Bladder injuries overwhelmingly involve a distended bladder. A distended bladder is no longer protected by its usual low-lying position in the pelvis, so compression of the bladder can occur against the spine. Severity of bladder injury ranges from contusion to frank rupture. Rupture can be intraperitoneal, usually involving the fundus or posterior bladder wall, or extraperitoneal, usually involving the anterior or lateral wall, near the bladder neck. Penetrating injuries to the bladder usually result in intraperitoneal rupture, whereas ruptures associated with pelvic fractures are commonly extraperitoneal.

Ureteral injuries are most commonly iatrogenic, often complications related to gynecologic surgery, urologic procedures, or vascular surgery. Most noniatrogenic cases are the result of penetrating trauma, generally involve the upper one third of the ureter, and are almost always associated with injuries to adjacent organs. Ureteral contusion may result from projectiles producing a “blast effect” in the region of the ureter. Ureteral laceration or avulsion usually occurs in the setting of a deceleration or crush injury (i.e., automobile tire), often resulting in disruption of the ureter at the ureteropelvic junction (UPJ). Combination injuries involving the upper and lower genitourinary tract are very rare, and when present, nearly universally associated with fatality.

Complications of bladder injury include urine peritonitis, in the case of intraperitoneal rupture, and tissue necrosis, and abscess or phlegmon formation in the case of extraperitoneal rupture. Ureteral injury can be complicated by urinoma, abscess, fistula, ureteral stricture, or hydronephrosis.

Symptoms and signs are variable. The degree of hematuria does not appear to correlate with the severity or nature of the bladder injury but is seen in almost all cases. Blood at the urethral meatus is suggestive of a urethral injury.

Routinely performed as initial evaluation of abdominal trauma.

Supine anteroposterior (AP) film of the abdomen.