Damage to the bladder. What causes closed injuries and bladder trauma? Intra-abdominal injured bladder first aid

23.04.2020

Leading clinical symptoms extraperitoneal rupture are severe cuts in the lower abdomen. Frequent false urge to urinate is accompanied by the release of a few drops of blood or complete urinary retention. Sometimes urination persists, but hematuria is noted. In the peri-vesicular tissue, urinary leaks appear, edema extends to the perineum, scrotum and labia, inner thighs, buttocks. Extraperitoneal tears bladder with fractures of the pelvic bones are accompanied by severe traumatic shock.

With an intraperitoneal rupture, urine, blood, and feces enter the abdominal cavity, which leads to the development of the classic picture of "acute abdomen".

First aid for bladder injuries

First aid for bladder injuries is provided according to the following algorithm.

Apply an aseptic dressing if there is a wound.
Provide rest in the "frog" position (bolsters under the knees) lying on the back with the head end raised. Note. With signs traumatic shock the patient should be given the position of Trandelburg.
Place the cold on the lower abdomen.
Warm up the victim.
Introduce coagulants as directed by your doctor.
Transport the victim to the medical facility.

Note. For closed injuries, do not administer pain medications.

V. Dmitrieva, A. Koshelev, A. Teplova

"Symptoms and first aid for bladder injuries" and other articles from the section

Often, a person has a bladder injury. An internal organ can rupture or partially damage the integrity of its walls and muscles. A problem arises for various reasons, sometimes even due to a minor injury, the bladder can burst. Trauma internal organ differs in types and shapes.

Main types

Combined trauma to the bladder and urethra occurs in accidents or other serious situations. In this case, hematoma often occurs in the organs. abdominal cavity.

Forms of defeat

Extraperitoneal and intraperitoneal injuries

Bladder contusion is divided into several forms, each of which differs in localization regarding the abdominal cavity. There are 3 forms:

The second type of organ rupture occurs when the peritoneum is damaged.

Extraperitoneal rupture of the bladder. In this case, the organ is torn in front or on the side of the peritoneum due to injury to the pelvic bones. At rupture, the bladder is completely emptied. All urine flows into soft tissues that are located near the organ.
Intraperitoneal. In the event of an intra-abdominal injury, the organ will rupture in the upper or back of the abdominal cavity. With such a lesion, the integrity of the abdominal cavity is also damaged, as a result of which an intraperitoneal breakthrough occurs.
Combined. This form of trauma to the urinary organ is observed in patients with fractures of the pelvic bones. Injury leads to multiple tears in different places. In this case, urine is poured into the peritoneum and small pelvis.

Partial and complete break

It is customary to separate the damage to the bladder, given its severity. In some patients, there is a slight bruise or distension of the bladder, which will soon disappear on its own. In others, the injury leads to partial or complete rupture of the organ. With a partial rupture, incomplete damage to the integrity of the walls is noted. Complete damage indicates that the bladder has ruptured completely and its walls are more destroyed.

Main reasons

The integrity of the bladder walls is damaged by various injuries inflicted in the peritoneal region. If the organ is not affected external factorsthen it is reliably protected by the pelvic bones. Injury often occurs when the bladder is full, because if the organ is emptied, a very hard blow is required to damage the integrity of the bladder. Allocate following reasons damage to the bladder:

If you jump incorrectly without first emptying the bubble, then it can burst.

Wrong jump. Injury occurs only if the bladder is heavily filled with urine.
Falling down. Damage often occurs when dropped from a height onto a hard surface. In this case, not only the bubble is noted to burst, but also other internal organs.
Gunshot or stab wound.
Strong blow to the lower peritoneum.
Surgery or medical procedures:
- placement of a catheter for diseases of the urinary system;
- dilation of the urethra;
Surgical intervention on organs localized in the small pelvis.
Untimely empty bladder with alcohol intoxication.
Pathologies in the body:
- tumors in the small pelvis or a number of localized organs;
- compression of the urethra.

In men, damage to the bladder wall can occur against the background of pathological proliferation of prostate tissue.
Typical symptoms
With closed injuries, a person feels pathological symptoms only after a few hours, or even days. This is due to the fact that the patient is in a state of shock, in which painful feelings are dulled. If the bladder has torn, then the person will feel the following symptoms:

A rapid pulse can be a symptom of organ injury.
improper excretion of urine, in which it will be problematic for a person to go to the toilet on his own;
blood in urine;
frequent trips to the toilet, if the urethra is damaged along with the bladder;
decline blood pressure due to profuse bleeding;
rapid pulse;
blanching skin.

