Bladder rupture from external trauma: diagnosis and management.

Rupture of the bladder from external trauma is usually due to a blow to the abdomen when the bladder is distended or associated with a fractured pelvis. The diagnosis is made by performance of a retrograde cystogram and observation of contrast extravasation. An intravenous contrast study is not acceptable. All patients with an intraperitoneal bladder rupture should have formal repair. Extraperitoneal bladder ruptures may be treated with catheter drainage if the urine clears of blood promptly, the catheter drains well, and the bladder neck is not involved in the injury. Otherwise, formal repair is mandatory.