Pediatric genitourinary trauma
David E. Wesson, Bindi Naik-Mathuria in Pediatric Trauma, 2017
The bladder is well protected by the bony pelvis; however, in younger children, the bladder occupies a more abdominal position, especially when full. The dome of the bladder is more mobile and distensible and is more susceptible to rupture from external forces. Intraperitoneal bladder rupture occurs in approximately one-third of all bladder injuries [59]. Extraperitoneal bladder rupture occurs almost exclusively in association with pelvic fractures. Interestingly, the incidence of lower urinary tract injury in association with pelvic fractures is lower in children (1%) than adults (10%–25%) [60]. A shearing injury at the anterior and lateral wall of the bladder base occurs with the disruption of the pelvic ring. Occasionally, the bladder may be lacerated by a sharp bony spicule.
Urologie Pain
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
One of the first therapeutic approaches described for the treatment of IC was hydrodistention of the bladder with the patient under anesthesia. In addition to providing therapeutic benefit, hydrodistention also provides information that may facilitate diagnosis as described above. The literature has detailed variable techniques for hydrodistention in terms of pressure and duration of distention. In an early study of 25 patients with IC, treatment by bladder distention was performed at a pressure that was similar to systolic blood pressure for a period of up to 3 hours (Dunn, Ramsden, Roberts, Smith, & Smith, 1977). While 16 patients were symptom-free at a mean follow-up of 14 months, bladder rupture occurred in 2 individuals. Although this study suggested that prolonged bladder distention had a role for the treatment of IC, it also demonstrated that care must be taken to avoid morbidity. Hanno (2002) recommends initial cystoscopy, bladder washings for cytology, and distention of the bladder for 1 to 2 minutes at a pressure of 80 cm H2O, followed by emptying of the bladder and refilling to assess for the presence of glomerulations or ulceration. A therapeutic distention is then performed for 8 minutes, and if a biopsy is necessary, it is performed following therapeutic distention. In patients with bladder capacity less than 600 ml, therapeutic response was excellent in 26% and fair in 29%, while in patients with larger bladder capacities, response was excellent in 12% and fair in 43% (Hanno & Wein, 1991). Overall, responses were brief, but those patients with a therapeutic benefit lasting 6 months are excellent candidates for repeat hydrodistention. It is thought that therapeutic benefit is secondary to damage of mucosal afferent nerve endings (Dunn, Ramsden et al., 1977).
Special Patient Situations
Kenneth D Boffard in Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
The hallmark of genitourinary tract injury is haematuria. However, the degree of haematuria does not correlate with injury severity, and the absence of blood in the urine does not exclude significant urological injury. The kidneys are most commonly involved. Less than 5% of children with renal injuries will need operative treatment. A CT scan of the abdomen is highly sensitive and specific, although it does not reliably exclude bladder rupture unless dedicated cystography views with bladder distension are obtained.
Lower urinary tract injuries in patients with pelvic fractures at a level 1 trauma center – an 11-year experience
Published in Scandinavian Journal of Urology, 2023
Lasse Rehné Jensen, Andreas Røder, Emma Possfelt-Møller, Upender Martin Singh, Mikael Aagaard, Allan Evald Nielsen, Lars Bo Svendsen, Luit Penninga
Urological injuries occur in 3–16% of patients with pelvic fractures and are most common in males [5,6]. Due to the protected anatomical location of the bladder, blunt bladder injuries can be associated with pelvic fractures. Bladder rupture can either be extraperitoneal (60%), intraperitoneal (30%) or a combination (10%) [6]. The lower risk of concomitant urethral injuries to pelvic fractures in females is due to the short length, limited mobility and lack of insertions to the pubic symphysis [7]. The risk for urethral injury is highest for major, instable and displaced pelvic fractures, and are rare in single and ipsilateral ramus fractures. Urethral injuries have not been reported in isolated fractures of the acetabulum, ileum and sacrum [8]. Genitourinary injuries are associated with morbidity and mortality following major pelvic trauma due to the risk of septicemia, uroplania, hematuria, prolonged catheter treatment and voiding problems [5,9]. Importantly, urological trauma may result in long-term complications such as urethral or bladder neck stenosis, incontinence, erectile dysfunction (ED) or use of permanent indwelling catheter that severely impair quality of life [8,10–15]. The specific management of urological injuries in pelvic trauma patients has limited support in evidence.
Fetal Bladder Rupture as a Complication of Adjunctive Therapy in Severe Maternal SARS-CoV-2 Pneumonia
Published in Fetal and Pediatric Pathology, 2022
Jorge Gutierrez, Waldo Sepulveda, Raul Ramirez, Gina Acosta, Sergio Ambiado
With the current COVID-19 pandemic, pregnant women are developing SARS-CoV-2 pneumonia. Some of these will develop the most severe form of the disease and require invasive ventilatory support. In our obstetric population involving 458 women with confirmed COVID-19 infection, 25.5% developed a severe form of disease, 5.6% required admission to the intensive care unit, and 2.8% required mechanical ventilation [12]. An integral part of the management of cases requiring invasive ventilatory support includes the use of high doses of sedative and opioid drugs. These medications easily reach high concentrations in the fetal circulation through transplacental transfer. High doses in the fetal compartment can then have a deleterious effect on the fetal detrusor muscle [13]. Acute and severe retention of urine could therefore develop and lead to bladder rupture, as shown in our case. Bladder rupture is unlikely to occur in cases of distal urinary obstruction. This is probably because of the slow installation of the megacystis. In the case reported here, however, the rapid introduction of continuous high levels of opioids resulting in an abrupt atonic bladder may explain the acute urinary retention and bladder rupture.
Urinary bladder rupture years after excision of urachal remnant
Published in Baylor University Medical Center Proceedings, 2020
Zoe Blumenthal, Kim H. Thai, Faris Hashim, Jeffrey Waxman, Marawan M. El Tayeb
Spontaneous bladder rupture without trauma is a rare clinical entity; without proper and prompt diagnosis, it can lead to severe complications. Without the presence of traumatic injury to the bladder, the ambiguity of symptoms can lead to a delay in diagnosis. In patients with acute abdominal pain, distention of the abdomen, evidence of acute kidney injury, and free intraperitoneal fluid, it is imperative to consider bladder perforation. It is also important to consider relevant urological history in patients with spontaneous urinary bladder rupture. A CT cystogram should be performed urgently to assess for urinary leak.
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