If a patient has a ruptured bladder inside the peritoneum, then symptoms resembling peritonitis are noted:
painful sensations of a sharp nature, which intensify when taking a lying position;
temperature increase;
bloating and nausea;
tension of the abdominal muscles.

For extraperitoneal injury, signs of peritonitis are not characteristic, it manifests itself with other symptoms:
swelling in the groin and pubic area;
hematoma in the lower peritoneum.

Effects
If the bladder bursts in women or men, then you will need to immediately seek help from doctors, since such an injury is fraught with serious consequences:
If the patient is not immediately helped, then he will develop shock.
Profuse bleeding and shock. With such a complication, the patient's pulse quickens and blood pressure indicators rapidly fall. If treatment is delayed, the patient may die.
Accession of infection. In the peritoneum there is open wound, in which pathogenic microorganisms easily enter the blood fluid.
Inflammation in the affected area.
Formation of a pathological canal. Such a complication occurs if the bladder bursts and a purulent-inflammatory process has developed. In this case, the skin is injured and a channel is formed through which microorganisms penetrate into neighboring organs.
Violation bone tissue... With a trauma of the bladder followed by its rupture, an inflammatory and infectious process develops in the bone tissue of the pelvic organs.

Bladder injuries are of a different nature: open and closed, isolated and combined, intraperitoneal, extraperitoneal and mixed.

With injuries of this nature, an urgent health care... This is justified by the fact that, in addition to the bladder, neighboring organs can also be injured. Among other things, urine can leak from the damaged bladder and fill the abdominal cavity. Often, such damage is incompatible with life.

A penetrating wound or blunt trauma can lead to similar consequences. In these cases, there is a high likelihood of bladder rupture. If the injury is closed, then the damage falls on the walls of the bladder, while the urine remains inside the organ.

Blunt trauma can rupture the bladder, and it can also be intraperitoneal, extraperitoneal, or combined. If the urethra is damaged, it is possible that it narrows or closes completely. This happens after a blunt injury or infection has entered the wound. Most often, injury to the urethra occurs due to a blow to the perineal region, where the organ is located.

Signs of damage

Most often, bladder damage occurs due to closed injury... Anatomically, the bladder is located in the pelvis, it is reliably protected from many injuries. But there are circumstances when even such protection cannot protect him from damage. This happens in the case of damage to bones, fractures, when a broken bone in the pelvis injures the organ. This can be caused by car accidents, falls from a height, domestic injuries, etc.

Along with damage to the bladder, the urethra can also be injured. In this case, there is a possibility of internal bleeding.

If the injury is closed, its symptoms are as follows:

Severe abdominal pain that spreads to the perineum.
The bubble cannot be emptied.
Bleeding.
Discharge of urine with blood.
Bloating.

When the urethra is injured, the following symptoms may appear:

The urine is delayed.
Urination occurs frequently at night.
Involuntary urination.
Frequent urination, uncontrolled leakage.
The discharge of urine is infrequent, with a delay.

Diagnostic measures

Initial examination of the victim by a physician may provide some results. But for a complete picture of what is happening, you should undergo diagnostics, which includes:

retrograde cystography;
computed tomography;
x-ray of the pelvic organs;
ultrasound procedure.

It should be noted that with a closed form of injury, it is very difficult to make a diagnosis. Symptoms may be mild even with a ruptured bladder. But if you miss the time and do not perform the operation, the consequences of trauma can be fatal for a person.

Treatment of pathologies

First aid:

If there is a wound, apply an aseptic dressing.
The patient should be laid on his back and put a roller under his head, bend his legs at the knees and ensure rest.
If the injured person is in shock, it is better to lay him down so that his head is below the body.
In case of a bladder injury, something cold is applied to the injury site, but the victim himself needs to be warmed.
Wait for the arrival of doctors or independently deliver a person to the hospital.

Treatment involves surgery... The most commonly used method is laparotomy. At the same time, the walls of the bladder are restored.

If the injury is closed, there are hematomas in the pelvic region, an autopsy is not performed. With a gunshot wound to the bladder without damaging the peritoneum, the operation is performed through the wound by drainage. If the injury is closed, then treatment largely depends on the characteristics of the injury. In the treatment of bladder injuries, several specialists can be involved: urologist, surgeon, traumatologist. Treatment has its own specifics depending on the type of injury.

