Mp64-18 Feasibility of Conservative Management for Intraperitoneal Bladder Perforation

You have accessJournal of UrologyReconstruction: External Genitalia and Urotrauma (Including Transgender Surgery and Traumatic Fistula) II (MP64)1 May 2024MP64-18 FEASIBILITY OF CONSERVATIVE MANAGEMENT FOR INTRAPERITONEAL BLADDER PERFORATION Ella Taubenfeld, Theodoros Karanikolas, Zorawar Singh, Andrea Moyer, Manish Vira, and Justin S. Han Ella TaubenfeldElla Taubenfeld , Theodoros KaranikolasTheodoros Karanikolas , Zorawar SinghZorawar Singh , Andrea MoyerAndrea Moyer , Manish ViraManish Vira , and Justin S. HanJustin S. Han View All Author Informationhttps://doi.org/10.1097/01.JU.0001008824.92877.7f.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder injuries are classified based on anatomical location into two categories: extraperitoneal bladder rupture or intraperitoneal bladder rupture. Standardly, clinicians manage most extraperitoneal bladder ruptures conservatively with catheter drainage, while intraperitoneal ruptures are surgically repaired. This study aims to evaluate the feasibility of conservative management of intraperitoneal bladder rupture in the largest series to date. METHODS: A retrospective review was performed of patients treated for intraperitoneal bladder perforations at two large tertiary care centers from 2015-2023. The charts of 290 patients were reviewed to identify patients who met inclusion criteria of having an intraperitoneal bladder rupture and undergoing initial conservative management of their rupture via Foley catheter. Demographic data was collected as well as variables related to patient characteristics, computed tomography (CT) measured size of perforation, management, complications, and follow-up. Data were analyzed using descriptive statistics and comparative analyses (T-test and Fisher's exact test). RESULTS: Our final analysis identified 16 patients with intraperitoneal bladder rupture treated with initial conservative management. The most frequent mechanism of bladder injury was iatrogenic, which was seen in 13 (81%) patients. Procedures leading to iatrogenic injury included hysterectomy, Cesarean section, sigmoidectomy, ileocecectomy, and transurethral resection of bladder tumor. Three patients (19%) experienced spontaneous idiopathic bladder injuries. The average size of conservatively managed perforations was 7.18 mm on CT (SD 5.18 mm). Of the 16 patients who were managed conservatively, 15 of them (94%) were successfully managed with Foley catheter placement. For the majority of patients, resolution of bladder injury was confirmed with CT cystogram. Four patients (25%) experienced complications after conservative management, which included long-term urinary incontinence/retention, UTI, and pelvic abscess. For patients successfully managed conservatively, the median duration of catheterization was 18 days (IQR 21.75). CONCLUSIONS: For patients with small intraperitoneal bladder ruptures, conservative management with prolonged Foley catheterization is a suitable and successful strategy. Future studies evaluating outcomes in larger cohorts of patients are essential in determining if conservative management of intraperitoneal bladder injury should be considered more frequently in select patient populations. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1048 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ella Taubenfeld More articles by this author Theodoros Karanikolas More articles by this author Zorawar Singh More articles by this author Andrea Moyer More articles by this author Manish Vira More articles by this author Justin S. Han More articles by this author Expand All Advertisement PDF downloadLoading ...