title: Prospective evaluation of the utility of routine postoperative cystogram after traumatic bladder injury.
abstract: BACKGROUND
  The value of routinely testing bladder repair integrity with a cystogram before urinary catheter removal is unclear. The purpose of this study was to prospectively evaluate the utility of routine postoperative cystogram after traumatic bladder injury.
  
  
  METHODS
  All patients sustaining a bladder injury requiring operative repair at two Level I trauma centers were prospectively enrolled during a 62-month study period ending on January 2011. Injury demographics, imaging data, and outcomes were extracted. All patients were evaluated with either a plain or a computed tomography cystogram.
  
  
  RESULTS
  A total of 127 patients were enrolled (mean [SD] age, 30.4 [13.5] years; blunt trauma, 63.8%, mean [SD] Injury Severity Score [ISS], 17.7 [10.6]). A total of 75 patients (59.1%) had an intraperitoneal (IP) bladder injury, 44 (34.6%) had an extraperitoneal (EP) bladder injury, and 8 had a (6.3%) combined IP/EP bladder injury. All patients with IP and IP/EP injuries (n = 83) underwent operative repair and a postoperative cystogram at 8.6 (1.8) days (range, 5-13 days). Sixty-nine IP injuries (83.1%) were simple (dome or body disruption/penetrating injury), while 14 (16.9%) were complex (trigone/requiring ureter implantation). There were no deaths during the follow-up period. With the exception of one patient (1.2%) with a complex injury requiring ureteric implantation, there were no leaks demonstrated on postoperative cystogram, and the urinary catheters were successfully removed.
  
  
  CONCLUSIONS
  In this prospective evaluation of the role of bladder evaluation after operative repair, routine use of follow-up cystograms for simple injuries did not impact clinical management. For complex repairs to the trigone or those requiring ureter implantation, a follow-up cystogram should be obtained before catheter removal.
  
  
  METHODS
  Diagnostic study, level II.
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Obi T
authors.initials: OT
authors.lastname: Okoye
authors.forename: Timothy
authors.initials: T
authors.lastname: Browder
authors.forename: Charles
authors.initials: C
authors.lastname: Best
authors.forename: Bernardino C
authors.initials: BC
authors.lastname: Branco
authors.forename: Pedro G
authors.initials: PG
authors.lastname: Teixeira
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.forename: Sravanthi
authors.initials: S
authors.lastname: Reddy
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D014193:Trauma Centers; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014567:Urography / Q000706:statistics & numerical data*; D013520:Urologic Surgical Procedures; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery; D055815:Young Adult