Contusion:

Drainage through a catheter is the most common initial observation.
Transurethral drainage is performed until the bladder heals.

Intraperitoneal rupture of the bladder:

With such an injury, a rupture of the apex of the organ is observed.
Surgery.
For mild damage, drainage is performed through a catheter.
Operation by laparoscopy is possible.

Extraperitoneal rupture of the bladder:

Transurethral drainage.
On the 10th day, cystography is performed, which most often shows nice results treatment.
It is mandatory for extraperitoneal rupture to take antibiotics in order to prevent bacteriological infection.

Sometimes a doctor prescribes a restorative surgery, which is carried out in the following cases:

If drainage through the catheter cannot be made for some reason, for example, if blood clots interfere with its passage, or if extravasation does not stop.
Damage to nearby organs, such as the vagina or rectum.
If the bladder neck is damaged.

Non-surgical therapy is possible with weak organ damage, it includes:

Introduction of a urethral catheter into the bladder for a specified number of days.
Compliance with bed rest.
Treatment aimed at stopping bleeding.
Antibacterial therapy course.
Taking anti-inflammatory drugs.
Anesthesia.

Causes of bladder injury

Fall from a height onto a hard surface or object.
A jump, in which there is a sharp shaking of the body in the presence of a filled bladder.
Strong blow to the stomach, bruise.
The use of firearms or cold weapons.
Medical actions: insertion of a catheter, bougienage, surgical intervention.
Alcohol, drunk in large quantities, contributes to the injury of the bladder, since at this moment a person cannot control the urinary system.
Certain diseases can also cause organ injury. These include prostate adenoma, prostate cancer, and narrowing of the urethra.

Possible complications:

Bleeding that is difficult to stop, leading to shock, often incompatible with life.
The onset of urosepsis, when an infection from the bladder enters the bloodstream and spreads throughout the body.
Suppurative formations in the blood and urine surrounding the bladder.
Formation of fistulas due to such suppurations that go out through the tissue, forming a passage to the internal organs.
Peritonitis is characterized by inflammation of the walls and interior of the abdominal cavity.
Osteomyelitis is an inflammation of the pelvic bone tissue.

Preventive measures

Engage in the prevention of diseases of the urinary system.
Avoid situations where injury can be caused.
Give up overuse alcoholic beverages.
If there was an injury that was operated on, you should regularly visit a urologist for three years to prevent possible complications.

You should also keep under control PSA - prostate-specific antigen. It is a protein that is responsible for the functioning of the prostate gland. If blood tests give information about its increase, then there may be deviations in the work of the prostate gland, up to oncology.

Anatoly Shishigin

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Quite often, as a result of a careless fall or for other reasons, a person gets an injury to the genitourinary organs. Any injury to organs in the urinary system is fraught with damage due to mechanical impact from the outside.

Based on which organ is affected, injury to the bladder, injury to the ureter or kidney may occur. Other components of the system are not considered, since their location differs in depth, and they are extremely rarely damaged.

What are the reasons for injuries to the organs of the urinary system?

The most common reasonwhen the kidney is damaged, there is a blunt blow to the lower back. This could be from a fall from a bike, skateboard or snowboard. Also, a kidney defect is often detected in a street fight, when a bruise can be applied tangentially.

The reasons for a bladder injury lie in a blow to the area above the pubis, and if the organ is overflowing with urine, then it ruptures. If the bladder was empty, then only a hematoma will appear in the area of \u200b\u200bthe mucous membranes, which resolves on its own without treatment within a couple of weeks.

A special injury is considered to be a rupture of the urethra. This happens when you fall onto a bicycle frame or into an open sewer hatch.

Reasons that caused closed or blunt injuries can also provoke open injuries. Is it cut or lacerationsstabbed or caused by a gunshot wound. In the case of participation in hostilities, multiple injuries to the genitourinary organs, as well as others, occurred due to mine ruptures, when fragments penetrated the urethra or bladder and ruptured them.

The main symptom of blunt trauma in the renal system is strong pain lower back, urinary problems and blood clots in the urine. Acute pain is felt from the side of the blow. When physical activity it grows, just like when urinating. In some cases, a large hematoma appears in this area, taking completely various forms and sizes. With deurination, the amount of urine can be reduced, the patient feels frequent urge, which may not even lead to urine discharge and wear a purely imperative form. Manifestations of hematuria range from a slight sediment in the fluid to large blood clots indicating profuse bleeding in such injuries.

