Nontraumatic spontaneous rupture of the urinary bladder.

Rupture of the urinary bladder without a history of recent trauma or instrumentation is rare; it is usually associated with bladder disease or outlet obstruction. The patient is usually seen as an emergency case and has an atypical clinical picture. The four patients in this report were initially seen and treated by a general surgeon; in only two was the diagnosis established preoperatively and confirmed by retrograde cystography. Awareness on the part of the consulting surgeon that bladder rupture is possible in a predisposed patient may lead to a correct preoperative diagnosis. In this series, early operation--removing urine from the peritoneal cavity or retropubic space, closing the rupture and securing good vesical drainage--resulted in resumption of vesical function in all four patients and there were no deaths.