This document discusses the grading and treatment of bladder trauma. It identifies 5 grades of bladder injuries ranging from hematomas to full thickness lacerations involving the bladder neck. Immediate repair is indicated for intraperitoneal injuries, penetrating injuries, inadequate bladder drainage, bladder neck injuries, rectal or vaginal injuries, open pelvic fractures, or bone fragments in the bladder. Follow up involves continuous bladder drainage, an initial cystography 7-10 days after injury, and catheter removal 7-10 days after simple repair without cystography or longer monitoring for complex injuries.

1. Bladder Trauma
(Follow Up)

2. Grade Injury type Description of injury
I Hematoma Contusion, intramural hematoma
I Laceration Partial thickness
II Laceration Extraperitonial bladder wall laceration <
2 cm
III Laceration Extraperitonial (<2 cm) or intraperitonial
(<2 cm) bladder wall laceration
IV Laceration Intraperitonial bladder wall laceration > 2
cm
V Laceration Intraperitonial or extraperitonial bladder
wall laceration extending into the
bladder neck or uretral orifice (trigone)

4. INDICATIONS FOR IMMEDIATE
REPAIR OF BLADDER INJURY
• Intraperitoneal injury from external trauma
• Penetrating or iatrogenic nonurologic injury
• Inadequate bladder drainage or clots in urine
• Bladder neck injury
• Rectal or vaginal injury
• Open pelvic fracture
• Pelvic fracture requiring open reduction and internal fixation
• Selected stable patients undergoing laparotomy for other reasons
• Bone fragments projecting into bladder

5. Follow Up ( EAU 2017 )
• Continuous bladder drainage  prevent elevated intravesical
pressure and allow the bladder to heal
• The first cystography is planned seven to ten days after injury. In case
of ongoing leakage, cystoscopy must be performed to rule out bony
fragments in the bladder and, if absent, cystography is done after one
week

6. • After operative repair of a simple injury in a healthy patient, the
catheter can be removed after seven to ten days without need for a
control cystography
• After repair of a complex injury (trigone involvement, ureteric
reimplantation) or in the case of risk factors of wound healing (e.g.
use of steroids, malnutrition), control cystography is advised