Management

When discovered intraoperatively, extraperitoneal injuries should be immediately repaired. Most postoperatively discovered extraperitoneal injuries may be managed conservatively with indwelling Foley catheter drainage and will heal spontaneously. Whether discovered intraoperatively or postoperatively, most intraperitoneal bladder injuries require exploration and primary closure. A two-layer closure is generally recommended using absorbable suture in a running watertight manner, at least in the mucosal layer. Care should be taken not to extend the injury to the trigone or bladder neck or incorporate these into the repair, or significant bladder dysfunction and/or inconti nence may ensue. If the ureterovesical junction is compromised or if there is simultaneous injury to the distal ureter, then any of the aforementioned techniques may be used with bladder repair. Postoperative drainage via a suprapu-bic cystotomy, urethral catheter, or both, should be typically used for a period of 7 to 10 days and only removed after a negative repeat cystogram. Pelvic drains should also be placed and removed when there is no more evidence of urinary leakage.

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