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Trauma to the bladder and ureter: a review of diagnosis, management, and prognosis

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

Injuries to the ureter or bladder are relatively rare. Therefore, a high level of clinical suspicion and knowledge of operative anatomy is of utmost importance for their management. Herein, a review of the literature related to the modern diagnosis, management, and prognosis for bladder and ureteral injuries is presented.

Methods

A literature search was conducted through PubMed. A thorough search of the world’s literature published in English was completed. Search terms included “injury, diagnosis, prognosis, and management for ureter and bladder”. All years, both genders, as well as penetrating, blunt, and iatrogenic mechanisms were evaluated for inclusion. Following PRISMA guidelines, studies were selected based on relevance and then categorized.

Results

172 potentially relevant studies were identified. Given our focus on modern diagnosis and treatment, we then narrowed the studies in each category to those published within the last 30 years, resulting in a total of 26 studies largely consisting of Level IV retrospective case series. Our review found that bladder ruptures occur from penetrating, blunt, or iatrogenic mechanisms, and most are extraperitoneal (63%). Ureteral injuries are incurred from penetrating mechanisms in 77% of cases. The overall mortality rates for bladder rupture and ureteral injury were 8 and 7%, respectively.

Limitations

Limitations of this article are similar to all PRISMA-guided review articles: the dependence on previously published research and availability of references.

Conclusion

The bladder is injured far more often than the ureter but ureteral injuries have higher injury severity. Both of these organs can be damaged by penetrating, blunt, or iatrogenic mechanisms and surgical intervention is often required for severe ureter or bladder injuries. Since symptoms of these injuries may not always be apparent, a high level of suspicion is required for appropriate diagnosis and treatment.

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Authors and Affiliations

  1. Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, Creighton University Medical Center, Creighton University School of Medicine, Omaha, NE, USA

    B. Phillips, S. Holzmer, L. Turco, M. Mirzaie, E. Mause, A. Mause, A. Person, D. L. Cornell, M. Wagner, R. Bertellotti & J. A. Asensio

  2. Division of Trauma Surgery and Surgical Critical Care, Department of Urology, Creighton University Medical Center, Creighton University School of Medicine, Omaha, NE, USA

    B. Phillips, S. Holzmer, L. Turco, M. Mirzaie, E. Mause, A. Mause, A. Person, S. W. Leslie, D. L. Cornell, M. Wagner, R. Bertellotti & J. A. Asensio

  3. Division of Trauma Surgery and Surgical Critical Care, Department of Clinical and Translational Science, Creighton University Medical Center, Creighton University School of Medicine, Omaha, NE, USA

    B. Phillips, S. Holzmer, L. Turco, M. Mirzaie, E. Mause, A. Mause, A. Person, D. L. Cornell, M. Wagner, R. Bertellotti & J. A. Asensio

  4. Vice Chair of Surgery, Surgical Research, Department of Surgery, Creighton University Medical Center, Creighton University School of Medicine, 601 North 30th Street, Suite 3701, Omaha, 68131-2137, NE, USA

    B. Phillips

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  1. B. Phillips
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Correspondence to B. Phillips.

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Conflict of interest

B. Phillips, MD, S. Holzmer, BS, L. Turco, BS, M. Mirzaie, E. Mause, A. Mause, A. Person, MD, S.W. Leslie, MD FACS+, D. L. Cornell, MD, M. Wagner, MD, FACS, R. Bertellotti, MD, and J. A. Asensio, MD, FACS, FCCM, FRCS (England), KM declare no conflict of interest.

Human and animal rights

This collective review study did not directly involve Human Participants and/or Animals. As such, informed consent was not required. This article does not contain any studies with human participants or animals performed by any of the authors. External sources of funding were not used in either the preparation or submission of this manuscript.

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External sources of funding were not used in either the preparation or submission of this manuscript.

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Phillips, B., Holzmer, S., Turco, L. et al. Trauma to the bladder and ureter: a review of diagnosis, management, and prognosis. Eur J Trauma Emerg Surg 43, 763–773 (2017). https://doi.org/10.1007/s00068-017-0817-3

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