Renal hypertension in the artery is often noted by doctors, characteristic feature kidney damage. This phenomenon often has a malignant etiology and is poorly treated.

Trauma to the bladder in the event of a rupture leads to the penetration of urine into the abdominal cavity. This can provoke the development of urinary peritonitis. In the absence of proper treatment, such a disease leads to the death of the patient. The person feels intense sharp pains in the abdomen, the peritoneal walls are very tense, and there is no urge to empty the bladder at all. If a certain amount of urine is released, then most often it appears along with blood and purulent discharge.

If the trauma of the bladder is not accompanied by its rupture, then the manifestation of symptoms in such acute form not. The patient feels some soreness in the area above the pubis, as well as insignificant difficulty in urination. Sometimes traces of blood may appear in the secreted urine, hematuria in this case is more often microhematuria.

In case of injuries of the lower back or small pelvis, you should immediately seek help from a urologist. Even minor causes can cause organ damage, the symptoms of which will appear after a while. It is the urologist who must determine the degree of injury and the danger of this phenomenon for human health.

Initially, when diagnosing injuries of the genitourinary organs, a survey radiography of all organs located in the abdominal cavity is performed. With the help of such a survey, you can identify the presence foreign objects and traumatic substances inside and behind the peritoneum.

To obtain more detailed data, an additional examination is performed - excretory urography. Even if it does not show changes in the structure of the renal parenchyma, it will display the functionality of the organ under study as much as possible. Usually, when the kidney is injured, a failure occurs in the filtration of one of their organs, and when the urethra ruptures, the contrast agent goes beyond the investigated limits.

When ultrasound examination organs of the peritoneal cavity can determine the morphology of the kidneys and their condition. Particular attention is paid to the capsule, which can be completely torn or torn. In order to confirm the ultrasound tests, a specialist can perform a renal angiography to study blood flow in the organ.

In case of rupture of the bladder, a voiding cystography is done, which consists in the introduction of a contrast agent into the cavity of the urethra. The area of \u200b\u200bthe urethral part is X-rayed, and the contrast preparation reveals the most clearly problematic areas. If there is no X-ray, a ruptured organ can be detected with a ball catheter inserted into the peritoneum. If there is a pathology, then along with urine they will be excreted blood clots or bloody sediment.

For organ diagnostics genitourinary system when they are injured, there is the most effective, cT scan from contrast agent... It is with such an examination that the results will be especially accurate, while ultrasound and excretory urography show multiple disadvantages.

If there are open injuries to the organs of the urinary system, a canal with a wound, then a special technique is used - fistulography. The process is characterized by filling this wound channel with solutions of brilliant green or methylene blue and detailed examination.

How is urinary trauma treated?

All trauma patients urinary tract any etiology must necessarily be hospitalized in specialized clinics. Only in a hospital setting is it possible to be examined and monitored by doctors and specialized specialists for the occurrence of complications and the correctness of the chosen treatment scheme in women and men. The prescribed treatment can be both conservative and surgical intervention.

For kidney ruptures, surgical intervention is used, in which the organ defect is sutured or completely removed. The operation ends with a nephrostomy, the purpose of which is to evacuate urine that constantly penetrates the wound surface after the operation. During the operation, a complete revision of all tissues near the organ is performed for the presence of foreign objects, especially in cases of kidney injury.

Treatment for a ruptured bladder is carried out in the form of an operation, during which the resulting defect must be eliminated by suturing. Surgeons make a suture in two rows, which tightly seals the organ cavity. After the operation, it is important to ensure complete and sufficient evacuation of urine from the inside so that there is no increased pressure... This is necessary for the integrity of the seams on its walls.

Surgical treatment of a ruptured urethra and urethra is carried out in the traditional way. With the intervention, suturing of the arisen defect of the urethra is also done and high-quality drainage is provided.

The conservative treatment regimen for injuries of the urinary system takes place in conditions antibacterial treatment and pain relief of the resulting spasms. The drugs Ofloxacin, Gatifloxacin and Ceftriaxone must fight bacteria and inflammation. Pain relief is achieved with the help of Ketans, Diclofenac and Analgin. The duration of the course depends on the severity of the disease and the patient's condition.

