Retrospective analysis of traumatic bladder injury: does suprapubic catheterization alter outcome of healing?

The role of suprapubic catheters in traumatic bladder injuries is not well defined. Current literature suggests that suprapubic catheters are only necessary with large intraperitoneal bladder ruptures. The purpose of this study is to show that all bladder injuries can be managed with transurethral catheterization alone with a similar leak rate, morbidity, and healing time. Retrospective analysis was done of all patients with traumatic bladder injuries at a level I urban trauma center from June 1992 through June 2003. Medical records were reviewed and data analyzed according to type of bladder catheterization (i.e., transurethral or suprapubic). All patients with urethral injuries were excluded. Fifty-six patients met inclusion criteria. Twenty-seven patients suffered penetrating bladder injuries, and 29 bladder injuries were secondary to blunt trauma. Forty-seven patients were treated with transurethral catheter drainage, two were treated with suprapubic catheters, and seven were treated with both transurethral and suprapubic catheters. Forty patients had follow-up cystograms prior to catheter removal. Of the 47 patients treated with transurethral drainage alone, 3 (6%) developed urinary leaks. Of the 9 patients with suprapubic catheters, 2 (22%) developed urinary leaks. The mean time to removal of transurethral catheters was 15 days. The mean time to removal of suprapubic tubes was also 15 days. All study patients successfully healed their bladder injuries regardless of catheterization method. Suprapubic catheter drainage may increase morbidity without improving healing time. These results effectively support the decision to use transurethral catheter drainage alone in all patients with traumatic bladder injuries.