[Can diminished bladder compliance favor spontaneous bladder rupture?].

A case of spontaneous rupture of the bladder was observed in a 53-year-old woman. Physical evaluation and diagnostic investigations showed the following findings: initial urinary retention presumed to be psychogenic as the patient had a confusional state and was free of anatomic or neurologic complications; low bladder compliance observed upon urodynamic investigation on the 21st postoperative day and one year later; repeated coughing fits due to chronic bronchitis at the time of the accident. Rupture of the bladder requires the coexistence of an obstacle to urinary outflow and decreased parietal resistance to distension upon filling. According to the Laplace rule, the tension of the bladder wall (T) needed to resist distension is T = KPR, where P is the endovesical pressure and R the bladder sphere radius. Low bladder compliance therefore induces a disproportionate increase in intravesical pressure during filling and may be a significant etiologic parietal factor in the occurrence of spontaneous rupture of the bladder.