Treatment with folk remedies

A compress on the damaged area can give a positive result. In this case, the pain syndrome is removed, the resorption of the hematoma is accelerated. If there is a gap and open bleeding, then similar methods can be dangerous, since they will postpone the call of a specialized specialist. For these reasons, it is necessary to consult a urologist, and only then apply compresses and other methods recommended by traditional medicine.

Restrict the patient's nutrition in case of damage to the bladder or adjacent organs only in the case of surgical intervention. The prescribed diet is number zero, which means complete starvation on the eve of manipulation. This is important so that during anesthesia the patient does not have an emetic effect that complicates the beginning of the operation.

Postoperative period

Patients are prescribed physiotherapy throughout the recovery period after surgery. UHF and darsonvalization are extremely useful, according to experts, for tissue restoration and skin healing. It is imperative to drink antibacterial drugs and a course of drugs that restore the intestinal microflora.

Possible complications

The most dangerous of possible complications - peritonitis and open or internal bleeding... Ruptures of blood vessels can occur with injuries to any of the organs, if a large vessel is damaged. All the blood that is released enters the bladder cavity or the area behind the peritoneum.

The development of peritonitis occurs with perforation of the urinary wall, when urine penetrates through the defects and fills all the available space inside the peritoneum. Such a process starts acute inflammation and can be fatal.

Prevention of injuries of the genitourinary system

The most dangerous and vulnerable to injury, according to experts, professions are builders and motocross racers. During work, they especially strictly need to follow the rules safely and apply everything possible means protection.

Just as often, kidney or bladder injuries occur in car accidents. The presence of airbags in the car and the increased comfort of the model are one of the preventive measures against damage to the urinary system.

Bladder rupture belongs to the group of diagnoses based on organ trauma. Injuries can result from blunt, penetrating, or iatrogenic (treatment) trauma. The likelihood of injury varies with the degree of distension of the organ walls — a full bladder is more prone to injury than an empty bladder. Treatment ranges from conservative approaches that focus on maximizing urine diversion to major surgical procedures aimed at long-term recovery.

Reasons for ruptured bladder

There are only a few reasons why bladder wall rupture can occur.

Blunt trauma is characterized by rupture of the bladder wall without damage to the outer tissues

Blunt injuries are often caused by pelvic fractures, when bone fragments or sharp parts of them damage the integrity of the bladder wall. Approximately 10% of patients with a pelvic fracture experience significant bladder damage. The tendency of this organ to injury is associated with its degree of stretching at the time of injury. A blunt punch or kick to the abdomen can rupture the bladder when it is significantly full. Bladder rupture has been reported in children affected by stroke in lower part belly while playing with a soccer ball.

Penetrating trauma

This group includes gunshot wounds and stabbing. Often, patients suffer concomitant trauma to the abdominal cavity and pelvic organs.

Obstetric injuries

During prolonged work or difficult labor, when constant pressure from the fetal head on the mother's bladder is applied, her bladder may rupture. This happens due to the thinning of the organ wall at the point of constant contact. Direct rupture of the walls occurs in 0.3% of women who have undergone cesarean section. Previous surgeries complicated by adhesions are a serious risk factor, as excessive scarring can disrupt the normal density and stability of tissues.

Gynecological injuries

Bladder injuries can occur during vaginal or abdominal hysterectomy. Blind dissection of tissue in an irregular plane, between the base of the bladder and the fascia neck, usually damages the bladder wall.

Urological trauma

Possible during bladder biopsy, cystolitolapaxy, transurethral resection of the prostate, or transurethral resection of a bladder tumor. Perforation of the bladder wall during biopsy reaches 36%.

Orthopedic injuries

Orthopedic equipment can easily perforate the bladder, especially during internal fixation of pelvic fractures. In addition, thermal injury can occur during the placement of cementitious substances used for endoprosthetics.

Idiopathic bladder injury

Patients diagnosed with chronic alcoholism and those who chronically drink large amounts of fluids are prone to hypertensive bladder trauma. Previous bladder surgery is a risk factor for scarring.

This type of injury can result from a combination of an overcrowded bladder and minor external trauma from a fall.

Classification and emergency treatment for suspected bladder injury

The classification of bladder injury is based on several characteristics that describe the injury.

