21. INVESTIGATION CYSTOGRAPHY Gold standard for dx bladder rupture (85-100%) Dx: injected contrast are out of the bladder Require plain film, filled film and post-drainage film CT CYSTOGRAPHY: bladder is inadequately distended to allow extravasation through perforated bladder

23. Catheterization: if blood noted at urethral meatus, don’t insert Foley’s catheter -> retrograde urethrogram2) DETERMINE EXTENT OF PERITONEAL EXTRAVASATION : RETROGRADE CYSTOGRAPHY

25. presence of bone fragments in the bladder wall