title: Evaluating the Role of Operative Repair of Extraperitoneal Bladder Rupture Following Blunt Pelvic Trauma.
abstract: OBJECTIVE
  Catheter drainage has become a standard management strategy for extraperitoneal bladder rupture from blunt trauma. However, data are lacking critically comparing outcomes between operative and nonoperative management. In this study we evaluate management strategies and identify risk factors for complications.
  
  
  METHODS
  Patients with uncomplicated extraperitoneal bladder rupture due to blunt trauma from 2000 to 2014 were identified from our trauma registry. Initial management consisted of early cystorrhaphy or catheter drainage. Outcomes analyzed were incidence of inpatient complications, length of stay and time to negative cystography. Subgroup analysis was performed comparing outcomes between patients who did vs did not undergo cystorrhaphy during nonurological operative intervention.
  
  
  RESULTS
  A total of 56 patients treated with catheter drainage and 24 who underwent early cystorrhaphy were identified. All early cystorrhaphies were performed as secondary procedures during nonurological interventions. There was no difference in demographics, complications, median intensive care unit or median hospital length of stay between the groups. Subgroup analysis comparing patients who did vs did not undergo cystorrhaphy during nonurological operative intervention showed that patients without cystorrhaphy experienced higher rates of urological complications (p <0.05), increased intensive care unit (9.0 vs 4.0 days, p=0.0219) and hospital (18.9 vs 10.6 days, p=0.0229) length of stay, as well as prolonged time to negative cystography (25.5 vs 20.0 days, p=0.0262).
  
  
  CONCLUSIONS
  Conservative management of simple extraperitoneal bladder rupture with catheter drainage alone results in equivalent outcomes relative to operative repair in most patients. However, for those undergoing operations for other indications, cystorrhaphy decreases the risk of complications and is associated with decreased intensive care unit and hospital length of stay.
authors: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: niels.v.johnsen@vanderbilt.edu.
authors: Niels V
authors: NV
authors: Johnsen
authors: Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Jason B
authors: JB
authors: Young
authors: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: W Stuart
authors: WS
authors: Reynolds
authors: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Melissa R
authors: MR
authors: Kaufman
authors: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Douglas F
authors: DF
authors: Milam
authors: Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Oscar D
authors: OD
authors: Guillamondegui
authors: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Roger R
authors: RR
authors: Dmochowski
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery*; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D010537:Peritoneum; D012189:Retrospective Studies; D012421:Rupture / Q000601:surgery; D001743:Urinary Bladder / Q000293:injuries* / Q000601:surgery*; D013520:Urologic Surgical Procedures; D014945:Wound Healing; D014949:Wounds, Nonpenetrating / Q000601:surgery*
keywords: pelvis; rupture; urinary bladder; wound healing; wounds and injuries