Chapter 47 · Postoperative and iatrogenic complications
Bladder perforation and urinary extravasation
Definition
Bladder perforation is an iatrogenic or traumatic injury to the bladder wall.
Causes:
- Cystoscopy.
- Catheterization.
- Trauma.
- Postoperative complications.
Clinical presentation
- Lower abdominal pain.
- Peritoneal signs.
- Reduced urine output.
- Urine leakage through a drain.
- Fever with infection.
Diagnosis
- CT cystography.
- Retrograde cystography.
- Ultrasonography for intraperitoneal fluid.
Emergency management
- Intraperitoneal perforation: surgical repair + drainage.
- Extraperitoneal perforation: catheterization for 7–14 days in the absence of clinical leakage.
- Antibiotics if infection is present.
Algorithm
| Step | Action |
|---|---|
| 1 | Suspected injury (pain, peritoneal signs, urine leakage) |
| 2 | CT cystography/retrograde cystography |
| 3 | Intraperitoneal → surgery |
| 4 | Extraperitoneal → catheterization |
| 5 | Follow-up cystography |