Johnsen Niels V, Young Jason B, Reynolds W Stuart, Kaufman Melissa R, Milam Douglas F, Guillamondegui Oscar D, Dmochowski Roger R
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee.
J Urol. 2016 Mar;195(3):661-5. doi: 10.1016/j.juro.2015.08.081. Epub 2015 Aug 28.
Catheter drainage has become a standard management strategy for extraperitoneal bladder rupture from blunt trauma. However, data are lacking critically comparing outcomes between operative and nonoperative management. In this study we evaluate management strategies and identify risk factors for complications.
Patients with uncomplicated extraperitoneal bladder rupture due to blunt trauma from 2000 to 2014 were identified from our trauma registry. Initial management consisted of early cystorrhaphy or catheter drainage. Outcomes analyzed were incidence of inpatient complications, length of stay and time to negative cystography. Subgroup analysis was performed comparing outcomes between patients who did vs did not undergo cystorrhaphy during nonurological operative intervention.
A total of 56 patients treated with catheter drainage and 24 who underwent early cystorrhaphy were identified. All early cystorrhaphies were performed as secondary procedures during nonurological interventions. There was no difference in demographics, complications, median intensive care unit or median hospital length of stay between the groups. Subgroup analysis comparing patients who did vs did not undergo cystorrhaphy during nonurological operative intervention showed that patients without cystorrhaphy experienced higher rates of urological complications (p <0.05), increased intensive care unit (9.0 vs 4.0 days, p=0.0219) and hospital (18.9 vs 10.6 days, p=0.0229) length of stay, as well as prolonged time to negative cystography (25.5 vs 20.0 days, p=0.0262).
Conservative management of simple extraperitoneal bladder rupture with catheter drainage alone results in equivalent outcomes relative to operative repair in most patients. However, for those undergoing operations for other indications, cystorrhaphy decreases the risk of complications and is associated with decreased intensive care unit and hospital length of stay.
导管引流已成为钝性创伤所致腹膜外膀胱破裂的标准治疗策略。然而，目前缺乏关于手术治疗与非手术治疗效果的关键对比数据。在本研究中，我们评估了治疗策略并确定了并发症的危险因素。
从我们的创伤登记系统中识别出2000年至2014年因钝性创伤导致单纯性腹膜外膀胱破裂的患者。初始治疗包括早期膀胱修补术或导管引流。分析的结果包括住院并发症发生率、住院时间和膀胱造影转阴时间。进行亚组分析，比较在非泌尿外科手术干预期间接受与未接受膀胱修补术的患者的治疗效果。
共识别出56例接受导管引流治疗的患者和24例接受早期膀胱修补术的患者。所有早期膀胱修补术均在非泌尿外科手术中作为二期手术进行。两组患者在人口统计学、并发症、重症监护病房中位数或住院时间中位数方面无差异。对在非泌尿外科手术干预期间接受与未接受膀胱修补术的患者进行亚组分析显示，未接受膀胱修补术的患者泌尿系统并发症发生率更高（p<0.05），重症监护病房（9.0天对4.0天，p=0.0219）和住院（18.9天对10.6天，p=0.0229）时间延长，以及膀胱造影转阴时间延长（25.5天对20.0天，p=0.0262）。
对于大多数患者，单纯采用导管引流对单纯性腹膜外膀胱破裂进行保守治疗，其效果与手术修复相当。然而，对于因其他指征接受手术的患者，膀胱修补术可降低并发症风险，并缩短重症监护病房和住院时间。