Extraperitoneal rupture of the bladder - the contents of the organ do not penetrate into the abdominal cavity.
Intraperitoneal bladder rupture - the contents penetrate into the abdominal cavity. A frequent occurrence with ruptures at the time of maximum filling of the bladder.
Combined rupture of the bladder - the contents penetrate into the abdominal cavity and the pelvic cavity.

Damage types

Open damage to the bladder is a common occurrence with penetrating wounds in the bladder area or with other violations of the integrity of the outer layers.
Closed bladder injury - blunt trauma.

The severity of the injury

Injury (the integrity of the bladder is not compromised).
Incomplete break the wall of the bladder.
Complete break the wall of the bladder.

Damage to other organs

Isolated bladder injury - only the bladder is damaged.
Combined trauma to the bladder - other organs are damaged.

If you suspect a bladder rupture, you should take all measures to ensure the preservation of the victim's life before the arrival of an ambulance.

Need to superimpose a tight bandage in the pubic areaif a penetrating wound is observed.
The position of the patient is lying on his side with legs bent at the knees, if it is possible.
On lower abdomen put cold.
Provide patient immobility.

Diagnostics for trauma to the bladder

Laboratory tests can be a key method in diagnosing minor injuries to the bladder.

Serum creatinine levels can help diagnose an organ wall rupture. With absence acute injury kidney and urinary tract obstruction, elevated serum creatinine may be a sign of urine leakage.

Visual research

CT scan

Often, computed tomography (CT) is the first test performed on patients with blunt abdominal trauma. Transverse images of the pelvic organs provide information about their condition and possible damage bone structures... This procedure is largely capable of replacing conventional fluoroscopy as the most sensitive tool for detecting bladder perforation.

A CT scan of the bladder is performed by filling the bladder with a urethral catheter and performing a non-contrast examination to assess damage. The finished result is able to reflect even minor perforations, helping to clearly determine the frequency of urine leakage and in which area.

Cystography

It is the historical standard for visualizing suspected bladder injury. Although, ideally, the study should be conducted under fluoroscopy, clinical circumstances often do not allow this. In such cases, a simple cystography is performed. Examinations can be easily done in bed with portable imaging equipment.

Specialists perform a number of procedures if urethral injury is excluded and a catheter can be used.

The results of the primary X-ray examination are obtained.
Placed in the bladder.
Slowly fill the bladder by gravity to a volume of 300-400 ml with contrast fluid.
An x-ray of the anterior wall of the bladder is obtained.
If no leak is observed, continue filling the bladder.
Oblique and lateral images are obtained.
Discard contrast fluid.

The importance of correct filling and subsequent drainage is of paramount importance in diagnosis. Trauma can be missed if the x-ray of the bladder is not taken correctly. A well-performed procedure can detect leaks with 85-100% accuracy.

If the patient is quickly transported to the operating room, an immediate examination of the bladder is done. In this case, if damage to the urethra is excluded, a urethral catheter is used. Otherwise, a suprapubic cystostomy can be performed, excretion of urine into the external environment through the stoma. After that, the bladder is carefully examined for perforation, for which it is filled with fluid. In some cases, apply intravenous administration indigo carmine or methylene blue to color urine, which is very helpful in visualizing possible perforations.

If a surgical intervention delayed or not indicated, access to the bladder is provided by urethral or suprapubic catheterization. CT or conventional bladder x-ray is used for control purposes.

Histological examination of tissue is usually not performed in conditions of damage and subsequent repair of the bladder. However, if perforation of the bladder occurs secondary to the pathological process or foreign formations are noticed, samples can be sent for analysis. The results will reflect the underlying disease.

Treatments for a ruptured bladder

Most extraperitoneal damage the bladder can be effectively drained through a urethral or suprapubic catheter and conservatively managed. Depending on the expected size of the defect, there is a need for artificial drainage of urine from 10 to 14 days. Then a control X-ray is taken, which determines the quality of healing. Approximately 85% of these injuries show the first signs of healing within 7-10 days. Thereafter, the catheter can be removed and the first urination test performed. In general, almost all extraperitoneal bladder injuries heal within 3 weeks.

Essentially, each intraperitoneal injury the bladder requires surgical treatment. Such lesions do not heal on their own with prolonged drainage of the bladder alone, because urine will continue to flow into the abdominal cavity despite the presence of a functional catheter. This leads to metabolic disorders and results in urinary ascites, bloating and intestinal obstruction... All gunshot wounds must be surgically examined, as the likelihood of injury to other abdominal organs and vascular structures is high.