Bladder trauma in the multiple injured patient.

There was a 20 per cent mortality rate of 193 patients with bladder injury and in 94 percent of all patients there were associated injuries that caused the deaths. Blunt external trauma was responsible for 95 per cent of the injuries. Cystography revealed a falsely negative result in 3 patients with extraperitoneal rupture. Management of the 29 intraperitoneal, 36 extraperitoneal and 2 intraperitoneal and extraperitoneal ruptures comprised vesical repair and drainage in 60 patients, urethral catheter alone in 1 patient and no treatment in 6 in whom the rupture was found at autopsy. The advantages and disadvantages of urethral catheter drainage are discussed. Early diagnosis and treatment of bladder rupture are important if the significant mortality is to be reduced.