Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Division of Urology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
BJU Int. 2023 Jun;131(6):660-674. doi: 10.1111/bju.15974. Epub 2023 Feb 7.
To perform a systematic review of all cases of spontaneous rupture of the urinary bladder (SRUB) and to describe the demographic data, associated comorbidities, clinical presentation, diagnosis, relevant laboratory findings, associated factors, management, morbidity and mortality associated with the presentation of SRUB.
The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). A search was carried out across the following electronic databases: PubMed, Web of Science, Scopus, Google Scholar and the Cochrane Database of Systematic Reviews. Full texts of selected studies were analysed, and data extracted. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
A total of 278 articles comprising 240 case reports and 38 case series, with a total of 351 patients were included. The median (interquartile range [IQR]) age of all included patients was 47.5 (33-65) years. The median (IQR) time to presentation was 48 (24-96) h, with the major presenting symptom being abdominal pain (76%). In patients in whom the diagnosis was made prior to any intervention, the condition was misdiagnosed in 64% of cases. The diagnosis was confirmed during explorative open surgery in 42% of cases. Pelvic radiation (13%) and alcohol intoxication (11%) were the most common associated factors. Intraperitoneal rupture (89%) was much more common, with the dome of the bladder being most frequently involved (55%). The overall mortality was 15%.
This review identified a number of key factors that appear to be associated with an increased incidence of SRUB. It also emphasized the high rate of misdiagnosis and challenge in confirming the diagnosis. Overall, it highlighted the importance of the need for increased awareness and maintaining a high index of suspicion for this condition.
对所有自发性膀胱破裂 (SRUB) 病例进行系统回顾，并描述其人口统计学数据、相关合并症、临床表现、诊断、相关实验室发现、相关因素、治疗、与 SRUB 表现相关的发病率和死亡率。
本研究方案已在国际前瞻性系统评价注册库（PROSPERO）中注册。在以下电子数据库中进行了检索：PubMed、Web of Science、Scopus、Google Scholar 和 Cochrane 系统评价数据库。对选定研究的全文进行了分析，并提取了数据。该综述的报告符合系统评价和荟萃分析的首选报告项目 (PRISMA)。
共纳入 278 篇文章，其中包括 240 篇病例报告和 38 篇病例系列，共纳入 351 例患者。所有纳入患者的年龄中位数（四分位距 [IQR]）为 47.5（33-65）岁。中位（IQR）就诊时间为 48（24-96）小时，主要表现症状为腹痛（76%）。在诊断前未进行任何干预的患者中，有 64%的患者误诊。在 42%的病例中，通过开放性探查手术确诊。盆腔放疗（13%）和酒精中毒（11%）是最常见的相关因素。腹膜内破裂（89%）更为常见，膀胱穹窿最常受累（55%）。总的死亡率为 15%。
本综述确定了一些似乎与 SRUB 发生率增加相关的关键因素。它还强调了误诊率高和确诊困难的问题。总的来说，它强调了提高对这种疾病的认识和保持高度警惕的重要性。
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