title: The incidence, spectrum and outcomes of traumatic bladder injuries within the Pietermaritzburg Metropolitan Trauma Service.
abstract: BACKGROUND
  The purpose of this study is to provide a comprehensive overview of the incidence, spectrum and outcomes of traumatic bladder injury in Pietermaritzburg, South Africa, and to identify the current optimal investigation and management of patients with traumatic bladder injuries.
  
  
  METHODS
  The Pietermaritzburg Metropolitan Trauma Service (PMTS) trauma registry was interrogated retrospectively for all traumatic bladder injuries between 1 January 2012 and 31 October 2014.
  
  
  RESULTS
  Of 8129 patients treated by the PMTS over the study period, 58 patients (0.7% or 6.5 cases per 1,000,000 population per year) had bladder injuries, 65% caused by penetrating trauma and 35% by blunt trauma. The majority (60%) were intraperitoneal bladder ruptures (IBRs), followed by 22% extraperitoneal bladder ruptures (EBRs). There was a high rate of associated injury, with blunt trauma being associated with pelvic fracture and penetrating trauma being associated with rectum and small intestine injuries. The mortality rate was 5%. Most bladder injuries were diagnosed at surgery or by computed tomography (CT) scan. All IBRs were managed operatively, as well as 38% of EBRs; the remaining EBRs were managed by catheter drainage and observation. In the majority of operative repairs, the bladder was closed in two layers, and was drained with only a urethral catheter. Most patients (91%) were managed definitively by the surgeons on the trauma service.
  
  
  CONCLUSIONS
  Traumatic bladder rupture caused by blunt or penetrating trauma is rare and mortality is due to associated injuries. CT scan is the investigative modality of choice. In our environment IBR is more common than EBR and requires operative management. Most EBRs can be managed non-operatively, and then require routine follow-up cystography. Simple traumatic bladder injuries can be managed definitively by trauma surgeons. A dedicated urological surgeon should be consulted for complex injuries.
authors: Department of Urology, Greys Hospital, Pietermaritzburg, South Africa; School of Clinical Medicine, University of KwaZulu-Natal, Nelson R Mandela School of Medicine, South Africa. Electronic address: james@urry.co.za.
authors: R J
authors: RJ
authors: Urry
authors: Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospitals Complex, Pietermaritzburg, South Africa; School of Clinical Medicine, University of KwaZulu-Natal, Nelson R Mandela School of Medicine, South Africa.
authors: D L
authors: DL
authors: Clarke
authors: Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospitals Complex, Pietermaritzburg, South Africa; School of Clinical Medicine, University of KwaZulu-Natal, Nelson R Mandela School of Medicine, South Africa.
authors: J L
authors: JL
authors: Bruce
authors: Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospitals Complex, Pietermaritzburg, South Africa; School of Clinical Medicine, University of KwaZulu-Natal, Nelson R Mandela School of Medicine, South Africa.
authors: G L
authors: GL
authors: Laing
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D012421:Rupture; D013019:South Africa / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014546:Urinary Catheterization; D014567:Urography; D013520:Urologic Surgical Procedures; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D014950:Wounds, Penetrating / Q000150:complications / Q000175:diagnosis* / Q000601:surgery
keywords: Bladder neck avulsion; Bladder trauma; Blunt trauma; Extraperitoneal bladder rupture; Intraperitoneal bladder rupture; Penetrating trauma; Traumatic bladder injury; Urinary bladder