Diagnosis

Injuries to the bladder are more easily recognized than injuries to the ureter because of immediate extravasation of urine into the operative field when operating near the organ. For this reason, most bladder injuries are repaired at the time of original injury. Unrecognized bladder injury may be clinically suspected with unexplained gross hema-turia, decreased urine output, or postoperative fever, abdominal pain and/or suprapubic tenderness. Urine in the peritoneum is quite caustic and causes a significant inflammatory response. The diagnosis should be confirmed with a cystogram. A good-quality cystogram should include oblique views in addition to anterior/posterior views as well as a postdrainage film to completely rule out injury. Extraperitoneal injury is heralded by contrast extravasation limited or confined to the lateral pelvic side-walls or perivesicular deep pelvic space whereas free extravasation of contrast with outlined bowel loops or a "ground glass" appearance of the abdomen indicates intraperitoneal injury.

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