Blunt traumatic bladder rupture: The role of retrograde cystogram

Study objective: We evaluated the importance of microscopic and gross hematuria and the role of retrograde cystography and computed tomography (CT) in the diagnosis of blunt traumatic bladder rupture. Design: All cases at a Level I trauma center between January 1, 1986, and March 31, 1989, were reviewed retrospectively. Setting: Level I trauma center, university hospital. Type of participants: All patients with acute blunt abdominal trauma admitted to this Level I trauma center. Interventions: The patients' charts were reviewed with emphasis on mode of diagnosis, treatment, and outcome. Measurements and main results: Twenty-one patients had bladder rupture. All 21 had hematuria with more than 50 RBCs/high-power field, 17 gross and four microscopic. Twenty patients underwent retrograde cystography, which accurately identified bladder rupture, and one was found at laparotomy for other injuries. Seven patients had CT of the abdomen and pelvis, which failed to demonstrate bladder rupture. There were no associated urethral injuries in any of the patients with bladder rupture. Conclusion: Significant (more than 50 RBCs/high-power field) hematuria is the principal indication for evaluation for blunt bladder injury, and retrograde cystography is the diagnostic procedure of choice. CT is neither sensitive nor specific enough as primary diagnostic modality.