Bladder Injury

A semi-emergent condition is bladder trauma, particularly when it causes uroperitoneum. If surgery without correction is not done for such injuries, sepsis might appear within 24 hours.

Causes

• Falls
• Accident
• Surgery of a hernia
• During catheterization in male
• Forcefully hit to male in scrotum etc

Signs and Symptoms

• During micturation pain
• Blood in urine
• Blood pressure low
• Small weeks urine stream
• Unconsciousness
• Shock, coma
• White, pale skin etc

Diagnosis

• History taking
• Physical examination
• X-ray
• USG
• Retrograde pyelogram

Management

• Management of symptoms
• Apply ABC (airway, breathing, circulation)
• Activate IV line
• Observe more pelvic damage symptoms.
• If a patient's blood pressure is low and their heart rate is rapid, they are in shock.
• Prevention of infection
• Blood transfusion
• Utilize antibiotics to avoid getting sick
• Surgical treatment

Intraperitoneal Bladder Rupture

Almost all intraperitoneal bladder ruptures need to be surgically treated. Because urine will continue to seep into the abdominal cavity despite the presence of a working catheter, such an injury will typically not heal with extended bladder draining alone. This leads to metabolic disturbances, which can result in ileus, abdominal distention, and potentially urine ascites. The possibility of injury to adjacent abdominal organs and vascular structures is considerable, hence all gunshot wounds to the abdominopelvic area should be medically investigated. Any bladder injury that is present at the time can be treated effectively.

Extraperitoneal Extravasation

Large-scale extraperitoneal extravasation in the bladder is frequently treated surgically. Minor extraperitoneal leaks can be fixed in circumstances where surgical exploration for other damage is explored. This promotes quicker healing, lessens the chance of complications, and, in many cases, reduces the amount of time an indwelling catheter must be used.

Surgical Principles

Closing bladder abnormalities in trauma patients typically involves two layers of surgery. Some surgeons successfully seal the bladder in one layer when treating an iatrogenic damage. A flowing suture is inserted in either case to achieve a water-tight closure. On the bladder, only absorbable sutures should be utilized because permanent sutures can act as a nidus for infection and stone formation in the future. An indwelling catheter is retained in place for at least 10 to 14 days to help the defect repair, similar to nonoperative bladder leak care. Prior to removing the catheter, a cystogram is performed.

References

• documentslide.com › Documents
• Mandal, G. (August 2013). A Textbook of Adult Health Nursing (2nd ed.). Dilllibazar kathmandu: Makalu publication house. Retrieved August 2013
• emedicine.staging.medscape.com/article/441124-treatment
• misc.medscape.com/pi/iphone/medscapeapp/html/A441124-business.html
• https://www.ncbi.nlm.nih.gov › NCBI › Literature › PubMed Central (PMC)