Bladder Injuries: Evaluation, Management, and Outcome.

Abstract

Background: Civil violence in Iraq has reached an epidemic level during the last few years, and an increasing number of urological injuries were faced in dealing with unprotected civilians who were exposed daily to violence in streets, at homes, and at work. Bladder injuries are an example of injuries which were faced rarely before but increasingly now, if not dealt with properly such injuries may end with serious morbidity and even crippling, on the other hand proper management will greatly decrease morbidity and mortality of such injuries.
Patients and method: over the period from March 2004 to June 2005 all the patients triaged to the emergency unit of Medical City with genitourinary trauma were included in the study, those with bladder injury discovered pre-operatively or per-operatively were involved in the study, for all patients the mechanism, grade, site, associated other organ injury, and outcome were defined. Data collected and statistically analyzed.
Results: The total number of patients sustained genitourinary tract injuries was 197, only 73 (37%) of them had bladder injuries, the majority were males (87.6%) in their active life (67% aged 20-40 years). Most of the injuries were caused by bullets (50.6%) and shells (25.3%), were sever (82.1% had grades III and IV), and affecting the dome of the bladder (39.7%). The gastrointestinal tract was the commonest system to be injured in association with the bladder (87.6%), but the mortality rate was associated only with affection of chest, head, and vascular systems. The over all mortality rate was 9.5% and the morbidity rate was 12.3%. 
Conclusion: the incidence of bladder injury in urological trauma is high in civilian casualties because of lack of protection, they are usually severe and of high grade, and associated with other organ injuries. Bullets are the main causative factor, and the dome is the mostly affected site. The mortality rate is low (9.2%) and is related to the associated organ injury, but not related to the severity of injury. We need to continuously evaluate our experience in trauma management, and to establish specialized trauma centers to cope with the increasing number of civilian victims.